Assessment of Bowel Wall Enhancement for the Diagnosis of Intestinal Ischemia in Patients with Small Bowel Obstruction: Value of Adding Unenhanced CT to Contrast-enhanced CT

被引:50
作者
Chuong, Anh Minh [1 ]
Corno, Lucie [1 ]
Beaussier, Helesne [2 ]
Boulay-Coletta, Isabelle [1 ]
Millet, Ingrid [3 ]
Hodel, Jerone [1 ,4 ,5 ]
Taourel, Patrice [3 ]
Chatellier, Gilles [2 ,6 ]
Zins, Marc [1 ]
机构
[1] Hop St Joseph, Dept Radiol, 185 Rue Raymond Losserand, F-75014 Paris, France
[2] Hop St Joseph, Clin Res Unit, 185 Rue Raymond Losserand, F-75014 Paris, France
[3] CHU Lapeyronie, Dept Med Imaging, Montpellier, France
[4] Hop Univ Henri Mondor, AP HP, Dept Neuroradiol, Creteil, France
[5] Univ Paris Est Creteil, Fac Med, Creteil, France
[6] Univ Paris 05, Hop Europeen Georges Pompidou, Clin Res Unit, Paris, France
关键词
DUAL-ENERGY CT; PERFORMANCE; ATTENUATION; AGREEMENT; ADHESIONS;
D O I
10.1148/radiol.2016151029
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Purpose: To determine whether adding unenhanced computed tomography (CT) to contrast material-enhanced CT improves the diagnostic performance of decreased bowel wall enhancement as a sign of ischemia complicating mechanical small bowel obstruction (SBO). Materials and Methods: This retrospective study was approved by the institutional review board, which waived the requirement for informed consent. Two gastrointestinal radiologists independently performed retrospective assessments of 164 unenhanced and contrast-enhanced CT studies from 158 consecutive patients (mean age, 71.2 years) with mechanical SBO. The reference standard was the intraoperative and/or histologic diagnosis (in 80 cases) or results from clinical follow-up in patients who did not undergo surgery (84 cases). Decreased bowel wall enhancement was evaluated with contrast-enhanced images then and both unenhanced and contrastenhanced images 1 month later. Diagnostic performance of decreased bowel wall enhancement and confidence in the diagnosis were compared between the two readings by using McNemar and Wilcoxon signed rank tests. Interobserver agreement was assessed by using k statistics and compared with bootstrapping. Results: Ischemia was diagnosed in 41 of 164 (25%) episodes of SBO. For both observers, adding unenhanced images improved decreased bowel wall enhancement sensitivity (observer 1: 46.3% [19 of 41] vs 65.8% [27 of 41], P = .02; observer 2: 56.1% [23 of 41] vs 63.4% [26 of 41], P = .45), Youden index (from 0.41 to 0.58 for observer 1 and from 0.42 to 0.61 for observer 2), and confidence score (P < .001 for both). Specificity significantly increased for observer 2 (84.5% [104 of 123] vs 94.3% [116 of 123], P = .002), and interobserver agreement significantly increased, from moderate (k = 0.48) to excellent (k = 0.89; P < .0001). Conclusion: Adding unenhanced CT to contrast-enhanced CT improved the sensitivity, diagnostic confidence, and interobserver agreement of the diagnosis of ischemia, a complication of mechanical SBO, on the basis of decreased bowel wall enhancement. (C) RSNA, 2016
引用
收藏
页码:98 / 107
页数:10
相关论文
共 28 条
  • [1] CLOSED-LOOP AND STRANGULATING INTESTINAL-OBSTRUCTION - CT-SIGNS
    BALTHAZAR, EJ
    BIRNBAUM, BA
    MEGIBOW, AJ
    GORDON, RB
    WHELAN, CA
    HULNICK, DH
    [J]. RADIOLOGY, 1992, 185 (03) : 769 - 775
  • [2] Intestinal ischemia in patients in whom small bowel obstruction is suspected: Evaluation of accuracy, limitations, and clinical implications of CT in diagnosis
    Balthazar, EJ
    Liebeskind, ME
    Macari, M
    [J]. RADIOLOGY, 1997, 205 (02) : 519 - 522
  • [3] Blake MA, 2011, RADIOGRAPHICS, V31, P1047, DOI 10.1148/rg.314105159
  • [4] Catel L, 2003, J RADIOL, V84, P27
  • [5] Ellis H, 1997, EUR J SURG, V163, P5
  • [6] Small bowel obstruction: A population-based appraisal
    Foster, Nova M.
    McGory, Marcia L.
    Zingmond, David S.
    Ko, Clifford Y.
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2006, 203 (02) : 170 - 176
  • [7] Detection of intestinal ischemia in patients with acute small-bowel obstruction due to adhesions or hernia: Efficacy of CT
    Frager, D
    Baer, JW
    Medwid, SW
    Rothpearl, A
    Bossart, P
    [J]. AMERICAN JOURNAL OF ROENTGENOLOGY, 1996, 166 (01) : 67 - 71
  • [8] CT diagnosis of small bowel obstruction: Scanning technique, interpretation and role in the diagnosis
    Furukawa, A
    Yamasaki, M
    Takahashi, M
    Nitta, N
    Tanaka, T
    Kanasaki, S
    Yokoyama, K
    Murata, K
    Sakamoto, T
    [J]. SEMINARS IN ULTRASOUND CT AND MRI, 2003, 24 (05) : 336 - 352
  • [9] Increased Unenhanced Bowel-Wall Attenuation at Multidetector CT Is Highly Specific of Ischemia Complicating Small-Bowel Obstruction
    Geffroy, Yann
    Boulay-Coletta, Isabelle
    Julles, Marie-Christine
    Nakache, Serge
    Taourel, Patrice
    Zins, Marc
    [J]. RADIOLOGY, 2014, 270 (01) : 159 - 167
  • [10] Differentiation of simple and strangulated small-bowel obstructions: Usefulness of known CT criteria
    Ha, HK
    Kim, JS
    Lee, MS
    Lee, HJ
    Jeong, YK
    Kim, PN
    Lee, MG
    Kim, KW
    Kim, MY
    Auh, YH
    [J]. RADIOLOGY, 1997, 204 (02) : 507 - 512