Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Rd. Pudong, Shanghai, 200127, People's Republic of China.
Abdom Radiol (NY). 2017 Sep;42(9):2233-2242. doi: 10.1007/s00261-017-1134-3.
To determine reliable CT features to distinguish cancerous from inflammatory colorectal perforations.
A total of 43 patients with surgically and pathologically confirmed colorectal perforation caused by either colorectal cancer (n =27) or an inflammatory conditions (n = 16) were identified. Two radiologists independently assessed the contrast-enhanced CT features for locations of perforation, mural configurations, soft-tissue alterations, lymphadenopathy, and metastases. Intergroup comparisons for univariate analysis were performed using Fisher's exact test or chi-square test for categorical data and Mann-Whitney test for numeric data. Stepwise logistic regression analysis was conducted with features that were found significant under the univariate analysis. Interobserver agreement was assessed using intraclass correlation coefficient (ICC) and kappa test.
Maximal mural thickness >1.39 cm (sensitivity, 100%; specificity, 68.75%), luminal mass or shoulder formation (sensitivity, 88.89%; specificity, 68.75%), absence of diverticula (sensitivity, 96.30%; specificity, 50.00%), irregular mural thickening (sensitivity, 92.59%; specificity, 81.25%), lymphadenopathy (sensitivity, 40.74%; specificity, 93.75%), and metastases (sensitivity, 25.93%; specificity, 100%) were significantly frequent in cancerous perforations. The maximal mural thickness (P = 0.0493, odds ratio = 439.83) and irregular mural thickening (P = 0.0343, odds ratio = 4.69) were identified as the highly distinguished identifiers.
The CT manifestations of cancerous and inflammatory colorectal perforations overlap. Definitive diagnosis is not always possible with imaging alone. The maximal mural thickness >1.39 cm and irregular configuration of the thickened bowel wall were the two highly statistically significant CT features that may help order the difference between the two entities.
确定可靠的 CT 特征，以区分癌性与炎症性结直肠穿孔。
共纳入 43 例经手术和病理证实的结直肠穿孔患者，其中由结直肠癌（n = 27）或炎症性疾病（n = 16）引起。两位放射科医生独立评估了穿孔位置、壁结构、软组织改变、淋巴结病和转移的增强 CT 特征。对单变量分析的组间比较使用 Fisher 精确检验或卡方检验进行分类数据比较，Mann-Whitney 检验进行数值数据比较。对单变量分析中发现的有统计学意义的特征进行逐步逻辑回归分析。使用组内相关系数（ICC）和 Kappa 检验评估观察者间一致性。
最大壁厚度>1.39cm（敏感性，100%；特异性，68.75%）、管腔肿块或肩部形成（敏感性，88.89%；特异性，68.75%）、无憩室（敏感性，96.30%；特异性，50.00%）、不规则壁增厚（敏感性，92.59%；特异性，81.25%）、淋巴结病（敏感性，40.74%；特异性，93.75%）和转移（敏感性，25.93%；特异性，100%）在癌性穿孔中更常见。最大壁厚度（P = 0.0493，优势比=439.83）和不规则壁增厚（P = 0.0343，优势比=4.69）被确定为高度区分的指标。
癌性和炎症性结直肠穿孔的 CT 表现有重叠。仅通过影像学检查无法确定明确的诊断。最大壁厚度>1.39cm 和增厚肠壁的不规则形态是两个具有统计学意义的高度显著 CT 特征，可能有助于区分这两种实体。
