Service de Radiologie, CHU Besançon, 3 Blvd Fleming, Besançon, France 25000.
Service de Chirurgie digestive et endocrinienne, CHU Besançon, Besançon, France.
AJR Am J Roentgenol. 2020 Jan;214(1):90-95. doi: 10.2214/AJR.19.21693. Epub 2019 Sep 25.
The purpose of this study was to assess whether transmural bowel necrosis has distinct CT features based on the three main causes: occlusive acute mesenteric ischemia (AMI), nonocclusive AMI, and strangulated small-bowel obstruction (SBO). From January 2010 to December 2017, the records of all patients with a pathologic diagnosis of transmural bowel necrosis were extracted from the pathology department database of a university hospital. The inclusion criteria for the study were presence of transmural bowel necrosis at pathologic examination and available contrast-enhanced CT images obtained within the 24 hours before surgery. Seventy-seven patients were finally included. The CT scans were retrospectively independently reviewed by two abdominal radiologists to identify the classic CT findings of transmural bowel necrosis. Statistical analyses were performed. Pneumatosis intestinalis was statistically more frequent in nonocclusive AMI (59%) than in occlusive AMI (29%) and strangulated SBO (7%) ( < 0.01), as were superior mesenteric venous gas (55%, 29%, and 0%; < 0.01) and portal venous gas (48%, 10%, and 0%; < 0.01). Decreased or absent bowel wall enhancement was more frequent in AMI than in SBO (nonocclusive AMI, 83%; occlusive AMI, 81%; SBO, 56%; = 0.02), as was thinned bowel wall (nonocclusive AMI, 52%; occlusive AMI, 48%; SBO, 18%; = 0.02). Spontaneous hyperattenuation of the bowel wall was more frequent in strangulated SBO (41%) than in nonocclusive AMI (10%) and occlusive AMI (14%) ( < 0.01). Transmural bowel necrosis has distinct CT findings according to its three main causes. Occlusive AMI is characterized by an absence of bowel wall enhancement and less mesenteric fat stranding, nonocclusive AMI by a high prevalence of pneumatosis intestinalis and portal venous gas, and strangulated SBO by spontaneous hyperattenuation of the bowel wall and an absence of pneumatosis intestinalis and portal venous gas.
本研究旨在评估透壁性肠坏死是否具有基于三种主要病因的特征性 CT 表现：阻塞性急性肠系膜缺血（AMI）、非阻塞性 AMI 和绞窄性小肠梗阻（SBO）。 从 2010 年 1 月至 2017 年 12 月，从一家大学医院的病理科数据库中提取了所有经病理诊断为透壁性肠坏死的患者记录。本研究的纳入标准为病理检查证实存在透壁性肠坏死和术前 24 小时内获得的增强 CT 图像。最终纳入了 77 名患者。由两位腹部放射科医生对 CT 扫描进行回顾性独立评估，以确定透壁性肠坏死的典型 CT 表现。进行了统计学分析。 非阻塞性 AMI（59%）比阻塞性 AMI（29%）和绞窄性 SBO（7%）更常出现气肿性肠病（<0.01），肠系膜上静脉积气（55%、29%和 0%；<0.01）和门静脉积气（48%、10%和 0%；<0.01）也是如此。肠壁增强减少或消失在 AMI 中比 SBO 更常见（非阻塞性 AMI，83%；阻塞性 AMI，81%；SBO，56%；=0.02），肠壁变薄在 AMI 中比 SBO 更常见（非阻塞性 AMI，52%；阻塞性 AMI，48%；SBO，18%；=0.02）。绞窄性 SBO 中肠壁自发性高信号更为常见（41%），而非阻塞性 AMI（10%）和阻塞性 AMI（14%）中则较为少见（<0.01）。 根据其三种主要病因，透壁性肠坏死具有不同的 CT 表现。阻塞性 AMI 的特征是肠壁增强消失，肠系膜脂肪条索征减少，非阻塞性 AMI 以气肿性肠病和门静脉积气高发为特征，绞窄性 SBO 以肠壁自发性高信号和无气肿性肠病及门静脉积气为特征。
