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Predictors of transmural intestinal necrosis in patients presenting with acute mesenteric ischemia on computed tomography

  • Special Section: Intestinal Ischemia
  • Published:
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Abstract

Purpose

The purpose of this study was to identify the significant imaging predictors of transmural intestinal necrosis in patients with acute mesenteric ischemia (AMI).

Methods

The medical records and CT imaging of 48 patients between 2011 and 2019 suspected of having AMI that underwent exploratory laparotomy with bowel resection and pathological confirmation of ischemic bowel injury were retrospectively reviewed. Using histopathology as a gold standard, various parameters related to vascular insufficiency and bowel injury were analyzed and correlated with outcome of ischemic bowel necrosis using nonparametric tests. Univariate analysis was performed using Fisher’s exact test followed by binary logistic regression test for multivariate analysis.

Results

48 Patients (19 females, 40%) with a median age of 68.5 years (IQR of 17 years) built our retrospective cohort. 26 (54%) patients were found to have transmural intestinal necrosis on histopathology (case group) whereas 22 (46%) patients had partial mucosal injury (control group). Pneumatosis intestinalis (p = 0.005, odd’s ratio of 2.07–63.14) and severity (> 70% or complete occlusion) of vascular narrowing (p = 0.019, odd’s ratio of 1.39–42.30) were identified as the most significant predictors of transmural ischemic necrosis on imaging. Dilatation of bowel did not approach the statistical significance on multivariate analysis although it was found significant on univariate analysis (p = 0.041).

Conclusion

Pneumatosis intestinalis and severity of vascular luminal narrowing are the most important imaging predictors of transmural ischemic bowel necrosis in patients presenting with AMI. The presence of these findings on CT scan should raise high index of suspicion for irreversible transmural ischemic necrosis. In the absence of these factors, endovascular management might be beneficial.

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Abbreviations

AMI:

Acute mesenteric ischemia

CTA:

Computed tomography angiography

CTV:

Computed tomography venography

SMA:

Superior mesenteric artery

SMV:

Superior mesenteric vein

ITIN:

Irreversible transmural ischemic necrosis

EVT:

Endovascular treatment

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Funding

No funding was received for this research study.

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Authors and Affiliations

  1. Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA

    Isha D. Atre, Kulyada Eurboonyanun, Aileen O’Shea, Rita Maria Lahoud & Mukesh G. Harisinghani

  2. Department of Pathology, Massachusetts General Hospital, Boston, MA, USA

    Angela Shih

  3. Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA

    Sanjeeva Kalva

  4. Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA

    Sandeep Hedgire

  5. Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Room 217, White Building, Boston, MA, 02114, USA

    Isha D. Atre

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  1. Isha D. Atre
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Correspondence to Isha D. Atre.

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Atre, I.D., Eurboonyanun, K., O’Shea, A. et al. Predictors of transmural intestinal necrosis in patients presenting with acute mesenteric ischemia on computed tomography. Abdom Radiol 47, 1636–1643 (2022). https://doi.org/10.1007/s00261-020-02558-8

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  • DOI: https://doi.org/10.1007/s00261-020-02558-8

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