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Updated: Oct 29, 2025
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Relationship of superior mesenteric artery thrombus density with transmural intestinal necrosis on multidetector
Wei Tang1,2, Jing Zhang1, Lian-Qin Kuang1
1Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China.
Background:
Acute arterial occlusive mesenteric ischemia with transmural intestinal necrosis (TIN) is a fatal disease, which is difficult to diagnose on multidetector computed tomography (MDCT). The aim of the present study was to determine the relationship of superior mesenteric artery (SMA) thrombus density with TIN on MDCT in patients with acute mesenteric ischemia (AMI) due to SMA thromboembolism.
Methods:
In this retrospective study, 33 patients who underwent abdominal MDCT and angiography for AMI due to SMA thromboembolism were divided into two groups: the AMI with TIN group and the AMI without TIN group. We analyzed the relationships of clinical characteristics, qualitative MDCT signs, and SMA thrombus density with TIN. The SMA thrombus density was measured on non-contrast MDCT. Univariate and multivariate analyses were performed to determine the risk factors for predicting TIN. The diagnostic performances of risk factors were evaluated by receiver-operating characteristic (ROC) curve analysis.
Results:
Of the patients with AMI enrolled in this study, 33.3% (11/33) were diagnosed with TIN. Peritonitis (P=0.042), bowel wall thinning (P=0.033), and pneumatosis/portomesenteric gas (P=0.010) were significantly associated with TIN. AMI patients with TIN exhibited a higher SMA thrombus density than AMI patients without TIN [41.2±6.1 vs. 34.2±3.0 Hounsfield unit (HU), P=0.003]. Multivariate analysis showed that SMA thrombus density was an independent predictor of TIN [P=0.044, hazard ratio (HR): 1.82, 95% confidence interval (CI): 1.02-3.25]. For diagnosing AMI with TIN, the area under the ROC curve (AUC) of SMA thrombus density (0.83) was larger than those of peritonitis (0.68), bowel wall thinning (0.66), and pneumatosis/portomesenteric gas (0.71).
Conclusions:
In patients with AMI, erythrocyte-rich thrombus blocking the SMA trunk which has a higher density on MDCT is prone to the occurrence of TIN compared with erythrocyte-scarce thrombus with a lower density. SMA thrombus density could be an independent risk factor for TIN in patients with AMI due to SMA thromboembolism.
Insights
Higher superior mesenteric artery thrombus density on multidetector computed tomography (MDCT) predicts transmural intestinal necrosis (TIN) in acute mesenteric ischemia (AMI). This finding aids in diagnosing this fatal condition.
Area of Science:
- Radiology
- Gastroenterology
- Vascular Surgery
Background:
- Acute arterial occlusive mesenteric ischemia with transmural intestinal necrosis (TIN) is a critical condition with diagnostic challenges on multidetector computed tomography (MDCT).
- Superior mesenteric artery (SMA) thromboembolism is a common cause of acute mesenteric ischemia (AMI).
Purpose of the Study:
- To investigate the correlation between SMA thrombus density measured by MDCT and the presence of TIN in patients with AMI due to SMA thromboembolism.
- To identify SMA thrombus density as a potential predictor for TIN in AMI.
Main Methods:
- Retrospective analysis of 33 patients with AMI due to SMA thromboembolism who underwent MDCT and angiography.
- Patients were categorized into AMI with TIN and AMI without TIN groups.
- SMA thrombus density was measured on non-contrast MDCT; univariate, multivariate, and ROC curve analyses were performed to assess risk factors and diagnostic performance.
Main Results:
- 11 out of 33 patients (33.3%) were diagnosed with TIN.
- Higher SMA thrombus density was observed in the AMI with TIN group (41.2±6.1 HU) compared to the AMI without TIN group (34.2±3.0 HU) (P=0.003).
- SMA thrombus density independently predicted TIN (P=0.044) with a higher area under the ROC curve (0.83) compared to other clinical signs.
Conclusions:
- Increased SMA thrombus density on MDCT, indicative of erythrocyte-rich thrombus, is associated with a higher likelihood of TIN in AMI patients.
- SMA thrombus density serves as a valuable independent risk factor for predicting TIN in acute mesenteric ischemia caused by SMA thromboembolism.
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