Acute Mesenteric Ischemia (AMI) is a time-critical surgical emergency associated with high mortality secondary to reduction in blood supply to the mesenteric vessels. Although laparotomy remains the standard clinical practice for determining bowel viability, this method is invasive and non-therapeutic in settings where findings are equivocal. CT angiogram in conjunction with Dual energy CT (DECT) allow for reliable radiological assessments of bowel perfusion and viability and may contribute to surgical decision-making to reduce unnecessary laparotomy. We present a review of AMI with clinical examples, focussing on radiological features that are more predictive of reversible bowel ischemia and hence bowel viability. Late imaging features of non-viable bowel including absent bowel wall enhancement, pneumatosis coli, portal venous gas or free intraperitoneal air are highly predictive of necrosis and mandate laparotomy for consideration of bowel resection. However, CT features of reversible ischemia are less commonly known and include bowel wall dilatation with reduced bowel enhancement, bowel wall thickening and mild mesenteric edema. Most importantly relatively lower densities and iodine concentrations to surrounding bowel tissue on iodine maps and monoenergetic images are very early indicators of hypoperfusion, highlighting the importance of DECT. The identification of these early CT features enables clinical focus towards consideration of timely revascularisation in cases where arterial occlusion is the determined cause. Although there are benefits with advanced imaging such as DECT, cases with indeterminate imaging findings including mesenteric stranding and mixed enhancement patterns will require multidisciplinary discussion and serial clinical review. Although clinical judgement is core to management, there may be a role for DECT in identifying early mesenteric ischemia allowing for prioritisation of revascularisation and reducing unnecessary laparotomy.