Department of Radiology, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
Department of Radiology, Hamilton General Hospital, Hamilton, ON, Canada.
AJR Am J Roentgenol. 2021 Sep;217(3):560-568. doi: 10.2214/AJR.20.24636. Epub 2020 Sep 30.
Scarce evidence exists on the diagnostic benefit of enteric contrast administration for abdominopelvic CT performed in the setting of penetrating trauma. The purpose of this systematic review and meta-analysis is to compare the diagnostic accuracy of CT using enteric contrast material with that of CT not using enteric contrast material in penetrating traumatic abdominopelvic injury in adults. A protocol was registered a priori (PROSPERO CRD42019139613). MEDLINE and EMBASE databases were searched until June 25, 2019. Studies were included that evaluated the diagnostic accuracy of abdominopelvic CT either with or without enteric (oral and/or rectal) contrast material in patients presenting with penetrating traumatic injury. Relevant study data metrics and risk of bias were assessed. Bivariate random-effects meta-analyses and meta-regression modeling were performed to assess and compare diagnostic accuracies. From an initial sample of 829 studies, 12 studies were included that reported on 1287 patients with penetrating injury (389 with confirmed bowel, mesenteric, or other abdominopelvic organ injury). The enteric contrast material group (seven studies; 506 patients; 124 patients with confirmed penetrating injury) showed a sensitivity of 83.8% (95% CI, 73.7-90.5%) and specificity of 93.8% (95% CI, 83.6-97.8%). The group without enteric contrast administration (six studies; 781 patients; 265 patients with confirmed penetrating injury) showed a sensitivity of 93.0% (95% CI, 86.8-96.4%) and a specificity of 90.3% (95% CI, 81.4-95.2%). No statistically significant difference was identified for sensitivity ( = .07) or specificity ( = .37) between the groups with and without enteric contrast material according to meta-regression. Nine of 12 studies showed risk of bias in at least one QUADAS-2 domain (most frequently limited reporting of blinding of radiologists or lack of blinding of radiologists, insufficient clinical follow-up for the reference standard, and limited reporting of sampling methods). The use of enteric contrast material for CT does not provide a significant diagnostic benefit for penetrating traumatic injury. Eliminating enteric contrast administration for CT in penetrating traumatic injury can prevent delays in imaging and surgery and reduce cost.
在穿透性创伤的情况下进行的腹盆腔 CT 检查中，肠内对比剂给药的诊断益处的证据很少。本系统评价和荟萃分析的目的是比较在成人穿透性创伤性腹盆损伤中使用肠内对比剂的 CT 和不使用肠内对比剂的 CT 的诊断准确性。方案预先进行了注册（PROSPERO CRD42019139613）。检索了 MEDLINE 和 EMBASE 数据库，直到 2019 年 6 月 25 日。评估了在有或没有肠内（口服和/或直肠）对比剂的情况下进行腹盆腔 CT 检查的诊断准确性的研究，这些研究纳入了有穿透性创伤的患者。评估了相关研究数据指标和偏倚风险。采用双变量随机效应荟萃分析和荟萃回归建模来评估和比较诊断准确性。从最初的 829 项研究中，有 12 项研究纳入了 1287 名穿透性损伤患者（389 例有确认的肠、肠系膜或其他腹盆器官损伤）。肠内对比剂组（7 项研究；506 例患者；124 例有确认的穿透性损伤）的敏感性为 83.8%（95%CI，73.7-90.5%），特异性为 93.8%（95%CI，83.6-97.8%）。未给予肠内对比剂组（6 项研究；781 例患者；265 例有确认的穿透性损伤）的敏感性为 93.0%（95%CI，86.8-96.4%），特异性为 90.3%（95%CI，81.4-95.2%）。根据荟萃回归，在有和没有肠内对比剂的组之间，敏感性（=.07）或特异性（=.37）均未发现统计学差异。12 项研究中有 9 项至少在一个 QUADAS-2 领域存在偏倚风险（最常见的是放射科医生的报告受限或放射科医生的报告不受限、参考标准的临床随访不足以及采样方法的报告有限）。在穿透性创伤中，CT 使用肠内对比剂并不能提供显著的诊断益处。在穿透性创伤中，消除 CT 检查中的肠内对比剂给药可以防止影像学和手术的延迟，并降低成本。
