单独使用计算机断层扫描能诊断肠梗阻吗?

IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING World journal of radiology Pub Date : 2023-10-28 DOI:10.4329/wjr.v15.i10.281
Ozlem Kadirhan, Volkan Kızılgoz, Sonay Aydin, Esra Bilici, Ekrem Bayat, Mecit Kantarci
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引用次数: 0

摘要

背景:肠梗阻是一种腹部病理状况,表现为医学紧急情况。它的特点是潜在的并发症,如穿孔和缺血,如果不及时处理,可导致显著的发病率和死亡率。肠梗阻的成功治疗在很大程度上依赖于病情的及时和准确的识别。虽然常规x线摄影(CR)通常被用作主要诊断工具,但其识别阻塞的准确率在46%至80%之间。此外,通过CR识别肠梗阻的位置和病因的诊断准确性有限,因此计算机断层扫描(CT)是这方面的理想成像方式。目的:结合观察者的经验,探讨急性肠梗阻(BO)在腹部CT场景图上是否存在,以及判断其可能位置的准确性。方法:对2021年1月至2022年1月期间因严重腹痛就诊于急诊科并随后监测疑似肠梗阻的46例患者进行回顾性筛查。这些患者的腹部CT扫描由三名具有不同经验水平(1年、3年和10年)的放射科医生在不同的时间间隔(间隔1个月)进行评估。评估的重点是确定BO的存在与否,以及确定梗阻的潜在位置(小肠或大肠)。本研究采用Kappa统计评估观察者间方差,采用McNamer检验评估观察间的阻塞和分割差异。以P < 0.05为差异有统计学意义。结果:在46例患者的总样本量中,女性15例(32.6%),男性31例(67.4%)。42例(91.3%)最终诊断为机械性梗阻(MO)引起的肠梗阻。其中14例(33%)发生大肠梗阻,28例(66%)发生小肠梗阻。初步评估结果显示,三名观察者对BO的敏感度分别为76.19%、83.31%和83.33%,诊断准确率分别为69.56%、76.08%和80.43%。初步研究发现,三名观察者对MO致肠梗阻的平均敏感度为80.94%,诊断准确率为75.35%。在第一次评价的基础上,根据最终诊断,高级观察员在准确估计厚分割和薄分割时灵敏度最高(85.71%),阴性预测值最高(92.60%),诊断准确率最高(80.43%)。在第二次评估中,在识别肠梗阻的敏感性上,以及在LB或SB内节段水平的精确测定上,比较第二和第三个观察者时,没有观察到统计学上的显著差异。然而,虽然第一观察者对肠梗阻的检出率没有统计学意义上的变化,但段估计的准确率明显上升(73.91%)。与其他评估者相比,高级评估者在评估肠梗阻和分割是否存在方面具有更高的准确性。结论:我们的研究结果表明,腹部CT扫描在诊断急性MO的敏感性和准确率与CR相似或更高。此外,研究表明,经验丰富的放射科医生比经验不足的放射科医生更有可能准确预测MO的存在和潜在定位。
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Does the use of computed tomography scenogram alone enable diagnosis in cases of bowel obstruction?

Background: Ileus is a pathological condition of the abdomen that presents as a medical emergency. It is characterized by potential complications such as perforation and ischemia, which can lead to significant morbidity and mortality if not promptly addressed. The successful management of ileus relies heavily on the timely and precise identification of the condition. While conventional radiography (CR) is commonly used as the primary diagnostic tool, its accuracy in identifying obstructions ranges from 46% to 80%. Furthermore, the diagnostic accuracy of identifying the location and etiology of intestinal obstruction by CR is limited, therefore making computed tomography (CT) the ideal imaging modality in this regard.

Aim: To determine the presence of acute bowel obstruction (BO) on abdominal CT scenogram images and the accuracy of determining its possible location, taking into account the experience of the observers.

Methods: A retrospective screening was conducted on an ensemble of 46 individuals who presented to the emergency department between January 2021 and January 2022 with severe abdominal pain and were subsequently monitored for suspected ileus. The abdominal CT scans of these patients were assessed by three radiologists with varying levels of experience (1, 3, and 10 years) at different intervals (1 mo apart). The evaluation focused on determining the presence or absence of BO, as well as identifying the potential location of the obstruction (small bowel or large bowel). The study employed Kappa statistics to assess inter-observer variances, while the McNamer test was used to evaluate obstruction and segmentation discrepancies between observations. A significance level of P < 0.05 was determined to indicate statistical significance.

Results: Out of the total sample size of 46 patients, 15 individuals (32.6%) were identified as female, while the remaining 31 individuals (67.4%) were identified as male. The ultimate diagnosis of 42 instances (91.3%) indicated ileus resulting from mechanical obstruction (MO). Among these patients, 14 (33%) experienced obstruction in the large bowel (LB), while 28 (66%) experienced obstruction in the small bowel (SB). The initial evaluation yielded sensitivity rates of 76.19%, 83.31%, and 83.33%, and diagnostic accuracy rates of 69.56%, 76.08%, and 80.43% for the detection of BO among the three observers. The initial study revealed that the average sensitivity of three observers in detecting the presence of ileus caused by MO was 80.94%, while the diagnostic accuracy was 75.35%. Based on the first evaluation, the senior observer demonstrated the highest sensitivity (85.71%), negative predictive value (92.60%), and diagnostic accuracy (80.43%) when accurately estimating the thick and thin segmentation, as per the final diagnosis. There was no statistically significant disparity observed in the sensitivities pertaining to the identification of ileus during the second assessment, as well as the precise determination of the segment level inside the LB or SB, when comparing the second and third observers. Nevertheless, although there was no statistically significant alteration in the detection rate of ileus by the first observer, there was a notable rise in the accuracy rate of segment estimating (73.91%). The senior assessor had a higher level of accuracy in assessing the existence of ileus and segmentation compared to the other evaluators in both evaluations.

Conclusion: The findings of our study indicate that the sensitivity and accuracy rates of abdominal CT scenogram scans in diagnosing acute MOs are similar to or greater than those of CR. Additionally, the study revealed that radiologists with more experience demonstrated a higher likelihood of accurately predicting the existence and potential localization of MO compared to their less experienced counterparts.

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World journal of radiology
World journal of radiology RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
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