This prospective single-center study investigated whether bowel-wall iodine concentration measured with dual-energy CT (DECT) could improve the diagnosis and severity assessment of non-occlusive mesenteric ischemia (NOMI). The study included 177 patients with circulatory shock who underwent DECT, of whom 31 were diagnosed with NOMI and 23 had irreversible transmural necrosis (ITN).
The visual absence of bowel-wall enhancement on 50-keV virtual monoenergetic images showed the highest diagnostic accuracy for NOMI and outperformed quantitative iodine concentration measurements. However, conventional binary CT findings were unable to distinguish ITN from potentially reversible ischemic injury.
In contrast, the minimum bowel-wall iodine concentration was significantly lower in patients with irreversible necrosis and showed good diagnostic performance, with an area under the curve of 0.86 and an optimal threshold of 0.52 mgI/mL.
Overall, although bowel-wall iodine concentration failed to improve the detection of NOMI compared with visual assessment, it did provide valuable quantitative information for identifying ITN.