Goyal Riya, Lee Hwayoung K, Akerman Meredith, Mui Leonora W
Hofstra Northwell School of Medicine, 500 Hofstra Blvd, Hempstead, NY, 11549, USA.
Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY, 11030, USA.
Emerg Radiol. 2017 Aug;24(4):341-346. doi: 10.1007/s10140-017-1484-8. Epub 2017 Feb 6.
The purpose of this retrospective study was to determine clinical and imaging factors on computed tomography (CT) associated with clinically worrisome pneumatosis intestinalis (PI) that may aid in the decision to provide conservative management or urgent surgical intervention.
Informed consent was waived in this IRB approved study. Imaging features assessed included the presence, location, and pattern of PI, bowel dilatation, thickening, enhancement, stranding, portal venous (PV) and mesenteric venous gas, mesenteric edema, free air, and ascites. Two radiologists retrospectively evaluated 167 patients with CT reports containing the text "PI" between 1/1/11 and 12/31/13. Clinical data collected included serum lactate, malignancy, bowel disease, operative findings, and death during admission. Clinically, worrisome PI was tabulated by summation of surgical diagnosis of dead bowel and/or death during admission. Chi-square test or Fisher's exact test was used when appropriate to compare subjects with benign or worrisome PI for categorical variables and the Mann-Whitney test used to compare continuous measures.
Clinically, worrisome PI was present in 44 cases. Benign PI was diagnosed in 97 cases, and these patients were followed conservatively. There was a statistically significant association between clinically worrisome PI and imaging features: location in small bowel (p < 0.0001), bowel dilatation (p = 0.0003), stranding (p = 0.0002), bowel enhancement (p = 0.0384), PV gas (p < 0.0001), mesenteric venous gas (p = 0.0141), and moderate mesenteric edema (p = 0.0036). Location of PI in the small bowel exhibited a statistically significant association with benign PI (p < 0.0002). Statistical significance was found between worrisome PI and the following clinical features: elevated serum lactate (p = 0.0003), underlying bowel disease (p = 0.0004), and mechanical cause of bowel obstruction (p = 0.0497).
CT imaging characteristics and clinical features can help predict clinically worrisome PI and guide crucial management decisions.
本回顾性研究的目的是确定计算机断层扫描（CT）上与临床可疑的肠壁积气（PI）相关的临床和影像因素，这可能有助于决定采取保守治疗还是紧急手术干预。
在这项经机构审查委员会批准的研究中，无需获得知情同意。评估的影像特征包括PI的存在、位置和形态、肠管扩张、增厚、强化、条索状影、门静脉（PV）和肠系膜静脉气体、肠系膜水肿、游离气体和腹水。两名放射科医生回顾性评估了2011年1月1日至2013年12月31日期间167例CT报告中包含“PI”字样的患者。收集的临床数据包括血清乳酸、恶性肿瘤、肠道疾病、手术发现和住院期间的死亡情况。临床上，可疑的PI通过汇总手术诊断的坏死肠段和/或住院期间的死亡情况来统计。对于分类变量，在适当情况下使用卡方检验或Fisher精确检验来比较良性或可疑PI的受试者，使用Mann-Whitney检验来比较连续测量值。
临床上，44例存在可疑的PI。97例被诊断为良性PI，这些患者接受了保守治疗。临床上可疑的PI与影像特征之间存在统计学显著关联：位于小肠（p < 0.0001）、肠管扩张（p = 0.0003）、条索状影（p = 0.0002）、肠管强化（p = 0.0384）、PV气体（p < 0.0001）、肠系膜静脉气体（p = 0.0141）和中度肠系膜水肿（p = 0.0036）。PI位于小肠与良性PI之间存在统计学显著关联（p < 0.0002）。在可疑的PI与以下临床特征之间发现了统计学显著性：血清乳酸升高（p = 0.0003）、潜在肠道疾病（p = 0.0004）和肠梗阻的机械性原因（p = 0.0497）。
CT影像特征和临床特征有助于预测临床上可疑的PI并指导关键的治疗决策。
