Rigiroli Francesca, Nakhaei Masoud, Karam Ramy, Tabah Nicolas, Brook Alexander, Siewert Bettina, Brook Olga Rachel
Beth Israel Deaconess Medical Center, Boston, USA.
Tulane University, New Orleans, USA.
Abdom Radiol (NY). 2025 Jan 28. doi: 10.1007/s00261-025-04814-1.
Pneumatosis intestinalis on CT presents a diagnostic dilemma, because it could reflect bowel ischemia or benign finding.
To determine radiological and clinical features that can predict bowel ischemia in patients with pneumatosis intestinalis on CT.
Patients with "pneumatosis" in abdominal CT reports performed between 1/1/2002 and 12/31/2018 were retrospectively included. Pneumatosis intestinalis was confirmed by review of images. Radiological features of pneumatosis, laboratory data, clinical signs and symptoms were collected. Pathologic pneumatosis intestinalis (PPI) was defined as presence of ischemic (viable or dead) bowel on surgery or death during admission or within 30 days of discharge due to ischemia. Univariate statistical analysis was used to identify features associated with PPI, followed by multivariate logistic regression models.
A total of 313 consecutive patients with pneumatosis intestinalis (162 (52%) men, median age 67 years, IQR 55-78 years) were included. Pathologic pneumatosis intestinalis was present in 114/313 (36%) patients. Presence of arterial or venous thrombosis, porto-mesenteric gas, fat stranding, and location in the small bowel were significantly associated with PPI. A combined clinical and radiological model, which included age, WBC, creatinine, abdominal distention, rebound or guarding, shock, presence of porto-mesenteric gas and fat stranding showed an AUC of 0.85 for prediction of PPI, higher than models using clinical (AUC = 0.80, p = 0.005) or radiological factors (AUC = 0.80, p < 0.0001) alone.
Improved prediction of pathological pneumatosis intestinalis can be achieved by a model incorporating both clinical and radiological features (AUC = 0.85)rather than by either clinical (AUC = 0.80) or radiological (AUC = 0.80) features alone.
CT上的肠壁积气存在诊断难题，因为它可能反映肠缺血或为良性表现。
确定CT上肠壁积气患者中可预测肠缺血的影像学和临床特征。
回顾性纳入2002年1月1日至2018年12月31日期间腹部CT报告中有“积气”的患者。通过图像复查确认肠壁积气。收集肠壁积气的影像学特征、实验室数据、临床体征和症状。病理性肠壁积气（PPI）定义为手术中存在缺血性（存活或坏死）肠段，或因缺血在入院期间或出院后30天内死亡。采用单因素统计分析确定与PPI相关的特征，随后建立多因素逻辑回归模型。
共纳入313例连续的肠壁积气患者（162例（52%）男性，中位年龄67岁，四分位间距55 - 78岁）。114/313例（36%）患者存在病理性肠壁积气。动脉或静脉血栓形成、门静脉 - 肠系膜积气、脂肪密度增高以及位于小肠与PPI显著相关。一个综合临床和影像学特征的模型，包括年龄、白细胞、肌酐、腹胀、反跳痛或肌紧张、休克、门静脉 - 肠系膜积气和脂肪密度增高的存在，预测PPI的曲线下面积（AUC）为0.85，高于单独使用临床因素（AUC = 0.80，p = 0.005）或影像学因素（AUC = 0.80，p < 0.0001）的模型。
通过纳入临床和影像学特征的模型（AUC = 0.85），而非单独的临床特征（AUC = 0.80）或影像学特征（AUC = 0.80），可实现对病理性肠壁积气更好的预测。
