Millet Ingrid, Taourel Patrice, Ruyer Alban, Molinari Nicolas
From Department of Medical Imaging, CHU Lapeyronie, 371 avenue Gaston Giraud, 34295, Montpellier Cedex 5, France,
Eur Radiol. 2015 Jun;25(6):1823-35. doi: 10.1007/s00330-014-3440-2. Epub 2015 Apr 8.
Our aim was to assess the diagnostic performance in determining strangulation in small bowel obstruction (SBO) for five CT findings commonly considered in published small bowel obstruction (SBO) management guidelines.
Medical databases were searched for "bowel obstruction", "computed tomography", "strangulation", and related terms. Two reviewers independently selected articles for CT findings investigated with surgical or histological reference standards for strangulation. Bivariate random-effects meta-analytical methods were used.
A total of 768 patients, including 205 with strangulation from nine studies, were evaluated. The reduced bowel wall enhancement CT sign had the highest specificity (95 %, CI 75-99), with a positive LR of 11.07 (2.27-53.88) and DOR of 22.86 (4.99-104.61). The mesenteric fluid sign had the highest sensitivity (89 %, CI 75-96) with a negative LR of 0.16 (0.07-0.39) and a DOR of 13.9 (5.73-33.75). The bowel wall thickness had a sensitivity of 48 % (CI 41-54), a specificity of 83 % (CI 74-89), a positive LR of 2.84 (1.83-4.41) and a negative LR of 0.62 (0.53-0.72). The other CT findings had lower diagnostic performance.
Two CT findings should be used in clinical practice: reduced enhanced bowel wall is highly predictive of ischemia, and absence of mesenteric fluid is a reliable finding to rule out strangulation.
• Reduced bowel wall enhancement on CT increases the probability of strangulation 11-fold. • Absence of mesenteric fluid on CT decreases the probability of strangulation 6-fold. • The clinical reliability of other CT signs is doubtful for predicting strangulation.
我们的目的是评估在已发表的小肠梗阻（SBO）管理指南中通常考虑的五种CT表现对判定小肠梗阻绞窄的诊断性能。
在医学数据库中检索“肠梗阻”“计算机断层扫描”“绞窄”及相关术语。两名审阅者独立选择以手术或组织学绞窄参考标准研究CT表现的文章。采用双变量随机效应荟萃分析方法。
共评估了768例患者，其中包括来自9项研究的205例绞窄患者。肠壁强化减弱CT征象具有最高的特异性（95%，可信区间75 - 99），阳性似然比为11.07（2.27 - 53.88），诊断比值比为22.86（4.99 - 104.61）。肠系膜积液征象具有最高的敏感性（89%，可信区间75 - 96），阴性似然比为0.16（0.07 - 0.39），诊断比值比为13.9（5.73 - 33.75）。肠壁厚度的敏感性为48%（可信区间41 - 54），特异性为83%（可信区间74 - 89），阳性似然比为2.84（1.83 - 4.41），阴性似然比为0.62（0.53 - 0.72）。其他CT表现的诊断性能较低。
临床实践中应采用两种CT表现：肠壁强化减弱高度提示缺血，肠系膜无积液是排除绞窄的可靠表现。
• CT上肠壁强化减弱使绞窄概率增加11倍。• CT上肠系膜无积液使绞窄概率降低6倍。• 其他CT征象预测绞窄的临床可靠性存疑。
