Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, Iran.
Research Center for Evidence-Based Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Radiography (Lond). 2021 May;27(2):716-720. doi: 10.1016/j.radi.2020.10.019. Epub 2020 Nov 12.
Toxic megacolon is a rare but life-threatening condition. Diagnosis is made when both systemic toxicity and an enlarged colon are present. We undertook a systematic review of the literature to provide a list of toxic megacolon findings on computed tomography (CT) imaging along with the prevalence rate for each finding.
PubMed, Embase, and Cochrane library were searched. After eligibility screening and quality assessment, the reported CT findings of toxic megacolon with their respective prevalence rates were extracted from the included studies. Pooled prevalence rates were calculated for each finding using random-effects model and inverse variance method. I statistics were used to estimate the heterogeneity. All statistical analyses were performed using R software. P-values less than 0.05 were considered significant.
Database search yielded a total of 122 records. Only 2 of these studies were finally selected following two-step eligibility screening. Most common CT features of toxic megacolon and their pooled prevalence rates [95% CI] were: colonic distension (reported in 100% of patients), abnormal haustration 96% [0.75-0.99], peri-colonic fat stranding 87% [0.29-0.99], nodular pseudo polyps 76% [0.52-0.91], multilayered appearance of colonic wall 58% [0.38-0.76], and ascites 57% [0.21-0.87]. Other reported CT features: colonic wall thickening, pleural effusion, accordion sign, small bowel/gastric distension, and segmental colonic wall thinning.
and implication for practice: Colonic distension can be accompanied by 10 other findings in CT images of patients with toxic megacolon. Although these findings are not specific, toxic megacolon should be included in the list of differential diagnoses when these findings are present.
中毒性巨结肠是一种罕见但危及生命的疾病。当出现全身毒性和结肠扩大时即可诊断。我们对文献进行了系统回顾，提供了一系列在 CT 成像上中毒性巨结肠的发现，并列出了每种发现的流行率。
在 PubMed、Embase 和 Cochrane 图书馆进行检索。在进行资格筛选和质量评估后，从纳入的研究中提取了关于中毒性巨结肠的 CT 发现及其各自的流行率。使用随机效应模型和逆方差法计算每种发现的汇总流行率。使用 I 统计量来估计异质性。所有统计分析均使用 R 软件进行。P 值小于 0.05 被认为具有统计学意义。
数据库搜索共产生了 122 条记录。经过两步资格筛选，最终只有 2 项研究被纳入。中毒性巨结肠最常见的 CT 特征及其汇总流行率[95%CI]为：结肠扩张（在 100%的患者中报告）、异常蠕动 96%[0.75-0.99]、结肠周围脂肪条纹 87%[0.29-0.99]、结节性假性息肉 76%[0.52-0.91]、结肠壁多层外观 58%[0.38-0.76]和腹水 57%[0.21-0.87]。其他报告的 CT 特征：结肠壁增厚、胸腔积液、手风琴征、小肠/胃扩张和节段性结肠壁变薄。
对实践的启示：中毒性巨结肠的 CT 图像上可能伴有 10 种其他发现。尽管这些发现没有特异性，但当这些发现存在时，应将中毒性巨结肠纳入鉴别诊断清单。
