Terlouw Luke G, van Noord Desirée, van Walsum Theo, Bruno Marco J, Moelker Adriaan
Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands.
Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Eur Radiol. 2021 Jun;31(6):4212-4220. doi: 10.1007/s00330-020-07530-0. Epub 2020 Dec 2.
A practical screening tool for chronic mesenteric ischemia (CMI) could facilitate early recognition and reduce undertreatment and diagnostic delay. This study explored the ability to discriminate CMI from non-CMI patients with a mesenteric artery calcium score (MACS).
This retrospective study included CTAs of consecutive patients with suspected CMI in a tertiary referral center between April 2016 and October 2019. A custom-built software module, using the Agatston definition, was developed and used to calculate the MACS for the celiac artery (CA), superior mesenteric artery (SMA), and inferior mesenteric artery. Scoring was performed by two blinded observers. Interobserver agreement was determined using 39 CTAs scored independently by both observers. CMI was defined as sustained symptom improvement after treatment. Non-CMI patients were patients not diagnosed with CMI after a diagnostic workup and patients not responding to treatment.
The MACS was obtained in 184 patients, 49 CMI and 135 non-CMI. Interobserver agreement was excellent (intraclass correlation coefficient 0.910). The MACS of all mesenteric arteries was significantly higher in CMI patients than in non-CMI patients. ROC analysis of the combined MACS of CA + SMA showed an acceptable AUC (0.767), high sensitivity (87.8%), and high NPV (92.1%), when using a ≥ 29.7 CA + SMA MACS cutoff. Comparison of two CTAs, obtained in the same patient at different points in time with different scan and reconstruction parameters, was performed in 29 patients and revealed significant differences in MACSs.
MACS seems a promising screening method for CMI, but correction for scan and reconstruction parameters is warranted.
• A mesenteric artery calcium score obtained in celiac artery and superior mesenteric artery has a high negative predictive value for chronic mesenteric ischemia and could serve as a screening tool. • Interobserver agreement of the mesenteric artery calcium score is excellent. • Scan and reconstruction parameters influence the mesenteric artery calcium score and warrant the development of a method to correct for these parameters.
一种实用的慢性肠系膜缺血（CMI）筛查工具可促进早期识别，并减少治疗不足和诊断延迟。本研究探讨了利用肠系膜动脉钙化评分（MACS）区分CMI患者与非CMI患者的能力。
这项回顾性研究纳入了2016年4月至2019年10月在一家三级转诊中心连续就诊的疑似CMI患者的CT血管造影（CTA）。开发了一个使用阿加斯顿定义的定制软件模块，并用于计算腹腔干动脉（CA）、肠系膜上动脉（SMA）和肠系膜下动脉的MACS。由两名盲法观察者进行评分。观察者间一致性通过两位观察者独立评分的39例CTA来确定。CMI定义为治疗后症状持续改善。非CMI患者包括经过诊断检查后未被诊断为CMI的患者以及对治疗无反应的患者。
184例患者获得了MACS，其中49例为CMI患者，135例为非CMI患者。观察者间一致性极佳（组内相关系数0.910）。CMI患者所有肠系膜动脉的MACS显著高于非CMI患者。当使用≥29.7的CA + SMA MACS临界值时，CA + SMA联合MACS的ROC分析显示出可接受的曲线下面积（AUC）（0.767）、高敏感性（87.8%）和高阴性预测值（92.1%）。对29例患者在不同时间点、使用不同扫描和重建参数获得的两次CTA进行比较，结果显示MACS存在显著差异。
MACS似乎是一种有前景的CMI筛查方法，但有必要对扫描和重建参数进行校正。
• 腹腔干动脉和肠系膜上动脉的肠系膜动脉钙化评分对慢性肠系膜缺血具有较高的阴性预测价值，可作为一种筛查工具。• 肠系膜动脉钙化评分的观察者间一致性极佳。• 扫描和重建参数会影响肠系膜动脉钙化评分，因此有必要开发一种校正这些参数的方法。
