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.

中文翻译：

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计算机断层扫描显示急性肠系膜缺血患者透壁性肠坏死的预测因素。

目的 本研究的目的是确定急性肠系膜缺血 (AMI) 患者透壁性肠坏死的重要影像学预测因子。方法回顾性分析2011-2019年48例疑似AMI患者行剖腹探查肠切除并病理证实缺血性肠损伤的病历和CT影像。使用组织病理学作为金标准，分析与血管功能不全和肠损伤相关的各种参数，并使用非参数检验与缺血性肠坏死的结果相关联。使用Fisher精确检验进行单变量分析，然后使用二元逻辑回归检验进行多变量分析。结果 48 名患者（19 名女性，40%）中位年龄为 68 岁。5 年（IQR 为 17 年）建立了我们的回顾性队列。组织病理学发现26例（54%）患者有透壁性肠坏死（病例组），而22例（46%）患者有部分黏膜损伤（对照组）。肠积气（p = 0.005，奇数比为 2.07-63.14）和血管狭窄的严重程度（> 70% 或完全闭塞）（p = 0.019，奇数比为 1.39-42.30）被确定为透壁缺血性坏死最重要的预测因子关于成像。尽管在单变量分析中发现肠扩张显着（p = 0.041），但在多变量分析中，肠扩张并未接近统计学意义。结论 肠积气和血管腔狭窄的严重程度是 AMI 患者透壁缺血性肠坏死最重要的影像学预测指标。CT 扫描中这些发现的存在应该提高对不可逆透壁缺血性坏死的高度怀疑。在没有这些因素的情况下，血管内治疗可能是有益的。