What affects the prognosis of NOMI patients? Analysis of clinical data and CT findings
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and Other Interventional Techniques
What affects the prognosis of NOMI patients? Analysis of clinical data and CT findings Ryo Miyazawa1 · Minobu Kamo1,2 Received: 20 April 2019 / Accepted: 6 December 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Background Non-occlusive mesenteric ischemia (NOMI) is a mesenteric ischemic disease with considerably high mortality rate, although little has been known about what factors affect the patients’ prognosis. The purpose of this study was to investigate prognostic factors of clinical data and computed tomography (CT) findings in patients with NOMI. Methods This was a single institutional, retrospective study, reviewing 21 consecutive patients diagnosed with NOMI on angiography. Patients were divided into either ‘‘survivor’’ group or ‘‘non-survivor’’ group based on their clinical courses 1 month after diagnosis. Clinical information such as laboratory data, Charlson Comorbidity Index, and time from CT to injecting vasodilator was obtained from patients’ medical records. Contrast-enhanced CT images were assessed in following items: defect of mural enhancement, pneumatosis intestinalis, hepatic portal venous gas, paralytic bowel dilatation, bowel wall thinning, and diameters of the relevant vessels. Results Eight patients belonged to ‘‘survivor’’ group, whereas eleven were allocated to ‘‘non-survivor’’ group. None of CT findings showed significant difference between survivor group and non-survivor group [defect of mural enhancement: 75% and 100% (p = 0.16), pneumatosis intestinalis: 50% and 45.5% (p = 1.00), hepatic portal venous gas: 37.5% and 45.5% (p = 1.00), paralytic bowel dilatation: 12.5% and 63.6% (p = 0.06), and bowel wall thinning: 50% and 45.5% (p = 1.00)]. The diameters of the relevant vessels did not have significant difference either. Time from CT to injecting vasodilator was revealed to be significantly shorter in survivor group [187.5 (122.5–294) min and 310 (187–925.5)] (p = 0.048). None of the other clinical information had significant difference between each group. Conclusion Prompt angiography may be a key to improve the prognosis of NOMI patients. Keywords Non-occlusive mesenteric ischemia · Acute mesenteric ischemia · Intra-arterial injection · Vasodilator agent · MDCT · Angiography Non-occlusive mesenteric ischemia (NOMI) was first described in 1958 by Ende et al. in patients with heart failure [1]. NOMI is thought to account for 5 to 15% of all causes of acute mesenteric ischemia [2] and is known as a life-threatening disease with considerably high mortality rate up to 90% [3]. Angiography has been long regarded as a gold standard of diagnosing NOMI [4]. On the other hand, contrast-enhanced computed tomography (CE-CT) is also * Ryo Miyazawa [email protected] 1
Department of Radiology, St. Luke’s International Hospital, 9‑1 Akashi‑cho, Chuo‑ku, Tokyo 104‑8560, Japan
Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinstrasse 51, 20251 Hamburg, Germa
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