Diagnostic value of dual-energy computed tomography in irreversible transmural intestinal necrosis in patients with acute occlusive mesenteric ischemia

Table 1 Clinical characteristics of included patients, n (%)

	All cohort (n = 102)	Non-ITIN (n = 54)	ITIN (n = 48)	t/χ2	P value
Age, years	70.00 ± 13.33	66.50 ± 13.72	73.94 ± 11.82	-2.914	0.004
Sex, male	54 (52.9)	32 (59.3)	22 (45.8)	1.839	0.175
Complication
Hypertension	50 (49.0)	27 (50.0)	23 (47.9)	0.044	0.834
Diabetes	16 (15.7)	9 (16.7)	7 (14.6)	0.083	0.773
Heart disease	51 (50.0)	25 (46.3)	26 (54.2)	0.630	0.427
History of cerebrovascular disease	16 (15.7)	8 (14.8)	8 (16.7)	0.066	0.797
Scanning mode				0.123	0.725
DECT	47 (46.1)	24 (44.4)	23 (47.9)
Conventional MDCT	55 (53.9)	30 (55.6)	25 (52.1)
Vascular involvement				3.970	0.137
SMA	62 (60.8)	33 (61.1)	29 (60.4)
SMV	29 (28.4)	18 (33.3)	11 (22.9)
SMA + SMV	11 (10.8)	3 (5.6)	8 (16.7)

ITIN: Irreversible transmural intestinal necrosis; DECT: Dual-energy computed tomography; MDCT: Multidetector computed tomography; SMA: Superior mesenteric artery; SMV: Superior mesenteric vein.

Table 2 The consistency of subjective computed tomography signs between radiologists A and B

CT signs	Kappa (95%CI)	P value
Intestinal wall thickening	0.781 (0.646, 0.898)	< 0.001
Reduced or absent bowel wall enhancement	0.739 (0. 601, 0.866)	< 0.001
Intestinal wall enhancement	0.370 (0.023, 0.764)	< 0.001
High density of the intestinal wall	0.593 (0.297, 0.889)	< 0.001
Bowel dilation	0.800 (0.672, 0.902)	< 0.001
Swelling and exudation in the mesentery	0.859 (0.759, 0.959)	< 0.001
Seroperitoneum	0.902 (0.818, 0.986)	< 0.001
Parenchymatous organ infarction	0.960 (0.896, 1.000)	< 0.001

CT: Computed tomography; CI: Confidence interval.

Table 3 Comparison of computed tomography subjective parameters between irreversible transmural intestinal necrosis and non-irreversible transmural intestinal necrosis groups, n (%)

CT signs	Total	ITIN	Non-ITIN	χ2	P value
Vascular CT sign	62	29	33
SMA stenosis/occlusion involved range				3.267	0.195
≤ 20 mm	8 (12.9)	2 (6.9)	6 (18.2)
20-50 mm	16 (25.8)	6 (20.7)	10 (30.3)
≥ 50 mm	38 (61.3)	21 (72.4)	17 (51.5)
SMA narrow/blocked area				9.939	0.148
I	5 (8.1)	2 (6.9)	3 (9.1)
II	0 (0)	0 (0)	0 (0)
III	2 (3.2)	0 (0)	2 (6.1)
IV	8 (12.9)	1 (3.4)	7 (21.2)
I + II	1 (1.6)	0 (0)	1 (3.0)
III + IV	24 (38.7)	14 (48.3)	10 (30.3)
I + II + III	4 (6.5)	1 (3.4)	3 (9.1)
II + III + IV	11 (17.7)	6 (20.7)	5 (15.2)
I + II + III + IV	7 (11.3)	5 (17.2)	2 (6.1)
Intestinal wall CT sign	102	48	54
Intestinal wall thickening	62 (60.8)	32 (66.7)	30 (55.6)	1.949	0.163
Reduced or absent bowel wall enhancement	74 (72.5)	43 (89.6)	31 (57.4)	4.543	0.033
Intestinal wall enhancement	4 (3.9)	0 (0)	4 (7.4)		0.122
High density of the intestinal wall	8 (7.8)	4 (8.3)	4 (7.4)	< 0.001	1
Bowel dilation	47 (46.1)	34 (70.8)	13 (24.1)	24.095	< 0.001
Parenteral CT sign
Swelling and exudation in the mesentery	61 (59.8)	30 (62.5)	31 (57.4)	0.588	0.443
Seroperitoneum	47 (46.1)	24 (50.0)	23 (42.6)	0.872	0.350
Parenchymatous organ infarction	45 (44.1)	27 (56.3)	18 (33.3)	5.413	0.020

The sample size of superior mesenteric artery stenosis/occlusion was 62 cases. ITIN: Irreversible transmural intestinal necrosis; CT: Computed tomography; SMA: Superior mesenteric artery.

Table 4 Binary logistic regression analysis of factor influencing irreversible transmural intestinal necrosis in computed tomography subjective signs

CT signs	B value	Wald value	O1	95%CI	P value
Reduced or absent bowel wall enhancement	1.718	6.903	5.576	1.547-20.093	0.009
Bowel dilation	2.452	18.420	11.613	3.790-35.586	< 0.001
Parenchymatous organ infarction	1.553	7.332	4.727	1.536-14.551	0.007

¹Patient age as a correction factor.

CT: Computed tomography; CI: Confidence interval.

Table 5 Efficacy of computed tomography subjective signs to predict Irreversible transmural intestinal necrosis

CT signs	AUC (95%CI)	P value	Sensitivity (95%CI)	Specificity (95%CI)
Reduced or absent bowel wall enhancement	0.681 (0.581-0.769)	0.002	91.67 (80.0-97.7)	44.44 (30.9-58.6)
Bowel dilation	0.753 (0.658-0.833)	< 0.001	72.92 (58.2-84.7)	77.78 (64.4-88.0)
Parenchymatous organ infarction	0.615 (0.513-0.709)	0.046	56.26 (41.2-70.5)	66.67 (52.5-78.9)
Combination signs	0.853 (0.769-0.915)	< 0.001	93.75 (82.8-98.7)	64.81 (50.6-77.3)

The difference between the two groups marked with the same letter is not statistically significant, and the difference between the two groups marked with different letters is statistically significant. CT: Computed tomography; CI: Confidence interval; AUC: Area under the curve.

Table 6 Comparison of the efficacy of dual energy computed tomography objective indicators and computed tomography subjective signs in predicting Irreversible transmural intestinal necrosis

CT parameters	AUC (95%CI)	P value	Sensitivity (95%CI)	Specificity (95%CI)
CT50 KeV normal/lesion	0.794 (0.615-0.916)	0.005	56.52 (34.5-76.8)	87.50 (67.6-97.3)
ICnormal/lesion	0.777 (0.596-0.904)	0.001	73.91 (51.6-89.8)	79.17 (57.8-92.9)
Combined subjective signs	0.801 (0.622-0.920)	0.006	80.95 (58.1-94.6)	72.73 (39.0-94.0)
CT50 KeV normal/lesion combined with intestinal dilatation and parenchymatous organ infarction	0.857 (0.688-0.955)	0.001	95.65 (78.1-99.9)	79.17 (57.8-92.9)
ICnormal/lesion combined with intestinal dilatation and parenchymatous organ infarction	0.894 (0.737-0.976)	< 0.001	100 (85.2-100)	70.83 (49.8-87.4)

The difference between the two groups marked with the same letter is not statistically significant, and the difference between the two groups marked with different letters is statistically significant. CT: Computed tomography; IC: Iodine concentration; CI: Confidence interval; AUC: Area under the curve.