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

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 (CT, CT) and iodine concentrations (IC and IC), 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 CT = 2.81, and an AUC of 0.777 with a cut-off value of IC = 2.39. The Delong test showed that there was no significant difference in the efficacy of subjective CT signs and objective DECT parameters ( > 0.05). Importantly, we observed that IC 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 ( = 0.017).

Conclusion: IC (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.