CT 诊断非闭塞性肠系膜缺血性肠壁坏死的性能。
Diagnostic performance of CT for the detection of transmural bowel necrosis in non-occlusive mesenteric ischemia.
机构信息
Department of Radiology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France.
EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, Besançon, France.
出版信息
Eur Radiol. 2021 Sep;31(9):6835-6845. doi: 10.1007/s00330-021-07728-w. Epub 2021 Feb 14.
OBJECTIVES
To evaluate the diagnostic performance of CT for transmural necrosis (TN) in non-occlusive mesenteric ischemia (NOMI) according to the bowel segment involved.
METHODS
From January 2009 to December 2019, all patients admitted to the intensive care unit (ICU) and requiring laparotomy for NOMI were retrospectively studied. CT had to have been performed within 24 h prior to laparotomy and were reviewed by two abdominal radiologists, with a consensus reading in case of disagreement. A set of CT features of mesenteric ischemia were assessed, separating the stomach, jejunum, ileum, and right (RC) and left colon (LC). Univariate and multivariate analyses were performed to identify features associated with TN. Its influence on overall survival (OS) was assessed.
RESULTS
Among 145 patients, 95 (66%) had ≥ 1 bowel segment with TN, including 7 (5%), 31 (21%), 43 (29%), 45 (31%), and 52 (35%) in the stomach, jejunum, ileum, RC, and LC, respectively. Overall inter-reader agreement of CT features was significantly lower in the colon than in the small bowel (0.59 [0.52-0.65] vs 0.74 [0.70-0.77] respectively). The absence of bowel wall enhancement was the only CT feature associated with TN by multivariate analysis, whatever the bowel segment involved. Proximal TN was associated with poorer OS (p < 0.001).
CONCLUSIONS
The absence of bowel wall enhancement remains the most consistent CT feature of transmural necrosis, whatever the bowel segment involved in NOMI. Inter-reader agreement of CT features is lower in the colon than in the small bowel. Proximal TN seems to be associated with poorer OS.
KEY POINTS
• The absence of bowel wall enhancement is the most consistent CT feature associated with transmural necrosis in NOMI, whatever is the bowel segment involved. • Inter-reader agreement is lower in the colon than in the small bowel in NOMI. • In NOMI, the more proximal the bowel necrosis, the worse the prognosis.
目的
根据受累肠段评估 CT 对非闭塞性肠系膜缺血（NOMI）中透壁性坏死（TN）的诊断性能。
方法
从 2009 年 1 月至 2019 年 12 月，回顾性研究了所有因 NOMI 入住重症监护病房（ICU）并需要剖腹手术的患者。CT 必须在剖腹手术前 24 小时内进行，由两名腹部放射科医生进行审查，如果意见不一致，则进行共识阅读。评估了一套肠系膜缺血的 CT 特征，将胃、空肠、回肠以及右（RC）和左结肠（LC）分开。进行了单变量和多变量分析，以确定与 TN 相关的特征。评估其对总生存率（OS）的影响。
结果
在 145 名患者中，95 名（66%）有≥1 个肠段有 TN，分别为 7 名（5%）、31 名（21%）、43 名（29%）、45 名（31%）和 52 名（35%）在胃、空肠、回肠、RC 和 LC 中。无论肠段如何，结肠的总体读者间 CT 特征一致性明显低于小肠（分别为 0.59 [0.52-0.65] 和 0.74 [0.70-0.77]）。多变量分析显示，不管肠段如何，肠壁增强缺失是唯一与 TN 相关的 CT 特征。近端 TN 与较差的 OS 相关（p<0.001）。
结论
肠壁增强缺失仍然是 NOMI 中透壁性坏死最一致的 CT 特征，无论受累肠段如何。在 NOMI 中，结肠的读者间 CT 特征一致性低于小肠。近端 TN 似乎与较差的 OS 相关。
关键要点
肠壁增强缺失是 NOMI 中与透壁性坏死最相关的 CT 特征，无论受累肠段如何。
在 NOMI 中，结肠的读者间一致性低于小肠。
在 NOMI 中，肠坏死越靠近近端，预后越差。
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