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Prognostic value of multidetector computed tomography in bowel infarction

Valore prognostico della tomografia computerizzata multidetettore nell’infarto intestinale

  • Abdominal Radiology / Radiologia Addominale
  • Published:
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Abstract

Purpose

This study aimed to correlate computed tomography (CT) findings and outcomes in patients affected by bowel infarction.

Materials and methods

Twenty-seven patients with bowel infarction due to vascular obstruction were evaluated with multidetector CT (MDCT) to establish the prognostic value of CT findings and their correlation with the origin of the ischaemia. The chi-square test was used to analyse the results (p≤0.05).

Results

MDCT images allowed recognition of the nature of ischaemia in all cases. In particular, arterial occlusion was found in 67% of patients and venous obstruction in 33%. The overall mortality rate was 63%. Outcome closely correlated with the kind of vascular obstruction, with a mortality rate of 89% in arterial forms and 11% in venous forms. Bowel-wall hyperdensity (2/9 venous occlusions), loss of wall enhancement (1/9 venous occlusions, 2/18 arterial occlusions) and wall thickening (8/9 venous obstructions, 2/18 arterial occlusions) were predictive of good outcome. Bowel-loop dilatation (4/9 venous occlusions, 13/18 arterial occlusions), intramural pneumatosis (1/9 venous occlusions, 17/18 arterial occlusions), mesenteric venous gas (2/9 venous occlusions, 11/18 arterial occlusions), portal venous gas (1/9 venous occlusions, 4/18 arterial occlusions), pneumoperitoneum (8/18 arterial occlusions) and pneumoretroperitoneum (1/18 arterial occlusions) were predictive of poor outcome. Ascites (6/9 venous occlusions, 12/18 arterial occlusions) did not add any prognostic information.

Conclusions

MDCT is able to detect the nature of bowel ischaemia and provide important prognostic information.

Riassunto

Obiettivo

Ricercare eventuali correlazioni tra informazioni ottenute con tomografia computerizzata (TC) e prognosi nell’infarto intestinale.

Materiali e metodi

Sono state valutate le immagini TC multidetettore (TCMD) di 27 pazienti con infarto intestinale da occlusione vascolare e sono state ricercate: significatività prognostica delle alterazioni evidenziate, correlazioni con la natura dell’ischemia. È stato applicato il test statistico del χ2 (p≤0,05).

Risultati

La TCMD ha riconosciuto sempre la natura dell’ischemia, secondaria ad occlusione arteriosa nel 67% dei casi e venosa nel 33%. Il tasso di mortalità complessivo è stato del 63%. L’eziologia della patologia in rapporto alla prognosi è risultata altamente significativa, con mortalità del 89% nelle forme arteriose e del 11% in quelle venose. L’iperdensità parietale (2/9 occlusioni venose), l’assenza di enhancement (1/9 occlusioni venose, 2/18 occlusioni arteriose), l’ispessimento di parete (8/9 occlusioni venose, 2/18 occlusioni arteriose) sono risultati significativi di evoluzione benigna, mentre la dilatazione delle anse (4/9 occlusioni venose, 13/18 occlusioni arteriose), la pneumatosi parietale (1/9 occlusioni venose, 17/18 occlusioni arteriose), l’aria nelle vene mesenteriche (2/9 occlusioni venose, 11/18 occlusioni arteriose), l’aria nei rami portali (1/9 occlusioni venose, 4/18 occlusioni arteriose), lo pneumoperitoneo (8/18 occlusioni arteriose) e il retropneumoperitoneo (1/18 occlusioni arteriose) sono risultati indici prognostici sfavorevoli. L’ascite (6/9 occlusioni venose, 12/18 occlusioni arteriose) non ha fornito indicazioni di tipo prognostico.

Conclusioni

La TCMD consente di definire la natura dell’ischemia intestinale e fornisce importanti valutazioni prognostiche.

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Authors and Affiliations

  1. Di.M.I.M.P. — Sezione di Diagnostica per Immagini, Policlinico Universitario, Piazza Giulio Cesare 11, 70124, Bari, Italy

    M. Moschetta, A. A. Stabile Ianora, P. Pedote, A. Scardapane & G. Angelelli

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  1. M. Moschetta
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  2. A. A. Stabile Ianora
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  3. P. Pedote
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  4. A. Scardapane
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  5. G. Angelelli
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Correspondence to M. Moschetta.

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Moschetta, M., Stabile Ianora, A.A., Pedote, P. et al. Prognostic value of multidetector computed tomography in bowel infarction. Radiol med 114, 780–791 (2009). https://doi.org/10.1007/s11547-009-0422-6

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  • DOI: https://doi.org/10.1007/s11547-009-0422-6

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