Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
AJR Am J Roentgenol. 2013 May;200(5):1042-7. doi: 10.2214/AJR.12.8942.
The purpose of this study is to determine the overall proportion of clinically worrisome and benign pneumatosis intestinalis (PI) occurring in patients with cancer and to evaluate associated risk factors and CT features.
We retrospectively studied the CT examinations of 84 patients treated at our tertiary cancer center. Reviewers who were blinded to clinical data and classification analyzed PI in terms of location, pattern (linear, cystic, or both), and associated CT features, including pneumoperitoneum, portomesenteric venous air, bowel wall thickening, bowel dilatation, and ascites. On the basis of the review of clinical information and criteria derived from prior literature, the cases were classified as clinically worrisome PI (underlying bowel disease) or benign PI (diagnosis of exclusion that resolved on follow-up imaging without targeted therapy). Clinical factors reviewed included age, sex, cancer type, steroid use, and chemotherapy administration.
Forty-seven patients were classified as having benign PI (56%) and the remainder as having clinically worrisome PI (44%). The following imaging features correlated significantly with clinically worrisome PI: bowel wall thickening (p < 0.001), mesenteric stranding (p < 0.001), ascites (p < 0.001), bowel dilatation (p = 0.004), location confined to small bowel (p = 0.012), and portomesenteric venous gas (p = 0.02). Benign PI was significantly associated with PI confined to the colon (p = 0.004).
Benign PI was slightly more prevalent than clinically worrisome PI in our cohort of patients with cancer. The presence of certain CT features (mesenteric stranding, bowel wall thickening, and ascites) and the location of PI may be indicators of more significant bowel disease and, therefore, of clinically worrisome cases. There was no statistical significance achieved for nonimaging clinical factors.
本研究旨在确定癌症患者中出现临床有意义和良性的肠积气（PI）的总体比例，并评估相关的危险因素和 CT 特征。
我们对在我们的三级癌症中心治疗的 84 例患者的 CT 检查进行了回顾性研究。审查员对临床数据和分类均不知情，他们根据 PI 的位置、模式（线性、囊性或两者兼有）以及相关的 CT 特征（包括气腹、门脉肠系膜静脉气、肠壁增厚、肠扩张和腹水）进行分析。根据对临床信息的回顾和先前文献得出的标准，将病例分为临床有意义的 PI（潜在的肠道疾病）或良性 PI（排除诊断，在没有靶向治疗的情况下随影像学随访而消退）。回顾的临床因素包括年龄、性别、癌症类型、类固醇使用和化疗。
47 例患者被归类为良性 PI（56%），其余患者被归类为临床有意义的 PI（44%）。以下影像学特征与临床有意义的 PI 显著相关：肠壁增厚（p < 0.001）、肠系膜条纹（p < 0.001）、腹水（p < 0.001）、肠扩张（p = 0.004）、局限于小肠的位置（p = 0.012）和门脉肠系膜静脉气（p = 0.02）。良性 PI 与局限于结肠的 PI 显著相关（p = 0.004）。
在我们的癌症患者队列中，良性 PI 略多于临床有意义的 PI。某些 CT 特征（肠系膜条纹、肠壁增厚和腹水）的存在和 PI 的位置可能是更严重肠道疾病的指标，因此也是临床有意义的病例的指标。非影像学临床因素未达到统计学意义。
