Filippone Antonella, Cianci Roberta, Grassedonio Emanuele, Di Fabio Francesca, Storto Maria Luigia
Department of Clinical Sciences and Bioimages, Section of Radiological Sciences, G. d'Annunzio University, SS. Annunziata Hospital, Chieti, Italy.
J Comput Assist Tomogr. 2007 Jul-Aug;31(4):499-507. doi: 10.1097/01.rct.0000238013.87802.3c.
To compare the diagnostic performance of axial and coronal views in multidetector-row computed tomography (MDCT) of patients with small-bowel obstruction (SBO) or large-bowel obstruction (LBO).
Among 157 patients with clinical and radiographic findings of BO, 73 patients, who underwent MDCT and were found to have surgically proven SBO (49/73) or LBO (24/73), were retrospectively evaluated. Portal-enhanced MDCT was performed using 4 x 2.5-mm collimation; 3-mm-thick axial images were reconstructed with 2 mm of increment. Coronal views were reformatted using 3-mm-thick sections with 1 mm of increment. Three radiologists analyzed axial (session A), coronal (session B), and axial plus coronal images (session C) to identify the site, cause, and type of BO. To correlate surgical findings and MDCT results, the bowel was divided into duodenum, oral jejunum, aboral jejunum, oral ileum, aboral ileum, cecum/ascending colon, transverse colon, descending colon, and sigmoid colon/rectum. The mean diagnostic accuracy and the mean confidence score of each reader and each reading session were calculated.
The diagnostic accuracy of axial images was higher than that of coronal views (P = 0.014) in SBO, whereas no significant differences were found in LBO. The definition of the SBO cause was correctly assessed in 45 of 49 patients during session A, in 40 of 49 during session B, and in 45 of 49 during session C. In patients with LBO, the cause was correctly assessed in 21 of 24 patients during session A and in 22 of 24 patients during sessions B and C. All readers interpreted axial plus coronal images with a significantly higher confidence level than axial or coronal views alone, either for the detection of the site (P = 0.002) or for the identification of the cause (P < 0.001) of SBO and LBO.
The MDCT allowed accurate detection of the site and the cause of obstruction. In SBO, axial images yielded a higher diagnostic accuracy than coronal views, whereas in LBO, no differences were found between axial and coronal planes. The reading of axial plus coronal views significantly improved diagnostic confidence.
比较多层螺旋计算机断层扫描（MDCT）轴位和冠状位图像对小肠梗阻（SBO）或大肠梗阻（LBO）患者的诊断效能。
在157例有肠梗阻临床及影像学表现的患者中，对73例行MDCT检查且经手术证实为SBO（49/73）或LBO（24/73）的患者进行回顾性评估。采用4×2.5mm准直进行门静脉增强MDCT扫描；重建层厚3mm、层间距2mm的轴位图像。冠状位图像采用层厚3mm、层间距1mm进行重组。三位放射科医生分析轴位图像（A组）、冠状位图像（B组）以及轴位加冠状位图像（C组），以确定肠梗阻的部位、病因及类型。为使手术结果与MDCT结果相关联，将肠管分为十二指肠、空肠上段、空肠下段、回肠上段、回肠下段、盲肠/升结肠、横结肠、降结肠以及乙状结肠/直肠。计算每位读者及每个读片阶段的平均诊断准确率及平均信心评分。
在SBO中，轴位图像的诊断准确率高于冠状位图像（P = 0.014），而在LBO中未发现显著差异。在A组49例SBO患者中，45例病因判断正确；B组49例中40例正确；C组49例中45例正确。在LBO患者中，A组24例中有21例病因判断正确，B组和C组24例中有22例正确。所有读者对轴位加冠状位图像的解读信心水平均显著高于单独的轴位或冠状位图像，无论是对SBO还是LBO的梗阻部位检测（P = 0.002）或病因识别（P < 0.001）。
MDCT能够准确检测梗阻部位及病因。在SBO中，轴位图像的诊断准确率高于冠状位图像；而在LBO中，轴位和冠状位平面之间未发现差异。同时读取轴位和冠状位图像可显著提高诊断信心。
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