Yang Ju-Shun, Xu Zhen-Yu, Chen Fei-Xiang, Wang Mei-Rong, Fan Xiao-Le, He Bo-Sheng
Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China.
Department of Ultrasonography, The Second People's Hospital of Nantong, Nantong 226002, Jiangsu Province, China.
World J Gastrointest Surg. 2025 Jul 27;17(7):105956. doi: 10.4240/wjgs.v17.i7.105956.
Irreversible transmural intestinal necrosis (ITIN) is associated with high mortality rates in patients with acute occlusive mesenteric ischemia (AOMI). Currently, there are not many studies on the use of dual energy computed tomography (DECT) for evaluating ITIN.
To evaluate the diagnostic value of DECT for ITIN in AOMI.
The cases and computed tomography (CT) images of 102 patients with clinically diagnosed AOMI (including 48 ITIN) from January 2012 to January 2022 were retrospectively collected. The CT scans included both multidetector CT and DECT. The raw data from DECT portal-venous phase were reconstructed into 120 kVp mixed energy image, 50 keV virtual monoenergetic imaging, and iodine map. Two radiologists independently completed the subjective visual assessment of CT signs related to AOMI. Objective parameters, including the attenuation of the normal and lesion intestinal wall segment (CT, CT) and iodine concentrations (IC and IC), were quantified. Furthermore, multivariate logistic regression, receiver operating characteristic curves, and area under the curve (AUC) values were used to evaluate the subjective and objective indicators in predicting ITIN.
Regarding subjective signs, logistic regression analysis revealed reduced or absent bowel wall enhancement [odds ratio (OR) = 5.576, 95% confidence interval (CI): 1.547-20.093], bowel dilation (OR = 11.613, 95%CI: 3.790-35.586), and parenchymatous organ infarction (OR = 4.727, 95%CI: 1.536-14.551) were independent risk factors for the ITIN. CT subjective signs had a high diagnostic efficacy for ITIN (AUC = 0.853). The two DECT objective parameters also exhibited excellent diagnostic value for ITIN, with an AUC of 0.79, a cut-off value of CT = 2.81, and an AUC of 0.777 with a cut-off value of IC = 2.39. The Delong test showed that there was no significant difference in the efficacy of subjective CT signs and objective DECT parameters ( > 0.05). Importantly, we observed that IC combined with subjective signs (bowel dilation and parenchymatous organ infarction) had the highest predictive performance (AUC = 0.894), sensitivity (100%), and specificity (70.83%), which was statistically different from the AUC of CT subjective signs ( = 0.017).
IC (DECT-based features) combined with CT subjective signs (bowel dilatation and parenchymatous organ infarction) showed favorable predictive performance for ITIN in AOMI, which may help clinicians develop timely treatment strategies.
不可逆性透壁性肠坏死（ITIN）与急性闭塞性肠系膜缺血（AOMI）患者的高死亡率相关。目前，关于使用双能计算机断层扫描（DECT）评估ITIN的研究并不多。
评估DECT对AOMI中ITIN的诊断价值。
回顾性收集2012年1月至2022年1月临床诊断为AOMI的102例患者（包括48例ITIN）的病例及计算机断层扫描（CT）图像。CT扫描包括多层螺旋CT和DECT。将DECT门静脉期的原始数据重建为120 kVp混合能量图像、50 keV虚拟单能成像和碘图。两名放射科医生独立完成与AOMI相关的CT征象的主观视觉评估。对正常和病变肠壁段的衰减（CT、CT）和碘浓度（IC和IC）等客观参数进行量化。此外，采用多因素逻辑回归、受试者工作特征曲线及曲线下面积（AUC）值评估主观和客观指标对ITIN的预测价值。
关于主观征象，逻辑回归分析显示肠壁强化减弱或消失[比值比（OR）=5.576，95%置信区间（CI）：1.547 - 20.093]、肠扩张（OR = 11.613，95%CI：3.790 - 35.586）和实质器官梗死（OR = 4.727，95%CI：1.536 - 14.551）是ITIN的独立危险因素。CT主观征象对ITIN具有较高的诊断效能（AUC = 0.853）。两个DECT客观参数对ITIN也具有良好的诊断价值，CT的AUC为0.79，截断值为2.81，IC的AUC为0.777，截断值为2.39。DeLong检验显示CT主观征象和DECT客观参数的效能无显著差异（>0.05）。重要的是，我们观察到IC结合主观征象（肠扩张和实质器官梗死）具有最高的预测性能（AUC = 0.894）、敏感性（100%）和特异性（70.83%），与CT主观征象的AUC相比有统计学差异（=0.017）。
IC（基于DECT的特征）结合CT主观征象（肠扩张和实质器官梗死）对AOMI中的ITIN显示出良好的预测性能，这可能有助于临床医生制定及时的治疗策略。
