Department of Surgical Education, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, OH, USA.
Trauma/Neuroscience Research Department, St. Elizabeth Youngstown Hospital, 1044 Belmont Ave, Youngstown, OH, USA.
Am J Surg. 2019 Jul;218(1):201-210. doi: 10.1016/j.amjsurg.2018.08.018. Epub 2018 Aug 30.
Computed tomography (CT) diagnostic accuracy for blunt bowel and mesenteric injuries (BBMI) is controversial.
A literature review to compute aggregate CT performance and individual CT sign sensitivity, specificity, and positive predictive value (PPV) for operative BBMI.
Sensitivity, specificity, and PPV were: overall CT performance 85.3%, 96.1%, 51.4%; abnormal wall enhancement 30.1%, 95.7%, 64.0%; bowel wall discontinuity 22.3%, 99.0%, 87.9%; bowel wall hematoma 22.5%, 100%, 19.5%; bowel wall thickening 35.2%, 96.5%, 32.1%; free air 32.0%, 98.7%, 57.1%; free fluid 65.6%, 85.0%, 25.5%; mesenteric air 27.6%, 99.1%, 85.3%; mesenteric extravasation 22.9%, 99.6%, 73.9%; mesenteric hematoma/fluid 33.9%, 98.7%, 52.8%; mesenteric stranding/streaking 34.3%, 91.8%, 31.6%; mesenteric vessel beading 32.1%, 97.2%, 60.4%; mesenteric vessel termination 31.6%, 97.2%, 63.5%; oral contrast extravasation 10.0%, 100%, 100%; retroperitoneal air 9.4%, 94.9%, 55.6%; and retroperitoneal fluid 44.2%, 49.4%, 38.5%. Sensitivity, specificity, and PPV vary substantially among known signs. Other clinical factors are necessary for comprehensive BBMI identification.
计算机断层扫描（CT）对钝性肠和肠系膜损伤（BBMI）的诊断准确性存在争议。
对手术 BBMI 的 CT 性能综合指标和个体 CT 征象敏感性、特异性和阳性预测值（PPV）进行文献回顾。
敏感性、特异性和 PPV 分别为：整体 CT 性能 85.3%、96.1%、51.4%；异常肠壁增强 30.1%、95.7%、64.0%；肠壁连续性中断 22.3%、99.0%、87.9%；肠壁血肿 22.5%、100%、19.5%；肠壁增厚 35.2%、96.5%、32.1%；游离气 32.0%、98.7%、57.1%；游离液 65.6%、85.0%、25.5%；肠系膜积气 27.6%、99.1%、85.3%；肠系膜外渗 22.9%、99.6%、73.9%；肠系膜血肿/积液 33.9%、98.7%、52.8%；肠系膜绞缠/条纹征 34.3%、91.8%、31.6%；肠系膜血管串珠征 32.1%、97.2%、60.4%；肠系膜血管终末征 31.6%、97.2%、63.5%；口服对比剂外渗 10.0%、100%、100%；腹膜后积气 9.4%、94.9%、55.6%；腹膜后积液 44.2%、49.4%、38.5%。各已知征象的敏感性、特异性和 PPV 差异很大。其他临床因素对全面识别 BBMI 是必要的。
