Reintam Blaser Annika, Koitmäe Merli, Laisaar Kaja-Triin, Forbes Alastair, Kase Karri, Kiisk Ele, Murruste Marko, Reim Martin, Starkopf Joel, Tamme Kadri
Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.
Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.
Sci Rep. 2025 Mar 22;15(1):9875. doi: 10.1038/s41598-025-94846-w.
Computed tomography (CT) is widely used in diagnosing acute mesenteric ischemia (AMI), but robust identification of distinctive subtypes and stages of progression is lacking. Systematic literature search in PubMed, Cochrane Library, Web of Science and Scopus was conducted in May 2024. Studies including at least 10 adult patients and reporting radiological diagnosis of AMI versus no AMI or transmural ischemia versus no transmural ischemia were included. Meta-analyses on sensitivity and specificity of different radiological features in diagnosing AMI were conducted. From 2628 titles, 490 studies underwent full text review, and 81 were included in 14 meta-analyses. Diagnostic accuracy of CT angiography (CTA) was high - sensitivity of 92.0% and specificity of 98.8% (I 45% and 79%, respectively), but lower for other CT protocols (sensitivity 75.8 and specificity 90.5; I 83%). In most included studies, distinction of subtypes and severity of AMI (non-transmural or transmural) was not possible. Amongst the non-vascular features, absent/reduced bowel wall enhancement provided the best prognostic value (sensitivity 57.9 and specificity 90.1). CTA is the method of choice for diagnosing AMI with high diagnostic accuracy. None of the non-vascular features alone is sufficiently reliable to diagnose AMI or its progression to transmural necrosis, whereas a combination of different radiological features conveys a potential.
计算机断层扫描（CT）广泛应用于急性肠系膜缺血（AMI）的诊断，但对于其独特亚型和进展阶段缺乏可靠的识别方法。2024年5月，我们在PubMed、Cochrane图书馆、Web of Science和Scopus数据库中进行了系统的文献检索。纳入了至少包含10名成年患者且报告了AMI与非AMI的放射学诊断或透壁缺血与非透壁缺血诊断结果的研究。对不同放射学特征在诊断AMI中的敏感性和特异性进行了荟萃分析。从2628篇标题中筛选出490项研究进行全文审查，其中81项被纳入14项荟萃分析。CT血管造影（CTA）的诊断准确性较高，敏感性为92.0%，特异性为98.8%（I²分别为45%和79%），但其他CT检查方案的准确性较低（敏感性为75.8%，特异性为90.5%；I²为83%）。在大多数纳入研究中，无法区分AMI的亚型和严重程度（非透壁或透壁）。在非血管特征中，肠壁强化缺失/减弱具有最佳的预后价值（敏感性为57.9%，特异性为90.1%）。CTA是诊断AMI的首选方法，诊断准确性高。单独的非血管特征均不足以可靠地诊断AMI或其进展为透壁坏死，而不同放射学特征的组合可能具有诊断价值。
