Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
AJR Am J Roentgenol. 2022 Aug;219(2):233-243. doi: 10.2214/AJR.21.27319. Epub 2022 Mar 16.
Data are limited regarding utility of positive oral contrast material for peritoneal tumor detection on CT. The purpose of this article is to compare positive versus neutral oral contrast material for detection of malignant deposits in nonsolid intraabdominal organs on CT. This retrospective study included 265 patients (133 men, 132 women; median age, 61 years) who underwent an abdominopelvic CT examination in which the report did not suggest presence of malignant deposits and a subsequent CT examination within 6 months in which the report indicated at least one unequivocal malignant deposit. Examinations used positive (iohexol; = 100) or neutral (water; = 165) oral agents. A radiologist reviewed images to assess whether the deposits were visible (despite clinical reports indicating no deposits) on unblinded comparison with the follow-up examinations; identified deposits were assigned to one of seven intraabdominal compartments. The radiologist also assessed adequacy of bowel filling with oral contrast material. Two additional radiologists independently reviewed examinations in blinded fashion for malignant deposits. NPV was assessed of clinical CT reports and blinded retrospective readings for detection of malignant deposits visible on unblinded comparison with follow-up examinations. Unblinded review identified malignant deposits in 58.1% (154/265) of examinations. In per-patient analysis of clinical reports, NPV for malignant deposits was higher for examinations with adequate bowel filling with positive oral contrast material (65.8% [25/38]) than for examinations with inadequate bowel filling with positive oral contrast material (45.2% [28/62], = .07) or with neutral oral contrast material regardless of bowel filling adequacy (35.2% [58/165], = .002). In per-compartment analysis of blinded interpretations, NPV was higher for examinations with adequate and inadequate bowel filling with positive oral contrast material than for examinations with neutral oral contrast regardless of bowel filling adequacy (reader 1: 94.7% [234/247] and 92.5% [382/413] vs 88.3% [947/1072], both = .045; reader 2: 93.1% [228/245] and 91.6% [361/394] vs 85.9% [939/1093], both = .01). CT has suboptimal NPV for malignant deposits in intraabdominal nonsolid organs. Compared with neutral material, positive oral contrast material improves detection, particularly with adequate bowel filling. Optimization of bowel preparation for oncologic CT may help avoid potentially severe clinical consequences of missed malignant deposits.
关于 CT 检查中阳性口服对比剂在腹膜肿瘤检测中的应用价值，相关数据有限。本文旨在比较阳性与中性口服对比剂在 CT 检查中对非实性腹腔器官恶性沉积物的检测效果。该回顾性研究纳入了 265 例患者（男 133 例，女 132 例；中位年龄 61 岁），这些患者均接受了腹盆腔 CT 检查，且检查报告未提示存在恶性沉积物，随后在 6 个月内进行了 CT 随访检查，随访报告提示至少存在一个明确的恶性沉积物。检查中使用了阳性（碘海醇；n = 100）或中性（水；n = 165）口服造影剂。一位放射科医生在盲法比较与随访检查的基础上，对图像进行了评估，以判断沉积物是否可见（尽管临床报告提示无沉积物）；对有可见沉积物的部位进行了评估，并将其分配到七个腹腔隔室之一。放射科医生还评估了口服对比剂对肠道充盈的充分性。另外两名放射科医生独立地对盲法检查进行了评估，以判断是否存在恶性沉积物。对临床 CT 报告和盲法回顾性阅读的检测效能进行了评估，以判断在与随访检查的非盲法比较中是否能发现恶性沉积物。盲法评估发现，在 265 次检查中，58.1%（154/265）次检查存在恶性沉积物。在基于患者的临床报告分析中，阳性口服对比剂充分充盈肠道时的恶性沉积物检测的阴性预测值（NPV）更高（65.8%[25/38]），而阳性口服对比剂充盈肠道不充分时的 NPV 较低（45.2%[28/62]，P =.07），中性口服对比剂无论肠道充盈情况如何，NPV 都较低（35.2%[58/165]，P =.002）。在盲法解读的基于隔室的分析中，阳性口服对比剂充盈和不充盈肠道时的 NPV 均高于中性口服对比剂时，无论肠道充盈情况如何（读者 1：94.7%[234/247]和 92.5%[382/413]与 88.3%[947/1072]，两者 P =.045；读者 2：93.1%[228/245]和 91.6%[361/394]与 85.9%[939/1093]，两者 P =.01）。CT 对腹腔非实性器官中恶性沉积物的 NPV 较低。与中性材料相比，阳性口服对比剂可提高检测效果，尤其是在肠道充盈充分的情况下。优化用于肿瘤 CT 检查的肠道准备，可能有助于避免漏诊恶性沉积物所带来的严重临床后果。
