Objective:

To evaluate predefined CT findings, AMI subtype, treatment pathways, intraoperative infarction or necrosis, and mortality in patients with CT-confirmed acute mesenteric ischemia (AMI).

Approach:

• Study Design: A retrospective single-center cohort study including 102 adult patients with CT-confirmed AMI.
• Classification: Patients were classified by AMI subtype: arterial occlusive AMI, venous AMI, non-occlusive mesenteric ischemia (NOMI), or secondary/mechanical ischemia.
• CT Findings Analysis: Eight predefined CT findings were analyzed, and their associations with intraoperative infarction or necrosis were evaluated.
• Endpoints: Primary endpoint was intraoperative evidence of bowel infarction or necrosis; secondary endpoints included in-hospital and 30-day mortality.

Key Findings:

• Arterial occlusive AMI was the most common subtype (57.8%).
• In-hospital mortality was 41.2%, and 30-day mortality was 46.5%.
• Intraoperative infarction or necrosis was present in 81.5% of assessable patients.
• No individual CT finding showed strong standalone discriminatory performance for intraoperative infarction or necrosis.
• Pneumatosis intestinalis showed the strongest descriptive performance for the primary endpoint (OR: 2.72, 95% CI: 0.76–9.80; p = 0.188; AUC 0.62).

Interpretation:

CT findings were clinically meaningful but had limited standalone discriminatory performance for surgically confirmed infarction or necrosis. Pneumatosis showed an exploratory association with 30-day mortality.

Limitations:

• The study was conducted at a single center, which may limit generalizability to broader populations.

Conclusion:

CT remains essential for diagnosis, subtype classification, and treatment planning in AMI, but findings should not be used as a validated triage or prognostic tool.