The Correlation Between CT Features And The Prognosis Of Acute Superior Mesenteric Artery Occlusion

Objective:To explore the correlation between CT features of vessels,intestinal wall and other organs in superior mesenteric artery(SMA)occlusion and intestinal necrosis and prognosis of patients,in order to improve the diagnosis and treatment level,survival rate and quality of life in patients with SMA occlusion.Materials and Methods:The image data and clinical data of patients diagnosed as SMA occlusion by contrast enhanced CT and/or mesenteric vascular CTA from January 2014 to June 2018 were retrospectively analyzed.According to the survival status of patients,patients were divided into survival group and death group.According to the histopathology after operation,the patients were divided into intestinal necrosis group and non-intestinal necrosis group.Gender,age and CT features of each group were recorded.The correlation between CT imaging features and intestinal necrosis and prognosis was analyzed by Chi-square test and Fisher exact test.The sensitivity,specificity,negative predictive value(NPV),positive predictive value(PPV)and accuracy of CT features in predicting intestinal necrosis and prognosis were calculated.Result:A total of 48 patients were enrolled in this study,with an average age of 68.9 ± 10.3 years,including 26 males(average age: 66.5 ± 12.0 years;range: 38-87 years),22 females(average age: 71.7 ± 7.1 years;range: 54-83 years),and there was a significant difference between the two groups(P < 0.05).Surgical pathology confirmed 19 cases of intestinal necrosis,with an average age of 68.7± 9.0 years,and 29 cases of non-intestinal necrosis,with an average age of 69.0 ± 1.2 years.There was no significant difference between the two groups(P < 0.05).There were 10 dead patients,with an average age of 70.1 ± 8.0 years,and 38 survivors,with an average age of 68.6 ± 10.9 years.There was no significant difference between the two groups(P < 0.05).In the 12 CT signs of SMA trunk occlusion,SMA branch occlusion,SMA trunk + branch occlusion,intestinal wall enhancement reduction,intestinal dilatation,intestinal wall thickening,pneumatosis intestinalis,intestinal wall thinning,mesenteric fat stranding,ascites,involvement of colon,other organ infarction,SMA trunk + branch occlusion,intestinal dilatation,pneumatosis intestinalis,intestinal wall thinning,ascites,and involvement of colon were correlated with intestinal necrosis.The sensitivity,specificity,PPV,NPV and accuracy for predicting bowel necrosis were 61.1%,73.3%,57.9%,75.9% and 68.9%,51.7%,62.1%,78.9%,81.8% and 68.8%,90%,73.7%,47.4%,96.6% and 77.1%,75%,92.3%,78.9%,82.8% and 81.2%,60.7%,90%,89.5%,62.1% and 72.9%,80%,78.8%,63.2%,89.7% and 79.2%,respectively.SMA branch occlusion,SMA trunk + branch occlusion,pneumatosis intestinalis,intestinal wall thinning,ascites,and involvement of colon were correlated with patient mortality.The sensitivity,specificity,PPV,NPV and accuracy for predicting bowel necrosis were were 29.4%,100%,100%,36.8% and 50%,40%,66.7%,80%,92.3% and 66.7%,70%,92.1%,70%,92.1% and 87.5%,40%,92.8%,80%,68.4% and 70.8%,35.7%,52.6%,100%,100% and 62.5%;53.3%,81.6%,80%,93.9% and 81.3%,respectively.Conclusion:The CT manifestations of SMA occlusion have certain characteristics,which can predict the necrosis of intestinal canal and judge the prognosis of patients to a certain extent.