Pongpornsup Sopa, Tarachat Kullaya, Srisajjakul Sittipong
Department of Radiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2009 Dec;92(12):1651-61.
The purpose of the present study was to determine the accuracy of 64 sliced multi-detector computed tomography (MDCT) in the diagnosis of patients with suspected small bowel obstruction (SBO) and identify the definite cause of SBO for further investigation or treatment.
A retrospective study was performed on 35 patients with suspected SBO who underwent 64 sliced MDCT to establish the diagnosis and cause of SBO. The patients were enrolled from January 1, 2005 to June 30, 2007. The MDCT scan of whole abdomen from patients with suspected SBO were retrospectively evaluated by two gastrointestinal radiologists without knowledge of the patients history determined the presence or absence of SBO, cause, location, small-bowel feces sign, complication (sign of associated bowel strangulation), and confident on a five-point scale. Sensitivity and specificity estimates with confidence intervals were calculated. Weighted-kappa statistics were used to estimate agreement between readers.
Twenty-five patients ultimately proved to have SBO, and ten patients had no evidence of SBO. The overall sensitivity, specificity, and accuracy of 64 sliced MDCT to establish the diagnosis of SBO were 96%, 100%, and 97%, respectively. The final diagnosis was established either by surgery (13 patients) or by the clinical evolution (12 patients). Causes of SBO included adhesions (n=10), metastases (n=4), post-radiative enteropathy (n=1), internal hernia (n=3), ileitis (n=2), inguinal hernia (n=1), submucosal hemorrhage (n=1), benign stricture secondary to chronic pancreatitis (n=1), midgut volvulus (n=1), and SMA syndrome (n=1). When obstructions were classified into low and high grade obstruction, CT results could be used to identify correctly 100% (13 of 13) of high grade SBO and 58% (7 of 12) of low grade SBO. The 64 sliced MDCT yielded one false-negative for patients with partial SBO due to adhesion band Small-bowel feces sign was detected in 4 of 25 patients, who were diagnosed as SBO.
The 64 sliced MDCT is a highly sensitivity and specificity method to diagnose SBO and cause of obstruction. The ability of MDCT to show the cause of SBO makes CT an important additional diagnostic tool when specific management issues must be addressed.
本研究旨在确定64层螺旋CT（MDCT）对疑似小肠梗阻（SBO）患者诊断的准确性，并明确SBO的确切病因，以便进一步检查或治疗。
对35例疑似SBO患者进行回顾性研究，这些患者均接受了64层MDCT检查以明确SBO的诊断及病因。患者纳入时间为2005年1月1日至2007年6月30日。由两名不了解患者病史的胃肠放射科医生对疑似SBO患者的全腹MDCT扫描进行回顾性评估，确定是否存在SBO、病因、位置、小肠粪石征、并发症（肠绞窄相关征象），并采用五点量表进行信心评估。计算带有置信区间的敏感性和特异性估计值。采用加权kappa统计量评估阅片者之间的一致性。
最终证实25例患者患有SBO，10例患者无SBO证据。64层MDCT诊断SBO的总体敏感性、特异性和准确性分别为96%、100%和97%。最终诊断通过手术（13例患者）或临床病程演变（12例患者）确定。SBO的病因包括粘连（n = 10）、转移瘤（n = 4）、放射性肠炎（n = 1）、内疝（n = 3）、回肠炎（n = 2）、腹股沟疝（n = 1）、黏膜下出血（n = 1）、慢性胰腺炎继发良性狭窄（n = 1）、中肠扭转（n = 1）和肠系膜上动脉综合征（n = 1）。当梗阻分为高位和低位梗阻时，CT结果能够正确识别100%（13/13）的高位SBO和58%（7/12）的低位SBO。对于因粘连带导致部分性SBO的患者，64层MDCT出现1例假阴性。25例诊断为SBO的患者中有4例检测到小肠粪石征。
64层MDCT是诊断SBO及其梗阻病因的一种高敏感性和特异性的方法。MDCT显示SBO病因的能力使CT成为解决特定管理问题时重要的辅助诊断工具。
