Maria A Mazzei1, Susanna Guerrini1, Nevada Cioffi Squitieri1, Carla Vindigni2, Giusi Imbriaco1, Francesco Gentili1, Daniela Berritto3, Francesco G Mazzei4, Roberto Grassi5, Luca Volterrani1. 1. 1 Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy. 2. 2 Division of Pathological Anatomy, Azienda Ospedaliera Universitaria Senese, Siena, Italy. 3. 3 Department of Diagnostic Imaging, Casa di Cura Villa dei Fiori Srl, Acerra, Napoli, Italy. 4. 4 Department of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy. 5. 5 Department of Radiology, Second University of Naples, Naples, Italy.
Abstract
OBJECTIVE: To investigate the CT features of reperfusion (presence/absence) in non-occlusive mesenteric ischaemia (NOMI) and their prognostic value in an emergency setting. METHODS: A revision was undertaken of imaging from 20 patients (16 males/4 females) with a dismissal summary of NOMI. All patients had previously undergone a minimum of one multidetector CT examination, and consequently underwent surgery (n = 8), autopsy (n = 2), angiography (n = 1) or endoscopy (n = 9). An evaluation of the CT scans was conducted to determine vessels, mesentery, bowel and peritoneal cavity features. The superior mesenteric artery (SMA) average diameter of NOMI cases were compared with 30 controlled cases. Kappa, Kolmogorov-Smirnov (K-S) and Fisher's exact tests were used for statistical analysis. RESULTS: A mean SMA diameter significantly smaller than that of the controlled cases was found for patients with NOMI (K-S test: D = 0.75, p = 3.7 × 10-08). Fisher's exact tests showed a strong connection between the presence of reperfusion and mesenteric fat stranding (p = 0.026), bowel wall thickening (p = 3.2 × 10-05) and a high attenuation of the bowel wall on unenhanced CT images (p = 2.8 × 10-04). A reduction in mortality was significantly linked to the combination of normal mesenteric vessels and wall thickening (p = 0.034). CONCLUSION: Analysis of not only vessels findings but also mesentery and bowel CT features will support the identification of NOMI with or without a reperfusion event in an emergency setting. A strong correlation between some CT features and lower mortality exists. ADVANCES IN KNOWLEDGE: CT features of NOMI with or without reperfusion are demonstrated. Correctly assessing the presence of reperfusion in NOMI, may allow better management of these conditions in the emergency setting.
OBJECTIVE: To investigate the CT features of reperfusion (presence/absence) in non-occlusive mesenteric ischaemia (NOMI) and their prognostic value in an emergency setting. METHODS: A revision was undertaken of imaging from 20 patients (16 males/4 females) with a dismissal summary of NOMI. All patients had previously undergone a minimum of one multidetector CT examination, and consequently underwent surgery (n = 8), autopsy (n = 2), angiography (n = 1) or endoscopy (n = 9). An evaluation of the CT scans was conducted to determine vessels, mesentery, bowel and peritoneal cavity features. The superior mesenteric artery (SMA) average diameter of NOMI cases were compared with 30 controlled cases. Kappa, Kolmogorov-Smirnov (K-S) and Fisher's exact tests were used for statistical analysis. RESULTS: A mean SMA diameter significantly smaller than that of the controlled cases was found for patients with NOMI (K-S test: D = 0.75, p = 3.7 × 10-08). Fisher's exact tests showed a strong connection between the presence of reperfusion and mesenteric fat stranding (p = 0.026), bowel wall thickening (p = 3.2 × 10-05) and a high attenuation of the bowel wall on unenhanced CT images (p = 2.8 × 10-04). A reduction in mortality was significantly linked to the combination of normal mesenteric vessels and wall thickening (p = 0.034). CONCLUSION: Analysis of not only vessels findings but also mesentery and bowelCT features will support the identification of NOMI with or without a reperfusion event in an emergency setting. A strong correlation between some CT features and lower mortality exists. ADVANCES IN KNOWLEDGE: CT features of NOMI with or without reperfusion are demonstrated. Correctly assessing the presence of reperfusion in NOMI, may allow better management of these conditions in the emergency setting.
Authors: A Brillantino; F Iacobellis; A Renzi; R Nasti; L Saldamarco; M Grillo; L Romano; M Castriconi; A Cittadini; M De Palma; M Scaglione; N Di Martino; R Grassi; F Paladino Journal: Eur J Trauma Emerg Surg Date: 2017-06-13 Impact factor: 3.693
Authors: Sara Kammerer; Christoph Schuelke; Shoma Berkemeyer; Aglae Velasco; Walter Heindel; Michael Koehler; Boris Buerke Journal: PLoS One Date: 2018-03-01 Impact factor: 3.240
Authors: Francesca Iacobellis; Donatella Narese; Daniela Berritto; Antonio Brillantino; Marco Di Serafino; Susanna Guerrini; Roberta Grassi; Mariano Scaglione; Maria Antonietta Mazzei; Luigia Romano Journal: Diagnostics (Basel) Date: 2021-05-30