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Open Access 25-03-2024 | Visceral Ischemia | Hollow Organ GI

Portal venous contrast enhancement ratio of the adrenal glands and spleen as prognostic marker of mortality in patients with acute mesenteric ischemia

Authors: Felix Pfister, Matthias Mehdorn, Christoph Schwartner, Daniel Seehofer, Hans-Michael Tautenhahn, Manuel Florian Struck, Timm Denecke, Hans-Jonas Meyer

Published in: Abdominal Radiology | Issue 5/2024

Abstract

Purpose

Contrast enhancement of the adrenal gland defined by computed tomography (CT) was previously analyzed as a prognostic factor for critically ill patients in various diseases. However, no study investigated this quantitative parameter in patients with acute mesenteric ischemia. Therefore, the aim of this study was to evaluate the prognostic value of the contrast enhancement of the adrenal glands in patients with clinically suspected AMI.

Methods

All patients with clinically suspected AMI were retrospectively assessed between 2016 and 2020. All patients underwent surgical exploration after CT imaging. Overall, 134 patients (52 female patients, 38.8%) with a mean age of 69.2 ± 12.4 years were included into the present analysis. For all patients, the preoperative CT was used to calculate the contrast media enhancement of the adrenal glands and the spleen.

Results

A total of 27 patients (18.5%) died within the first 24 h and over the following 30-day 94 patients (68.6%) died. There were statistically significant differences regarding the mean values for adrenal-to-spleen ratio for 24-h mortality (p = 0.001) and 30-day mortality (p = 0.004), whereas the radiodensity of the inferior vena cava and the radiodensity of the spleen was statistically significant between survivors and non-survivors after 30 days (p = 0.037 and p = 0.028, respectively). In Cox regression analysis, mean adrenal radiodensity was associated with 24-h mortality (HR 1.09, 95% CI 1.02–1.16, p = 0.01) but not with 30-day mortality (HR 1.03, 95% CI 0.99–1.07, p = 0.13).

Conclusion

The contrast media enhancement of the adrenal gland is associated with the 24-h and 30-day mortality in patients with AMI. However, the prognostic relevance for translation into clinical routine needs to be validated in other cohorts.

Graphical abstract

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Title: Portal venous contrast enhancement ratio of the adrenal glands and spleen as prognostic marker of mortality in patients with acute mesenteric ischemia
Authors: Felix Pfister
Matthias Mehdorn
Christoph Schwartner
Daniel Seehofer
Hans-Michael Tautenhahn
Manuel Florian Struck
Timm Denecke
Hans-Jonas Meyer
Publication date: 25-03-2024
Publisher: Springer US
Keywords: Visceral Ischemia
Computed Tomography
Computed Tomography
Published in: Abdominal Radiology / Issue 5/2024
Print ISSN: 2366-004X
Electronic ISSN: 2366-0058
DOI: https://doi.org/10.1007/s00261-024-04247-2

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