Computed Tomography Parameters for Prognosis Prediction in Non-Occlusive Mesenteric Ischemia.

Abstract

BACKGROUND Non-occlusive mesenteric ischemia (NOMI) is difficult to diagnose and has a high mortality rate. We aimed to determine the qualitative and quantitative parameters of computed tomography (CT) that can determine patient prognosis and contribute to early diagnosis in order to reduce mortality. MATERIAL AND METHODS The biphasic CT images of 40 patients, mean age 72.7±12 years, 24 men (60%), 14 women 14 (40%), with a diagnosis of NOMI were analyzed retrospectively. Patients were divided into survivor and non-survivor groups. Qualitative CT parameters, consisting of vascular, intestinal, and mesenteric and peritoneal findings, comorbidities, and surgical resection were compared using Fisher's exact test. Quantitative CT parameters of superior mesenteric artery (SMA), celiac trunk, inferior vena cava (IVC), superior mesenteric vein (SMV) diameters, and intestinal wall density difference (delta HU) in arterial and venous phases were compared with patient prognosis by using ANOVA. RESULTS Pneumatosis intestinalis (P=0.012), paper-thin bowel wall (P=0.015), and pale mesentery (P=0.008) were higher in the non-survivor group. In the survivor group, mesentery congestion (P=0.003), bowel wall thickening (P=0.001), bowel wall enhancement (P=0.044), and enhancing mucosa and submucosa of bowel wall (P=0.042) were higher. The celiac trunk, SMA, SMV, IVC, and IMA diameters, artery wall density, and delta HU were statistically significantly lower in the non-survivor group. The IVC diameter was correlated with patient prognosis (P=0.000). CONCLUSIONS A systematic evaluation of CT parameters can make important contributions to the early diagnosis and management of patients with NOMI.