Inter-reader agreement of CT features of acute mesenteric ischemia

Copin, P.; Ronot, Maxime; Nuzzo, Alexandre; Maggiori, Léon; Bouhnik, Yoram; Corcos, Olivier; Vilgrain, Valérie

doi:10.1016/j.ejrad.2018.05.027

Cited by 30 publications

(18 citation statements)

References 30 publications

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“…This is especially relevant for the analysis of temporal sequences extracted from EHRs and abdominal CT scans. Indeed, although many signs of bowel ischemia have been identified, their performance[ 16 ] and inter-rater agreement remain limited[ 107 , 111 ]. Recent advances in fusion models leveraging both imaging and EHR data have performed well in the detection of pulmonary embolism[ 112 ] and may be tested in NOMI.…”

Section: Diagnostic Pitfalls and Challenges For Future Researchmentioning

confidence: 99%

Non-occlusive mesenteric ischemia: Diagnostic challenges and perspectives in the era of artificial intelligence

Bourcier¹,

Klug²,

Nguyen³

2021

WJG

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Acute mesenteric ischemia (AMI) is a severe condition associated with poor prognosis, ultimately leading to death due to multiorgan failure. Several mechanisms may lead to AMI, and non-occlusive mesenteric ischemia (NOMI) represents a particular form of AMI. NOMI is prevalent in intensive care units in critically ill patients. In NOMI management, promptness and accuracy of diagnosis are paramount to achieve decisive treatment, but the last decades have been marked by failure to improve NOMI prognosis, due to lack of tools to detect this condition. While real-life diagnostic management relies on a combination of physical examination, several biomarkers, imaging, and endoscopy to detect the possibility of several grades of NOMI, research studies only focus on a few elements at a time. In the era of artificial intelligence (AI), which can aggregate thousands of variables in complex longitudinal models, the prospect of achieving accurate diagnosis through machine-learning-based algorithms may be sought. In the following work, we bring you a state-of-the-art literature review regarding NOMI, its presentation, its mechanics, and the pitfalls of routine work-up diagnostic exams including biomarkers, imaging, and endoscopy, we raise the perspectives of new biomarker exams, and finally we discuss what AI may add to the field, after summarizing what this technique encompasses.

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Section: Diagnostic Pitfalls and Challenges For Future Researchmentioning

confidence: 99%

Non-occlusive mesenteric ischemia: Diagnostic challenges and perspectives in the era of artificial intelligence

Bourcier¹,

Klug²,

Nguyen³

2021

WJG

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“…However, AMI patients present unspecific acute abdominal pain, which renders clinical suspicion and identification challenging and can often lead to missed or delayed diagnosis and care 2 , 9 . Moreover, AMI may be underdiagnosed on contrast-enhanced computed tomography (CT) of the acute abdomen when the suspicion is not evoked 10 – 12 .…”

Section: Introductionmentioning

confidence: 99%

Accuracy of citrulline, I-FABP and d-lactate in the diagnosis of acute mesenteric ischemia

Nuzzo

Guedj²,

Hercend³

et al. 2021

Sci Rep

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Early diagnosis of acute mesenteric ischemia (AMI) remains a clinical challenge, and no biomarker has been consistently validated. We aimed to assess the accuracy of three promising circulating biomarkers for diagnosing AMI—citrulline, intestinal fatty acid-binding protein (I-FABP), and d-lactate. A cross-sectional diagnostic study enrolled AMI patients admitted to the intestinal stroke center and controls with acute abdominal pain of another origin. We included 129 patients—50 AMI and 79 controls. Plasma citrulline concentrations were significantly lower in AMI patients compared to the controls [15.3 μmol/L (12.0–26.0) vs. 23.3 μmol/L (18.3–29.8), p = 0.001]. However, the area under the receiver operating curves (AUROC) for the diagnosis of AMI by Citrulline was low: 0.68 (95% confidence interval = 0.58–0.78). No statistical difference was found in plasma I-FABP and plasma d-lactate concentrations between the AMI and control groups, with an AUROC of 0.44, and 0.40, respectively. In this large cross-sectional study, citrulline, I-FABP, and d-lactate failed to differentiate patients with AMI from patients with acute abdominal pain of another origin. Further research should focus on the discovery of new biomarkers.

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“…Some of those criteria, known to be highly specific for mesenteric ischemia may also appear with fluid overload, sepsis, or organ failure (5,16–19). Despite the high specificity in patients with AMI, the occurrence of some markers may be related to the underlying cause of mesenteric ischemia (18–21), the stage of ischemia (e.g. gangrene, reperfusion) (22,23), and the extent of mural changes (1).…”

Section: Discussionmentioning

confidence: 99%

The role of computed tomography in the diagnostic pathway of acute mesenteric ischemia: a nested case-control study

et al. 2020

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Background Computed tomography (CT) can be used as the primary screening modality for the evaluation of patients suspected of having acute mesenteric ischemia known to show high sensitivity and specificity rates. Purpose To prove the value of CT in patients with pathological abdominal findings following cardiac surgery. Material and Methods In a retrospective case-control study, 12 different CT scan parameters of patients with or without mesenteric ischemia following cardiac surgery were compared using univariate and logistic regression analyses. Results Of 14,176 patients, 133 (0.9%) received an abdominal CT scan during postoperative care due to pathological abdominal findings. Sixty-eight patients were diagnosed with acute mesenteric ischemia. In-hospital mortality was 73.5% for this group. CT parameters with the highest specificity for indicating colonic ischemia were intestinal (99%) or porto-venous (96%) pneumatosis, abnormal contrast medium enhancement (89%), and occlusion of the proximal inferior mesenteric artery (81%). All of those parameters showed low sensitivity levels in the range of 15%–23%. A statistically significant association between acute mesenteric ischemia and CT appearance was obtained for contrast medium enhancement (odds ratio [OR] 12.2, 95% confidence interval [CI] 1.5–99.2) and intestinal pneumatosis (OR 21.0, 95% CI 2.7–165.2) only. Conclusion The typical CT criteria indicating mesenteric ischemia lose their accuracy in patients under critical clinical conditions. As CT remains the first-line diagnostic imaging modality for abnormal abdominal findings following cardiac surgery, negative signs should not prevent early laparotomy if clinical suspicion remains high.

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Inter-reader agreement of CT features of acute mesenteric ischemia

Cited by 30 publications

References 30 publications

Non-occlusive mesenteric ischemia: Diagnostic challenges and perspectives in the era of artificial intelligence

Non-occlusive mesenteric ischemia: Diagnostic challenges and perspectives in the era of artificial intelligence

Accuracy of citrulline, I-FABP and d-lactate in the diagnosis of acute mesenteric ischemia

The role of computed tomography in the diagnostic pathway of acute mesenteric ischemia: a nested case-control study

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