Radiological predictive factors of transmural intestinal necrosis in acute mesenteric ischemia: Systematic review and meta-analysis
Abstract
Objective Transmural intestinal necrosis (TIN) is related to high mortality in patients with acute mesenteric ischemia (AMI). Radiological predictive factors of TIN in AMI remains controversial. This study aimed to identify the CT-based predictive factors of TIN in AMI.Methods EMBASE and PUBMED were searched for publications predicting TIN using radiological features. Quality Assessment of Diagnostic Accuracy Studies-2 was used to assess the methodological quality of individual studies. Data were presented in terms of diagnostic odds ratio (DOR), sensitivity, specificity, and 95% confidence interval (CI). The random-effects models were used for the meta-analysis.Results Eleven studies including 1037 cases with AMI were considered. The meta-analysis showed that bowel wall thinning (DOR = 13.10; 95% CI: 3.71, 46.25), decreased or absent bowel wall enhancement (DOR = 5.77; 95% CI: 2.95, 11.30), bowel dilation (DOR = 3.23; 95% CI: 2.03, 5.15), pneumatosis intestinalis (DOR = 5.78; 95% CI: 2.24, 14.95), porto-mesenteric venous gas (DOR = 5.36; 95% CI: 2.14, 13.40), and arterial occlusive AMI (DOR = 2.66; 95% CI: 1.53, 4.63) were risk factors for predicting TIN. Bowel wall thinning and porto-mesenteric venous gas displayed high specificity to diagnose TIN (98%, 95%, respectively). The subgroup analysis showed that decreased or absent bowel wall enhancement (DOR = 8.23; 95% CI: 4.67, 14.51) and bowel dilation (DOR = 3.14; 95% CI: 1.55, 6.39) were predictors of TIN in venous occlusive AMI, which were not related to TIN in arterial-origin AMI.Conclusions For predicting TIN, there are specific radiological features. The radiological predictors of TIN may differ according to the various causes of AMI. Future primary studies should further evaluate the relationships between radiological signs and TIN based on different etiologies.Key points • Bowel wall thinning, decreased or absent bowel wall enhancement, bowel dilation, pneumatosis intestinalis, porto-mesenteric venous gas, and arterial occlusive AMI were risk factors for predicting TIN. • Decreased or absent bowel wall enhancement and bowel dilation were predictors of TIN in venous occlusive AMI, which were not related to TIN in arterial-origin AMI.
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Bowel wall thickening, portovenous gas, and mesenteric venous gas are highly specific for diagnosing transmural intestinal necrosis.
“Bowel wall thickening, portovenous gas, and mesenteric venous gas are highly specific for diagnosing transmural intestinal necrosis [28,29].”
From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [28]
CT radiographic factors for acute mesenteric ischemia include bowel wall thinning, decreased or absent bowel wall enhancement, bowel dilatation, pneumatosis intestinalis, portal mesenteric venous gas, and arterial occlusive acute mesenteric ischemia.
“These include bowel wall thinning, decreased or absent bowel wall enhancement, bowel dilatation, pneumatosis intestinalis, portal mesenteric venous gas, and arterial occlusive acute mesenteric ischemia [28,29].”
From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [28]
Decreased or absent bowel wall enhancement and dilatation can be predictors of transmural intestinal necrosis in venous occlusive acute mesenteric ischemia.
“Decreased or absent bowel wall enhancement and dilatation can be predictors of transmural intestinal necrosis in venous occlusive acute mesenteric ischemia [28,29].”
From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [28]
Among all radiological signs, bowel wall thinning and portomesenteric venous gas showed highest specificity (98 and 95 per cent) for diagnosis of transmural intestinal infarction.
“Among all radiological signs, bowel wall thinning and portomesenteric venous gas showed highest specificity (98 and 95 per cent) for diagnosis of transmural intestinal infarction16.”
From Acute mesenteric ischaemia (2023) · cites this paper as [16]
Typical signs of irreversible bowel ischaemia in the presence of AMI are intestinal dilatation and thickness, reduction or absence of visceral enhancement, pneumatosis intestinalis, portal venous gas, and free intraperitoneal air.
“Typical signs of irreversible bowel ischaemia in the presence of AMI are intestinal dilatation and thickness, reduction, or absence of, visceral enhancement, pneumatosis intestinalis, portal venous gas, and free intraperitoneal air6,16.”
From Acute mesenteric ischaemia (2023) · cites this paper as [16]
A systematic review and meta-analysis included 11 studies with 1,037 cases of AMI to identify CT findings associated with intestinal necrosis in AMI.
“A systematic review and meta-analysis that aimed to identify CT findings associated with intestinal necrosis in AMI included 11 studies with 1 037 cases of AMI. 142”
Diagnostic odds ratios for decreased or absent bowel wall enhancement, intestinal pneumatosis, and portomesenteric venous gas were between 5 and 6 for transmural intestinal necrosis.
“Diagnostic ORs for decreased or absent bowel wall enhancement, intestinal pneumatosis, and portomesenteric venous gas were between 5 and 6.”
Bowel wall thinning had a diagnostic odds ratio of 13.1 (95% CI 3.71-46.3) for transmural intestinal necrosis.
“Bowel wall thinning had a diagnostic odds ratio (OR) of 13.1 (95% CI 3.71 e 46.3) for transmural intestinal necrosis.”
Decreased bowel wall enhancement, pneumatosis, and portomesenteric venous gas are considered signs of intestinal ischaemia and are suggestive, although not definitive, signs of bowel necrosis.
“Decreased bowel wall enhancement, pneumatosis, and portomesenteric venous gas are considered signs of intestinal ischaemia and are suggestive, although not definitive signs, of bowel necrosis.”
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References 27 · Cited by 40
- Authors
- Zeng, Y., Yang, F., Hu, X., Zhu, F., Chen, W., & Lin, W.
- Affiliations
- Sichuan University (CN)
- Corresponding author
- Chen, Weixia
- Venue
- European Radiology
- Published
- 2022-11-30
- Volume
- 33
- Issue
- 4
- Pages
- 2792-2799
- ISSN
- 0938-7994 (ISSN-L)
- 1432-1084
- OpenAlex
- W4310465411
- Cited by
- 40
- References
- 27
- Citations by year
- 2026: 10 · 2025: 15 · 2024: 11 · 2023: 4
- FWCI
- 1.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- European Radiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
- Health Sciences › Medicine › Surgery › Intestinal and Peritoneal Adhesions
- Keywords
- acute mesenteric ischemia, computed tomography, predictive factors, bowel wall enhancement, bowel dilation, pneumatosis intestinalis, diagnostic accuracy, mortality risk stratification, bowel resection
- MeSH terms
- Humans, Intestinal Diseases, Ischemia, Necrosis, Retrospective Studies, Tomography, X-Ray Computed, Mesenteric Ischemia
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