Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 6, 2022; 10(13): 4020-4032
Published online May 6, 2022. doi: 10.12998/wjcc.v10.i13.4020
Role of clinical data and multidetector computed tomography findings in acute superior mesenteric artery embolism
Ju-Shun Yang, Zhen-Yu Xu, Fei-Xiang Chen, Mei-Rong Wang, Ruo-Chen Cong, Xiao-Le Fan, Bo-Sheng He, Wei Xing
Ju-Shun Yang, Wei Xing, Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, Jiangsu Province, China
Ju-Shun Yang, Fei-Xiang Chen, Mei-Rong Wang, Ruo-Chen Cong, 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, He BS and Xing W 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, Fan XL and Cong RC prepared the figures and tables; He BS and Xing W were responsible for revising manuscript. All authors have read and approved the final manuscript.
Supported by The "333" Talent Funding Project of Jiangsu Province, No. BRA2020198; Nantong City Social Development Project-Standardized Diagnosis and Treatment of Key Diseases No. HS2019002; and The Youth Project of Nantong City Health Committee, No. QA2019006 and QA2020002.
Institutional review board statement: The study was approved by the ethics committee of the Second Affiliated Hospital of Nantong University. Since this study is a retrospective study.
Informed consent statement: No informed consent was needed.
Conflict-of-interest statement: No financial or nonfinancial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.
Data sharing statement: All data generated or analyzed during this study are available from the corresponding author Wei Xing upon reasonable request.
STROBE statement: The authors have read the STROBE Statement checklist of items, and the manuscript was prepared and revised according to the STROBE Statement checklist of items.
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: Wei Xing, MD, Doctor, Department of Radiology, The Third Affiliated Hospital of Soochow University, No. 185 Juqian Street, Tianning District, Changzhou 213003, Jiangsu Province, China. suzhxingwei@suda.edu.cn
Received: November 2, 2021
Peer-review started: November 2, 2021
First decision: February 14, 2022
Revised: February 25, 2022
Accepted: March 16, 2022
Article in press: March 16, 2022
Published online: May 6, 2022
Processing time: 178 Days and 18.7 Hours
ARTICLE HIGHLIGHTS
Research background

Superior mesenteric artery embolism (SMAE) has acute onset and fast progression, which seriously threatens the life of patients. The early diagnosis of SMAE is related to the patients’ recovery. However, to date, there are serious challenges in the early diagnosis of SMAE, and clinical suspicion is the key to diagnosis. MDCT is one of the most important diagnostic methods for SMAE, which plays an important role in the diagnosis and prognosis of SMAE.

Research motivation

Superior mesenteric artery (SMA) in peripheral vessels or small-scale emboli is easy to be missed, leading to irreversible intestinal necrosis, which affects the prognosis of patients. High clinical suspicion and some extra-vascular computed tomography (CT) signs are helpful for the diagnosis of SMAE. Currently, few studies have combined clinical, biochemical and MDCT to predict the risk of irreversible intestinal necrosis and death in SMAE at early stages.

Research objectives

The purpose of this study is to evaluate the value of combining clinical data and MDCT in the diagnosis of SMAE and to predict the risk factors for death.

Research methods

We retrospectively analyzed the clinical and MDCT data of 53 patients with SMAE confirmed by digital subtraction angiography. We analyzed the impact of a high clinical suspicion on the radiologist's diagnosis of SAME on MDCT. The patients were divided into two groups: the death and survival groups. Univariate cox regression and multivariate cox model adjusted for confounding factors were used to analyze the association trend of mortality risk with clinical and CT signs in SMAE patients.

Research results

Under the premise of high clinical suspicion of SMAE, the radiologist was able to more accurately diagnose emboli with lengths ≤ 20 mm(P = 0.014) and in areas III and IV (P = 0.024). Univariate cox regression and multivariate cox model analysis adjusted for confounding factors determined that blood lactate > 2.1 mmol/L (HR, 5.26, 95%CI: 1.04-26.69, P = 0.045) and intestinal wall thinning (HR, 9.40, 95%CI: 1.05-83.46, P = 0.044) were consistently significantly associated with mortality in SAME patients.

Research conclusions

Increased blood lactate and intestinal wall thinning are risk factors for death in patients with SMAE. Meaningful clinical cues combined with MDCT can significantly improve the accuracy of radiologists in diagnosing SMAE with the length ≤ 20 mm and embolism in regions III and IV.

Research perspectives

With clinical suspicion of SMAE, a multiphase enhanced CT should be performed immediately to observe the SMA trunk and peripheral vessels, as well as extravascular MDCT. Intestinal wall thinning and increased blood lactate levels might be effective predictors for death in patients with SMAE, although further validation in large sample, prospective and multicenter studies is needed. With the advent of dual-energy CT, new post-processing techniques (Iodine mapping, virtual monoenergetic imaging) may provide important information on SMA peripheral small vessel embolization and whether intestinal wall is enhanced.