Prognostic value of multidetector computed tomography in bowel infarction

Moschetta, Marco; Ianora, Amato Antonio Stabile; Pedote, Pasquale; Scardapane, Arnaldo; Angelelli, Giuseppe

doi:10.1007/s11547-009-0422-6

Cited by 34 publications

(24 citation statements)

References 31 publications

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“…The choice of a control group in which the diagnosis of ischaemic bowel was a clinical possibility serves to better parallel daily practice; undoubtedly, the respective specificities would be higher if a healthy patient control group was selected. The prevalence of arterial occlusion (23.1%) and venous thrombosis (0%) was relatively low in our study compared with other studies, in which arterial occlusion was seen in 45-67% of cases [14,21,22] and venous thrombosis in 15-33% [14,20,22]. This is not unexpected in a population of patients following CPB surgery, where poor cardiac output and hypoperfusion and secondary splanchnic vasoconstriction is more likely to lead to a non-occlusive type of ischaemia [5,23].…”

Section: Discussioncontrasting

confidence: 55%

Multidetector CT findings in patients with mesenteric ischaemia following cardiopulmonary bypass surgery

Barrett¹,

Upponi²,

Benaglia³

et al. 2013

BJR

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Objective: To investigate CT findings in patients with pathologically proven mesenteric ischaemia postcardiopulmonary bypass surgery and compare them with the control group of patients without ischaemia. Methods: 68 patients were identified by a search of local surgical and pathological databases; these patients met the inclusion criteria of a laparotomy within 1 month of a procedure requiring cardiopulmonary bypass and a CT abdomen/pelvis within 1 week of the pathological diagnosis. Two radiologists independently reviewed the studies, evaluating 17 separate findings relating to the bowel, the vasculature or other structures; consensus was subsequently reached. The diagnostic value of CT findings was assessed using logistic regression. Results: 52 of 68 patients had pathologically proven ischaemia. Portal venous gas, mesenteric venous gas and small bowel faeces sign all had specificities of .0.94 for ischaemia but low sensitivity (,0.27). Differential mural enhancement had high sensitivity (0.92) but poor specificity (0.50). The combination of pneumatosis, bowel loop dilatation and differential mural enhancement predicted bowel ischaemia with a probability of 98%. The hardest signs to interpret based on poor interreader kappa agreement were bowel wall thinning, mesenteric stranding and differential mural enhancement. Conclusion: A combination of CT signs was predictive of ischaemic bowel; however, the more specific findings lacked sensitivity. If clinical suspicion is high for bowel ischaemia, prompt surgical intervention is warranted, regardless of CT findings. Advances in knowledge: Arterial occlusion was uncommon and venous occlusion was not present, which is supportive of a predominantly non-occlusive aetiology for ischaemia in this patient group.

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Section: Discussioncontrasting

confidence: 55%

Multidetector CT findings in patients with mesenteric ischaemia following cardiopulmonary bypass surgery

Barrett¹,

Upponi²,

Benaglia³

et al. 2013

BJR

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“…However, ischemic parietal pneumatosis is characterized by a typical linear or curved shape of air within bowel wall (1,(14)(15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

Reversible pneumatosis cystoides intestinalis after liver transplantation

Telegrafo¹,

Ianora²,

Angelelli³

et al. 2017

GHIR

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“…13,14 The main goal of current therapy for NOMI is reduction of spasm and improved perfusion of the mesenteric artery using vasodilators, and the role of surgery should be limited to the excision of irreversibly necrotized intestine. In cases of this type, the purpose of imaging in the diagnosis of NOMI is essential: firstly, for the earliest possible identification of this critical condition, to plan the most appropriate treatment that is based on a different approach from those of the occlusive forms of AMI, 3,6 then to identify effective reperfusion. In fact, in NOMI, the primary injury as a result of ischaemia could be repaired by reperfusion, meaning the re-establishment of normal mesenteric Annotations are as in Table 3.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Notwithstanding the technical evolution of non-invasive techniques, for example, multidetector CT (MDCT), many authors still believe angiography to be the only diagnostic modality that can reliably establish NOMI in an early phase, by identifying the presence of mesenteric vasospasm. 8,9 Only a few articles have explored the effectiveness of MDCT for NOMI diagnosis, with a very limited cohort of patients.…”

Section: Introductionmentioning

confidence: 99%

Reperfusion in non-occlusive mesenteric ischaemia (NOMI): effectiveness of CT in an emergency setting

Mazzei

Guerrini

Squitieri

et al. 2016

BJR

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Objective: To investigate the CT features of reperfusion (presence/absence) in non-occlusive mesenteric ischaemia (NOMI) and their prognostic value in an emergency setting. Methods: A revision was undertaken of imaging from 20 patients (16 males/4 females) with a dismissal summary of NOMI. All patients had previously undergone a minimum of one multidetector CT examination, and consequently underwent surgery (n 5 8), autopsy (n 5 2), angiography (n 5 1) or endoscopy (n 5 9). An evaluation of the CT scans was conducted to determine vessels, mesentery, bowel and peritoneal cavity features. The superior mesenteric artery (SMA) average diameter of NOMI cases were compared with 30 controlled cases. Kappa, KolmogorovSmirnov (K-S) and Fisher's exact tests were used for statistical analysis. Results: A mean SMA diameter significantly smaller than that of the controlled cases was found for patients with NOMI (K-S test: D 5 0.75, p 5 3.7 3 10-08). Fisher's exact tests showed a strong connection between the presence of reperfusion and mesenteric fat stranding (p 5 0.026), bowel wall thickening (p 5 3.2 3 10-05) and a high attenuation of the bowel wall on unenhanced CT images (p 5 2.8 3 10-04). A reduction in mortality was significantly linked to the combination of normal mesenteric vessels and wall thickening (p 5 0.034). Conclusion: Analysis of not only vessels findings but also mesentery and bowel CT features will support the identification of NOMI with or without a reperfusion event in an emergency setting. A strong correlation between some CT features and lower mortality exists. Advances in knowledge: CT features of NOMI with or without reperfusion are demonstrated. Correctly assessing the presence of reperfusion in NOMI, may allow better management of these conditions in the emergency setting. INTRODUCTIONNon-occlusive mesenteric ischaemia (NOMI) is an abdominal emergency that accounts for 20-30% of all intestinal ischaemic events.1 Bowel ischaemia and infarction in NOMI are present as a result of reduced mesenteric blood supply without vascular occlusion, because of a mesenteric arterial vasoconstriction on reflex to hypotension owing to various forms of shock, septicaemia, dehydration, heart or major abdominal surgery followed by hypotension and overuse of vasoconstrictive agents.

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Prognostic value of multidetector computed tomography in bowel infarction

Abstract: MDCT is able to detect the nature of bowel ischaemia and provide important prognostic information.

Cited by 34 publications

References 31 publications

Multidetector CT findings in patients with mesenteric ischaemia following cardiopulmonary bypass surgery

Multidetector CT findings in patients with mesenteric ischaemia following cardiopulmonary bypass surgery

Reversible pneumatosis cystoides intestinalis after liver transplantation

Reperfusion in non-occlusive mesenteric ischaemia (NOMI): effectiveness of CT in an emergency setting

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