Abstract：
OBJECTIVE: Primary acute intestinal ischaemia (AII) is an abdominal catastrophe caused by intravascular obstruction of blood supply. It is difficult to diagnose. Computerized tomography (CT) scan is the modality of choice for diagnostic evaluation. Majority of previous studies have evaluated CT findings in patients where AII was suspected. However, unveiling the unique radiological findings also in not initially suspected AII patients, might lead to the timely management of AII patients, and is the aim of this study.
METHODS: In a single-center, retrospective case-control study, preoperative radiological findings from abdominal CT scans in 48 patients with primary AII were compared with 80 non-ischemic controls. Radiological findings were analyzed using multivariable logistical regression with adjustment for age and gender and reported as odds ratios (OR) with 95% confidence intervals (CI) and p values.
RESULTS: Thirty-nine (81%) cases with AII were referred to an abdominal CT scan without a specific clinical suspicion of AII. Three main radiological categories (intestinal wall pathology [OR 7.4, CI 2.3-24.0, p value < 0.001], gastrointestinal vessel pathology [OR 19.3, CI 4.6-80.5, p value < 0.001) and intestinal diameter [OR 4.7, CI 1.6-13.4, p value 0.004]) were significantly different in AII patients. Subgroup analysis implied that pneumatosis intestinalis, increased contrast enhancement in the bowel wall, inferior mesenteric artery arteriosclerosis and colonic contraction were predictors of AII.
CONCLUSIONS: Radiological changes within the intestinal wall, luminal diameter and gastrointestinal vessels are independent predictors of AII. Awareness of these radiological findings, therefore, plays a central role in patients with an indistinct clinical picture in early recognition and treatment of a life-threatening AII.
BACKGROUND: NCT04361110 (April 24, 2020), retrospectively registered.
METHODS: In a single-center, retrospective case-control study, preoperative radiological findings from abdominal CT scans in 48 patients with primary AII were compared with 80 non-ischemic controls. Radiological findings were analyzed using multivariable logistical regression with adjustment for age and gender and reported as odds ratios (OR) with 95% confidence intervals (CI) and p values.
RESULTS: Thirty-nine (81%) cases with AII were referred to an abdominal CT scan without a specific clinical suspicion of AII. Three main radiological categories (intestinal wall pathology [OR 7.4, CI 2.3-24.0, p value < 0.001], gastrointestinal vessel pathology [OR 19.3, CI 4.6-80.5, p value < 0.001) and intestinal diameter [OR 4.7, CI 1.6-13.4, p value 0.004]) were significantly different in AII patients. Subgroup analysis implied that pneumatosis intestinalis, increased contrast enhancement in the bowel wall, inferior mesenteric artery arteriosclerosis and colonic contraction were predictors of AII.
CONCLUSIONS: Radiological changes within the intestinal wall, luminal diameter and gastrointestinal vessels are independent predictors of AII. Awareness of these radiological findings, therefore, plays a central role in patients with an indistinct clinical picture in early recognition and treatment of a life-threatening AII.
BACKGROUND: NCT04361110 (April 24, 2020), retrospectively registered.
摘要：
目的：原发性急性肠缺血（AII）是由血管内供血阻塞引起的腹部灾难。很难诊断。计算机断层扫描（CT）扫描是诊断评估的首选方式。大多数先前的研究都评估了怀疑AII的患者的CT表现。然而,在最初没有怀疑的AII患者中也公布了独特的放射学发现，可能会导致对AII患者的及时管理，是本研究的目的。
方法：在单中心，回顾性病例对照研究，对48例原发性AII患者和80例非缺血性对照患者的腹部CT扫描的术前放射学结果进行了比较.使用多变量逻辑回归分析放射学结果，并调整年龄和性别，并报告为比值比（OR），95％置信区间（CI）和p值。
结果：39例（81%）AII患者接受了腹部CT扫描，没有具体的临床怀疑AII。三个主要的放射学类别（肠壁病理学[OR7.4，CI2.3-24.0，p值<0.001]，在AII患者中，胃肠道血管病理学[OR19.3，CI4.6-80.5，p值<0.001）和肠直径[OR4.7，CI1.6-13.4，p值0.004]）存在显着差异。亚组分析提示肠积气，肠壁的对比度增强增强，肠系膜下动脉动脉硬化和结肠收缩是AII的预测因子。
结论：肠壁内的放射学变化，管腔直径和胃肠道血管是AII的独立预测因子。意识到这些放射学发现，因此,在早期识别和治疗危及生命的AII中，临床表现不清的患者起着重要作用。
背景：NCT04361110（2020年4月24日），追溯注册。
方法：在单中心，回顾性病例对照研究，对48例原发性AII患者和80例非缺血性对照患者的腹部CT扫描的术前放射学结果进行了比较.使用多变量逻辑回归分析放射学结果，并调整年龄和性别，并报告为比值比（OR），95％置信区间（CI）和p值。
结果：39例（81%）AII患者接受了腹部CT扫描，没有具体的临床怀疑AII。三个主要的放射学类别（肠壁病理学[OR7.4，CI2.3-24.0，p值<0.001]，在AII患者中，胃肠道血管病理学[OR19.3，CI4.6-80.5，p值<0.001）和肠直径[OR4.7，CI1.6-13.4，p值0.004]）存在显着差异。亚组分析提示肠积气，肠壁的对比度增强增强，肠系膜下动脉动脉硬化和结肠收缩是AII的预测因子。
结论：肠壁内的放射学变化，管腔直径和胃肠道血管是AII的独立预测因子。意识到这些放射学发现，因此,在早期识别和治疗危及生命的AII中，临床表现不清的患者起着重要作用。
背景：NCT04361110（2020年4月24日），追溯注册。
