Usefulness of computed tomography in differentiating transmural infarction from nontransmural ischemia of the small intestine in patients with acute mesenteric venous thrombosis.

OBJECTIVE: To determine computed tomographic findings that are helpful in differentiating transmural infarction from nontransmural ischemia in patients with mesenteric ischemia secondary to acute mesenteric venous thrombosis (MVT).
METHODS: Twenty-seven patients with symptomatic acute MVT were categorized into 2 groups: a transmural infarction (n = 13) and a nontransmural ischemia group (n = 14) based on findings at surgery and clinical follow-up. Computed tomographic scans were retrospectively reviewed by the consensus of 2 radiologists. Computed tomographic findings were compared between the 2 groups using the Fisher exact and the independent sample t test. Multifactorial logistic regression analysis was performed to determine the best predictors for differentiating transmural infarction from nontransmural ischemia.
RESULTS: Bowel segments with homogeneous enhancement (P = 0.001), decreased enhancement (P = 0.001), and indistinct outer margins (P = 0.006) were significantly more common in the transmural infarction group than in the nontransmural ischemia group. The differences in maximal lumen diameter (P = 0.027), extent of mesenteric haziness (P = 0.018), and amount of ascites (P = 0.035) were significant between the 2 groups. On multifactorial logistic regression analysis, decreased enhancement (P = 0.007) and maximal lumen diameter (P = 0.039) were independent significant variables in differentiating transmural infarction from nontransmural ischemia.
CONCLUSIONS: In patients with acute MVT, computed tomography is valuable in differentiating transmural infarction from nontransmural ischemia.