Randomized trial demonstrates moderate accuracy of a CT scoring tool for identifying irreversible bowel injury in acute mesenteric ischemia, suggesting the need for external validation.
Key Points
To evaluate whether bowel-related CT signs can reliably identify irreversible bowel injury in acute mesenteric ischemia and to establish a standardized radiological severity score.
Multicenter ancillary trial analysis involving 157 patients with suspected or confirmed acute mesenteric ischemia across 11 international sites (NCT06445660).
Two independent radiologists blinded to clinical outcomes retrospectively assessed predefined bowel-related CT features to construct predictive regression models for transmural necrosis.
The scoring model designated high risk based on decreased or absent bowel wall enhancement, pneumatosis intestinalis (2 points each), bowel dilatation, portal or mesenteric venous gas, or paper-thin bowel wall (1 point each).
Using a threshold of ≥ 2 points, the score correctly identified irreversible damage in 62 of 80 patients, achieving an overall accuracy of 70%.
Among false-negative results (n = 18), the interval between CT imaging and confirmed necrosis exceeded 6 hours in the majority of cases.