Non-occlusive mesenteric ischemia: CT features and their prognostic values

purpose: Non-occlusive mesenteric ischemia (NOMI) is the most lethal form of acute mesenteric ischemia (58-70%) because of the poor understanding of its pathophysiology, its mild and nonspecific symptoms and signs at imaging, which often delay the diagnosis. The purpose of our work has been to evaluate CT appearances in 16 patients with NOMI, to recognize their CT characteristic features and their prognostic values. material and methods: Twenty-two abdominal CT examinations of 16 patients (14 males and 2 females, mean age of 73 years, range 49-88) with a confirmed diagnosis of NOMI were retrospectively reviewed , randomly and individually by two radiologists (with 9 and 3 years’ experience in abdominal imaging, respectively) to evaluate mesenteric findings (mesenteric vessel caliber: normal, increased, reduced; fat stranding; fluid; pneumatosis), vessel features (diameter of superior mesenteric artery, superior mesenteric vein and inferior vena cava), loop findings (thickness and degree of attenuation of bowel wall; content: gasless or dilated; pneumatosis of bowel wall) and findings of peritoneal cavity (fluid and air). results: Global mortality was 50% (8/16 patients). The reduction of caliber of mesenteric vessels and the paper thin appearance of bowel walls were significantly associated with higher mortality (p = 0.05 and p = 0.084, respectively). Conclusion: Considering its characteristic features, the CT evaluation of patients with a clinical suspicion of NOMI could be useful to provide possible prognostic information.