Ksouri Aida, Copin Pauline, Bonvalet Fanny, Bozi Lilian, Cazals-Hatem Dominique, Garzelli Lorenzo, Panis Yves, Weiss Emmanuel, Castier Yves, Bouhnik Yoram, Corcos Olivier, Vilgrain Valérie, Ronot Maxime, Nuzzo Alexandre
Department of Radiology, Beaujon Hospital, APHP.Nord, 92110, Clichy, France.
Department of Pathology, Beaujon Hospital, APHP.Nord, 92110, Clichy, France.
Eur Radiol. 2022 Apr;32(4):2813-2823. doi: 10.1007/s00330-021-08318-6. Epub 2021 Oct 18.
This study aimed to investigate the prevalence, risk factors, and outcomes of colonic involvement in patients with acute mesenteric ischemia (AMI).
CT scans from a prospective cohort of 114 AMI patients treated in an intestinal stroke center between 2009 and 2018 were blindly reviewed by two radiologists. Colon involvement was defined on CT scan by the presence of at least one of the following CT colonic features: wall thickening, pneumatosis, decreased wall enhancement, dilatation, or perforation. In addition, the clinical, biological, and radiological characteristics of patients with and without colonic involvement were compared to identify risk factors for colonic involvement on CT and its impact on morbidity and mortality.
Colonic involvement was identified in 32/114 (28%) patients with AMI, the right colon being more frequently involved (n = 29/32, 91%). Wall thickening (n = 27/32) was the most common CT finding. Occlusion of the inferior mesenteric artery was the only statistically significant risk factor for colonic involvement (35% vs. 15%, p = 0.02). Patients with colonic involvement on CT vs. those without had more frequently transmural colonic necrosis (13% vs. 0%, p = 0.006), short bowel syndrome (16% vs. 4%, p = 0.04), need for long-term parenteral support (19% vs. 5%, p = 0.03), and death during follow-up (22% vs. 10%, p = 0.03).
In patients with AMI, colonic involvement is associated with increased morbidity and mortality and should be carefully searched for during initial CT scan assessment.
• In a prospective cohort of acute mesenteric ischemia patients from an intestinal stroke center, 28% had an associated colonic involvement on CT. • Colonic involvement on CT most commonly affected the right colon, and the occlusion of the inferior mesenteric artery was the only risk factor. • Colonic involvement on CT was associated with increased morbidity and mortality and should be carefully searched for during initial CT scan assessment.
本研究旨在调查急性肠系膜缺血（AMI）患者结肠受累的患病率、危险因素及预后。
两名放射科医生对2009年至2018年在一家肠道卒中中心接受治疗的114例AMI患者的前瞻性队列的CT扫描进行盲法评估。结肠受累在CT扫描上定义为存在以下至少一种CT结肠特征：肠壁增厚、积气、肠壁强化减弱、扩张或穿孔。此外，比较有和无结肠受累患者的临床、生物学和放射学特征，以确定CT上结肠受累的危险因素及其对发病率和死亡率的影响。
在114例AMI患者中，32例（28%）发现有结肠受累，右结肠受累更为常见（n = 29/32，91%）。肠壁增厚（n = 27/32）是最常见的CT表现。肠系膜下动脉闭塞是结肠受累唯一具有统计学意义的危险因素（35%对15%，p = 0.02）。CT上有结肠受累的患者与无结肠受累的患者相比，更常出现透壁性结肠坏死（13%对0%，p = 0.006）、短肠综合征（16%对4%，p = 0.04）、需要长期肠外支持（19%对5%，p = 0.03）以及随访期间死亡（22%对10%，p = 0.03）。
在AMI患者中，结肠受累与发病率和死亡率增加相关，在初始CT扫描评估时应仔细排查。
• 在一家肠道卒中中心的急性肠系膜缺血患者前瞻性队列中，28%的患者CT上存在相关结肠受累。• CT上结肠受累最常累及右结肠，肠系膜下动脉闭塞是唯一的危险因素。• CT上结肠受累与发病率和死亡率增加相关，在初始CT扫描评估时应仔细排查。
