A scoring-system for angiographic findings in nonocclusive mesenteric ischemia (NOMI): correlation with clinical risk factors and its predictive value.
OBJECTIVE
This study was designed to evaluate the clinical value of a standardized angiographic scoring system in patients with nonocclusive mesenteric ischemia (NOMI).


METHODS
Sixty-three consecutive patients (mean age: 73 ± 8 years) with suspect of NOMI after cardiac or major thoracic vessel surgery underwent catheter angiography of the superior mesenteric artery. Images were assessed by two experienced radiologists on consensus basis using a scoring system consisting of five categories, namely vessel morphology, reflux of contrast medium into the aorta, contrasting and distension of the intestine, as well as the time to portal vein filling. These were correlated to previously published risk factors of NOMI and outcome data.


RESULTS
The most significant correlation was found between the vessel morphology and death (p < 0.001) as well as reflux of contrast medium into the aorta and death (p = 0.005). Significant correlation was found between delayed portal vein filling and preoperative statin administration (p = 0.011), previous stroke (p = 0.033), and renal insufficiency (p = 0.043). Reflux of contrast medium correlated significantly with serum lactate >10 mmol/L (p = 0.046). The overall angiographic score correlated with death (p = 0.017) and renal insufficiency (p = 0.02). The ROC-analysis revealed that a score of ≥3.5 allows for identifying patients with increased perioperative mortality with a sensitivity of 85.7 % and a specificity of 49 %. With the use of a simplified score (vessel morphology, reflux of contrast medium into the aorta, and time to portal vein filling), specificity was increased to 71.4 %.


CONCLUSIONS
The applied scoring system allows standardized interpretation of angiographic findings in NOMI patients. Beyond that the score seems to correlate well with risk factors of NOMI and outcome.
Department of Diagnostic and Interventional Radiology, University Hospital Saarland, Kirrberger Strasse, 66421, Homburg/Saar, Germany, peterminko@yahoo.com.
Peter
P
Minko
Jonas
J
Stroeder
Heinrich V
HV
Groesdonk
Stefan
S
Graeber
Matthias
M
Klingele
Arno
A
Buecker
Hans Joachim
HJ
Schäfers
Marcus
M
Katoh
D000368:Aged; D000792:Angiography / Q000379:methods*; D013504:Cardiovascular Surgical Procedures; D003287:Contrast Media; D005260:Female; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging*; D065666:Mesenteric Ischemia / Q000000981:diagnostic imaging* / Q000401:mortality; D011169:Portal Vein / Q000000981:diagnostic imaging; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity
D003287:Contrast Media