Diagnostic performance of CT for the detection of transmural bowel necrosis in non-occlusive mesenteric ischemia

Verdot, Pierre; Calame, Paul; Winiszewski, Hadrien; Grillet, Franck; Malakhia, Alexandre; Lakkis, Zaher; Ronot, Maxime; Pili-Floury, Sébastien; Piton, Gaël; Delabrousse, Éric

doi:10.1007/s00330-021-07728-w

Cited by 19 publications

(28 citation statements)

References 26 publications

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“…Then, a relatively high proportion of our cohort (i.e., 24/59; 41%) did not have surgical or endoscopic confirmation of NOMI due to their poor prognosis. However, our group previously identified reliable CT findings of NOMI [ 7 , 18 ], and we believe that the risk of underdiagnosis of NOMI remains low (Specificity of absence of enhancement range from 79 to 97% according to the bowel segment involved [ 22 ]). Because of the time required by the calculation of abdominal calcium scores, the number of patients in the study is relatively limited.…”

Section: Discussionmentioning

confidence: 99%

Abdominal atherosclerosis is not a risk factor of nonocclusive mesenteric ischemia among critically ill patients: a propensity matching study

Konan

Piton²,

Ronot

et al. 2022

Ann. Intensive Care

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Background Although risk factors of occlusive acute mesenteric ischemia are well known, triggering factors of nonocclusive mesenteric ischemia (NOMI) remain unclear. Alongside to the known risk factors for NOMI, the role of atherosclerosis is not fully elucidated. The purpose of our study was to evaluate whether abdominal atherosclerosis is a risk factor for NOMI. Methods From January 2018 to December 2021, all consecutive patients admitted to the intensive care unit who underwent contrast-enhanced CT for suspicion of NOMI were evaluated for inclusion. Clinical and biological data at the time of the CT scan were retrospectively extracted from medical charts and reviewed by a single radiologist. The cohorts were matched by a 1:1 propensity score based on the patient clinical, biological data, and abdominal CT features associated with NOMI. Noncontrast CT acquisitions were used to calculate calcium scores of the abdominal aorta, celiac trunk, superior mesenteric artery (SMA), and common iliac artery according to the Agatston method. Analyses were performed before and after propensity score matching. Results Among the 165 critically ill patients included, 59 (36%) had NOMI. Before matching analysis, the SMA and total abdominal Agatston calcium scores were not different between patients without and with NOMI (52.00 [IQR = 0, 473] vs. 137.00 [IQR = 0, 259], P = 0.857, respectively, and 7253 [IQR = 1220, 21738] versus 5802 [IQR = 2075, 15,084]; P = 0.723). The results were similar after matching 38 patients with NOMI and 38 without: 153 [IQR = 0, 665] versus 85 [IQR = 0, 240] (P = 0.312) for the SMA calcium score, and 7915 [IQR = 1812, 21561] versus 4139 [IQR = 1440, 9858] (P = 0.170) for the total abdominal Agatston calcium score. Conclusion Our results suggest that atherosclerosis is not a risk factor for NOMI in critically ill patients.

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Section: Discussionmentioning

confidence: 99%

Abdominal atherosclerosis is not a risk factor of nonocclusive mesenteric ischemia among critically ill patients: a propensity matching study

Konan

Piton²,

Ronot

et al. 2022

Ann. Intensive Care

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“…Conversely, bowel dilation in patients with elevated serum lactate indicates the presence of necrosis, even without pneumatosis. Of note, bowel dilation cannot be used in NOMI because most critically ill patients suffer from gastrointestinal failure, receive parenteral nutrition, and suffer from paralytic ileus for multiple reasons [ 6 ].…”

Section: Main Textmentioning

confidence: 99%

“…1 ). Our group recently showed that more consistent CT features should be searched for [ 6 ], namely a thinned wall (more specific) and an absence of bowel wall enhancement (more sensitive). Those signs should be assessed independently from the presence of pneumatosis to diagnose transmural necrosis (Fig.…”

Section: Main Textmentioning

confidence: 99%

Letter to the editor: Pneumatosis in bowel ischemia: time to change the optics to improve patient care

2022

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CT features of bowel ischemia differ between occlusive and non-occlusive mesenteric ischemia. • In NOMI, pneumatosis overdiagnoses necrosis. The absence of bowel wall enhancement and a thinned wall on CT better predict transmural necrosis. • In occlusive AMI, necrosis is underdiagnosed if only pneumatosis is considered. More frequent features such as bowel dilation and should not be overlooked. • Overall, pneumatosis is not a synonym of irreversible transmural necrosis and should not systematically lead to surgical exploration.

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“…Some differences in imaging diagnostics related to assessment of the intestine have been recently nicely visualized in a recent review by Davarnapah and a letter by Calame [24 && ,25]. Verdot et al found that the absence of bowel wall enhancement was the most consistent computed tomography feature of transmural necrosis in NOMI at any location, whereas inter-observer agreement was generally lower in the colon than in the small bowel [44].…”

Section: Nonocclusive Mesenteric Ischemiamentioning

confidence: 99%

Acute mesenteric ischaemia

Blaser

Forbes

Björck

2022

Current Opinion in Critical Care

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Purpose of reviewTo summarize the recent evidence on acute mesenteric ischaemia (AMI).Recent findingsThe overall incidence of AMI is below 10/100 000 person years but increases exponentially with age. The overall mortality of AMI remains high, exceeding 50%, despite continuing progress and increasing availability of imaging and endovascular interventions. However, patients with (early) revascularization have significantly better outcomes. The majority of patients surviving the acute event are still alive at 1 year, but evidence on quality of life is scarce.Clinical suspicion of AMI is the key to timely diagnosis, with biphasic computed tomography-angiography the diagnostic method of choice. Currently, no biomarker has sufficient specificity to diagnose AMI.SummaryImproved awareness and knowledge of AMI are needed to raise the suspicion of AMI in relevant patients and thereby to achieve better outcomes.

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Diagnostic performance of CT for the detection of transmural bowel necrosis in non-occlusive mesenteric ischemia

Cited by 19 publications

References 26 publications

Abdominal atherosclerosis is not a risk factor of nonocclusive mesenteric ischemia among critically ill patients: a propensity matching study

Abdominal atherosclerosis is not a risk factor of nonocclusive mesenteric ischemia among critically ill patients: a propensity matching study

Letter to the editor: Pneumatosis in bowel ischemia: time to change the optics to improve patient care

Acute mesenteric ischaemia

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