title: Pneumatosis and portal venous gas: do CT findings reassure?
abstract: BACKGROUND
  Small, single-institution studies have suggested risk factors for bowel ischemia/necrosis (I/N) in patients with computed tomography (CT) findings of pneumatosis (PN) and portal venous gas (PVG). Here, analysis has been expanded in a large, multicenter study.
  
  
  METHODS
  Logistic regression models and receiver operating characteristic curves were used to construct a scoring system for I/N in cases of PN/PVG.
  
  
  RESULTS
  Of 265 patients with PN/PVG identified, 209 had adequate data. In unadjusted analyses the following variables were significantly associated with I/N: age, peritoneal signs, ascites, the presence of both PVG and PN, blood urea nitrogen (BUN), CO2, albumin, and a history of hypertension, myocardial infarction, or stroke. In contrast, the CT findings of mesenteric stranding, bowel-wall thickening, and type of PN were not associated with I/N. In adjusted analyses, three variables were significantly associated with I/N: age ≥60 y (odds ratio = 2.51, 95% confidence interval: 1.26-4.97), peritoneal signs (10.58, 4.23-26.4), and BUN >25 mg/dL (3.08, 1.54-6.17), whereas presence of both PN and PVG (versus only one) was associated with an increase (but not statistically significant increase) in odds (2.01, 0.94-4.36). Although several ad hoc models were used to maximize diagnostic ability, with maximal odds ratio = 174, the areas of receiver operating characteristic curves were all below 0.80, revealing suboptimal accuracy to diagnose I/N.
  
  
  CONCLUSIONS
  Older age, peritoneal signs, and high BUN are associated with I/N, suggesting an ability to predict which patients need operation. CT findings traditionally suggestive of ischemic PN/PVG, however, do not diagnose I/N accurately enough to reliably identify patients needing operation.
authors.affiliation: Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland.
authors.forename: Murad
authors.initials: M
authors.lastname: Bani Hani
authors.forename: Farin
authors.initials: F
authors.lastname: Kamangar
authors.forename: Sarah
authors.initials: S
authors.lastname: Goldberg
authors.forename: Jose
authors.initials: J
authors.lastname: Greenspon
authors.forename: Priti
authors.initials: P
authors.lastname: Shah
authors.forename: Carmine
authors.initials: C
authors.lastname: Volpe
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Turner
authors.forename: Karen
authors.initials: K
authors.lastname: Horton
authors.forename: Elliot K
authors.initials: EK
authors.lastname: Fishman
authors.forename: Isaac R
authors.initials: IR
authors.lastname: Francis
authors.forename: Barry
authors.initials: B
authors.lastname: Daly
authors.forename: Steven C
authors.initials: SC
authors.lastname: Cunningham
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D018579:Patient Selection; D011006:Pneumatosis Cystoides Intestinalis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D011169:Portal Vein / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
keywords: CT; Computed tomography; Intestine; Ischemia; Necrosis; Pneumatosis; Portal venous gas; Scoring system