Relationship of superior mesenteric artery thrombus density with transmural intestinal necrosis on multidetector computed tomography in acute mesenteric ischemia

Abstract

Background: Acute arterial occlusive mesenteric ischemia with transmural intestinal necrosis (TIN) is a fatal disease, which is difficult to diagnose on multidetector computed tomography (MDCT). The aim of the present study was to determine the relationship of superior mesenteric artery (SMA) thrombus density with TIN on MDCT in patients with acute mesenteric ischemia (AMI) due to SMA thromboembolism.Methods: In this retrospective study, 33 patients who underwent abdominal MDCT and angiography for AMI due to SMA thromboembolism were divided into two groups: the AMI with TIN group and the AMI without TIN group. We analyzed the relationships of clinical characteristics, qualitative MDCT signs, and SMA thrombus density with TIN. The SMA thrombus density was measured on non-contrast MDCT.Univariate and multivariate analyses were performed to determine the risk factors for predicting TIN. The diagnostic performances of risk factors were evaluated by receiver-operating characteristic (ROC) curve analysis.Results: Of the patients with AMI enrolled in this study, 33.3% (11/33) were diagnosed with TIN. Peritonitis (P=0.042), bowel wall thinning (P=0.033), and pneumatosis/portomesenteric gas (P=0.010) were significantly associated with TIN. AMI patients with TIN exhibited a higher SMA thrombus density than AMI patients without TIN [41.2±6.1 vs. 34.2±3.0 Hounsfield unit (HU), P=0.003]. Multivariate analysis showed that SMA thrombus density was an independent predictor of TIN [P=0.044, hazard ratio (HR): 1.82, 95% confidence interval (CI): 1.02-3.25]. For diagnosing AMI with TIN, the area under the ROC curve (AUC) of SMA thrombus density (0.83) was larger than those of peritonitis (0.68), bowel wall thinning (0.66), and pneumatosis/portomesenteric gas (0.71).Conclusions: In patients with AMI, erythrocyte-rich thrombus blocking the SMA trunk which has a higher density on MDCT is prone to the occurrence of TIN compared with erythrocyte-scarce thrombus with a lower density. SMA thrombus density could be an independent risk factor for TIN in patients with AMI due to SMA thromboembolism.

Diagnostic Role of MDCT in Acute Mesenteric Ischemia

“…Chronic mesenteric ischemia symptoms (postprandial pain, weight loss, etc) can be present in patients' history before the development of acute ischemia (acute on chronic form). At CT the intraarterial thromboembolic material can appear hyperdense on unenhanced CT, and high-density erythrocyte-rich thrombus(>36UH) have been reported in transmural intestinal necrosis [40]. After contrast IV administration an abrupt interruption of luminal enhancement is seen in vessel occlusion.…”

Diagnostic Role of Multi-Detector Computed Tomography in Acute Mesenteric Ischemia

“…can be present in patients’ history before the development of acute ischemia (acute-on-chronic form). At CT, the intra-arterial thromboembolic material can appear hyperdense on unenhanced CT, and high-density erythrocyte-rich thrombi (>36 UH) have been reported in transmural intestinal necrosis [ 46 ]. After contrast IV administration, an abrupt interruption of luminal enhancement is seen in vessel occlusion.…”

Study of ischemic progression in different intestinal tissue layers during acute intestinal ischemia using swept‐source optical coherence tomography angiography

“…Thirdly, they lack depth resolution, making it difficult to discern ischemic variations across individual layers of intestinal tissue. Imaging modalities such as CT angiography or digital subtraction angiography can only depict the blood supply to the mesentery and intestinal wall, making it difficult to assess the degree of ischemia in the intestinal wall [20,21]. Magnetic resonance angiography (MRA) predominantly illuminates larger blood vessels and vasculature, offering limited capabilities to show capillaries in the intestinal mucosa.…”