1 Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110.
AJR Am J Roentgenol. 2019 Jan;212(1):103-108. doi: 10.2214/AJR.18.20033. Epub 2018 Nov 7.
The objective of this study was to identify CT findings and determine interobserver reliability of surgically proven gastric volvulus.
This single-center retrospective study included 30 patients (21 women, nine men; mean age, 73 years old) with surgically proven gastric volvulus who underwent preoperative CT and 31 age- and sex-matched control subjects (21 women, nine men; mean age, 74 years old) with large hiatal hernias who were imaged for reasons other than abdominal pain. Two blinded radiologists reviewed the CT images and recorded findings of organoaxial and mesenteroaxial gastric volvulus and ischemia. Interobserver reliability, reader accuracy, sensitivity, specificity, and likelihood ratios of each CT finding were calculated.
The radiologists were overall 90% accurate (55/61; six false-negatives per reader) in identifying gastric volvulus. Interobserver agreement was substantial (κ = 0.71) for identifying the presence or absence of gastric volvulus. Agreement for most CT findings of gastric volvulus (11/14, 79%) was excellent (5/14, 36%) or substantial (6/14, 43%); the remaining findings showed moderate agreement (3/14, 21%). The most frequent and sensitive CT findings of volvulus with high positive likelihood ratios were stenosis at the hernia neck (reader 1, sensitivity = 80%, positive likelihood ratio = 26.66; reader 2, sensitivity = 77%, positive likelihood ratio = 12.83) and transition point at the pylorus (reader 1, sensitivity = 80%, positive likelihood ratio = 17; reader 2, sensitivity = 70%, positive likelihood ratio = 15). The presence of perigastric fluid or a pleural effusion were significantly more frequent in patients with ischemia at surgical pathology (p < 0.05 in all comparisons, both radiologists).
In our series, CT showed substantial interobserver agreement and fair accuracy in identifying the presence of gastric volvulus.
本研究旨在确定 CT 表现，并评估其对经手术证实的胃扭转的诊断价值及其观察者间的可靠性。
本单中心回顾性研究纳入了 30 例经手术证实的胃扭转患者（21 名女性，9 名男性；平均年龄 73 岁）和 31 例年龄和性别相匹配的因其他原因（而非腹痛）行上消化道造影检查而发现巨大食管裂孔疝的患者作为对照组（21 名女性，9 名男性；平均年龄 74 岁）。由两位经验丰富的放射科医师对 CT 图像进行盲法阅片，并记录器官轴型和系膜轴型胃扭转及胃缺血的影像学表现。计算每个 CT 表现的观察者间一致性、观察者诊断准确性、敏感度、特异度和阳性似然比。
两位放射科医师总体上诊断胃扭转的准确率为 90%（每例各有 6 例漏诊）。判断胃扭转存在与否的观察者间一致性较高（κ = 0.71）。胃扭转的大部分 CT 表现（11/14，79%）具有极好（5/14，36%）或高度一致性（6/14，43%），其余表现则为中度一致性（3/14，21%）。最常见且具有高阳性似然比的胃扭转的 CT 表现为疝颈部狭窄（观察者 1，敏感度=80%，阳性似然比=26.66；观察者 2，敏感度=77%，阳性似然比=12.83）和幽门移行点（观察者 1，敏感度=80%，阳性似然比=17；观察者 2，敏感度=70%，阳性似然比=15）。在手术病理证实有胃缺血的患者中，更常出现胃周积液或胸腔积液（两位观察者在所有比较中均具有统计学意义，p<0.05）。
在我们的研究中，CT 显示在识别胃扭转的存在方面具有较高的观察者间一致性和中等的准确性。
