Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2025; 17(7): 105956
Published online Jul 27, 2025. doi: 10.4240/wjgs.v17.i7.105956
Diagnostic value of dual-energy computed tomography in irreversible transmural intestinal necrosis in patients with acute occlusive mesenteric ischemia
Ju-Shun Yang, Zhen-Yu Xu, Fei-Xiang Chen, Mei-Rong Wang, Xiao-Le Fan, Bo-Sheng He
Ju-Shun Yang, Fei-Xiang Chen, Mei-Rong Wang, Xiao-Le Fan, Bo-Sheng He, Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
Zhen-Yu Xu, Department of Ultrasonography, The Second People’s Hospital of Nantong, Nantong 226002, Jiangsu Province, China
Author contributions: Yang JS and He BS were responsible for design of the study and reviewed the manuscript; Yang JS drafted the manuscript; Xu ZY, Chen FX, and Wang MR performed data collection and analysis; Yang JS and Fan XL prepared the figures and tables; He BS were responsible for revising manuscript; and all authors have read and approved the final manuscript.
Supported by The Project of Nantong City Health Committee, No. MS2023027 and WKZL2018017; The “333” Talent Funding Project of Jiangsu Province, No. BRA2020198; The Project of Jiangsu Provincial Health Commission, No. ZD2021059; and The Youth Research Fund of Nantong Municipal Health Commission, No. QNZ2023027.
Institutional review board statement: The study was approved by the ethics committee of the Second Affiliated Hospital of Nantong University (No. 2021KT154).
Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data generated or analyzed during this study were available from the corresponding author Bo-Sheng He upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bo-Sheng He, MD, PhD, Department of Radiology, The Second Affiliated Hospital of Nantong University, No. 666 Shengli Road, Nantong 226001, Jiangsu Province, China. boshenghe@126.com
Received: February 13, 2025
Revised: March 29, 2025
Accepted: May 29, 2025
Published online: July 27, 2025
Processing time: 161 Days and 8.4 Hours
Abstract
BACKGROUND

Irreversible transmural intestinal necrosis (ITIN) is associated with high mortality rates in patients with acute occlusive mesenteric ischemia (AOMI). Currently, there are not many studies on the use of dual energy computed tomography (DECT) for evaluating ITIN.

AIM

To evaluate the diagnostic value of DECT for ITIN in AOMI.

METHODS

The cases and computed tomography (CT) images of 102 patients with clinically diagnosed AOMI (including 48 ITIN) from January 2012 to January 2022 were retrospectively collected. The CT scans included both multidetector CT and DECT. The raw data from DECT portal-venous phase were reconstructed into 120 kVp mixed energy image, 50 keV virtual monoenergetic imaging, and iodine map. Two radiologists independently completed the subjective visual assessment of CT signs related to AOMI. Objective parameters, including the attenuation of the normal and lesion intestinal wall segment (CT50 keV lesion, CT50 keV normal/lesion) and iodine concentrations (IClesion and ICnormal/lesion), were quantified. Furthermore, multivariate logistic regression, receiver operating characteristic curves, and area under the curve (AUC) values were used to evaluate the subjective and objective indicators in predicting ITIN.

RESULTS

Regarding subjective signs, logistic regression analysis revealed reduced or absent bowel wall enhancement [odds ratio (OR) = 5.576, 95% confidence interval (CI): 1.547-20.093], bowel dilation (OR = 11.613, 95%CI: 3.790-35.586), and parenchymatous organ infarction (OR = 4.727, 95%CI: 1.536-14.551) were independent risk factors for the ITIN. CT subjective signs had a high diagnostic efficacy for ITIN (AUC = 0.853). The two DECT objective parameters also exhibited excellent diagnostic value for ITIN, with an AUC of 0.79, a cut-off value of CT50 keV normal/lesion = 2.81, and an AUC of 0.777 with a cut-off value of ICnormal/lesion = 2.39. The Delong test showed that there was no significant difference in the efficacy of subjective CT signs and objective DECT parameters (P > 0.05). Importantly, we observed that ICnormal/lesion combined with subjective signs (bowel dilation and parenchymatous organ infarction) had the highest predictive performance (AUC = 0.894), sensitivity (100%), and specificity (70.83%), which was statistically different from the AUC of CT subjective signs (P = 0.017).

CONCLUSION

ICnormal/lesion (DECT-based features) combined with CT subjective signs (bowel dilatation and parenchymatous organ infarction) showed favorable predictive performance for ITIN in AOMI, which may help clinicians develop timely treatment strategies.

Keywords: Acute mesenteric ischemia; Irreversible transmural intestinal necrosis; Dual-energy computed tomography; Virtual monoenergetic imaging; Iodine concentration

Core Tip: Acute occlusive mesenteric ischemia is an intestinal ischemic injury caused by sudden interruption of intestinal blood supply. If not treated promptly, acute occlusive mesenteric ischemia usually develops into irreversible transmural intestinal necrosis (ITIN). Accurate diagnosis of ITIN is challenging because of its non-specific clinical manifestations. Currently, there is limited research on predicting ITIN using dual energy computed tomography (DECT). We use DECT objective parameters including iodine concentration and virtual monoenergetic imaging to quantify the degree of intestinal wall ischemia, and then evaluate their predictive performance for ITIN. The results demonstrated that DECT quantitative parameters can provide important information about whether ITIN occurs.