Suzhou Medical College of Soochow University, Suzhou, China.
Department of General Surgery, PLA Rocket Force Characteristic Medical Center, Beijing, China.
Contrast Media Mol Imaging. 2022 Jul 19;2022:1980371. doi: 10.1155/2022/1980371. eCollection 2022.
We aimed to analyze the computed tomography (CT) imaging signs of bowel wall ischemia in patients with acute intestinal obstruction and construct an imaging prediction model to guide clinical treatment. The CT imaging signs of patients with acute intestinal obstruction diagnosed in our center in recent 6 years were collected for retrospective analysis. The etiology of intestinal obstruction and incidence rate of bowel wall ischemia were recorded, and the specific CT findings of bowel wall ischemia, including mesenteric edema, bowel wall thickening, and fish tooth sign, were analyzed. Among the 302 patients selected, 130 surgically treated patients were eligible for analysis. Bowel wall ischemia in acute intestinal obstruction showed an incidence rate of 14.90%, and the incidence rates of bowel wall ischemia in intra-abdominal hernia, intussusception, incarcerated external abdominal hernia, and volvulus were about 92.30%, 50%, 35.71%, 33.33%, and 12.59%, respectively. The incidence rate of bowel wall ischemia in simple adhesive intestinal obstruction was about 12.59%, and that in malignancy-induced intestinal obstruction was about 6.56%. Univariate analysis revealed 5 factors with statistical significance, including bowel wall thickening, mesenteric edema, bowel wall pneumatosis, ascites, and fish tooth sign. Multivariate logistic regression analysis indicated that fish tooth sign, bowel wall thickening, and mesenteric edema were able to predict bowel wall ischemia, and the corresponding partial regression coefficients were 2.164, 1.129, and 1.173, odds ratios (ORs) were 8.707, 3.093, and 3.232, sensitivity was 0.356, 0.400, and 0.844, and specificity was 0.859, 0.835, and 0.529, respectively. Imaging signs of bowel wall thickening, mesenteric edema, and fish tooth sign are valuable in predicting bowel wall ischemia, among which bowel wall thickening and mesenteric edema have relatively high specificity and fish tooth sign has a relatively high sensitivity. Furthermore, a fish tooth sign has the most favorable predictive value for bowel wall ischemia in acute intestinal obstruction, followed by bowel wall thickening and mesenteric edema.
目的 分析急性肠梗阻患者的 CT 肠壁缺血影像学征象，构建影像预测模型以指导临床治疗。
方法 回顾性分析本中心近 6 年收治的急性肠梗阻患者的 CT 影像学征象。记录肠梗阻病因及肠壁缺血发生率，分析肠壁缺血的具体 CT 表现，包括肠系膜水肿、肠壁增厚、鱼牙征等。
结果 302 例患者中，130 例行手术治疗患者纳入分析。急性肠梗阻肠壁缺血发生率为 14.90%，其中腹内疝、肠套叠、嵌顿性腹股沟疝和肠扭转所致肠壁缺血发生率分别约为 92.30%、50%、35.71%、33.33%、12.59%，单纯粘连性肠梗阻肠壁缺血发生率约为 12.59%，恶性肿瘤所致肠梗阻肠壁缺血发生率约为 6.56%。单因素分析显示，肠壁增厚、肠系膜水肿、肠壁积气、腹水、鱼牙征 5 项差异有统计学意义。多因素 Logistic 回归分析显示，鱼牙征、肠壁增厚、肠系膜水肿能够预测肠壁缺血，对应的偏回归系数分别为 2.164、1.129、1.173，优势比（OR）分别为 8.707、3.093、3.232，灵敏度分别为 0.356、0.400、0.844，特异度分别为 0.859、0.835、0.529。肠壁增厚、肠系膜水肿、鱼牙征等影像学征象对预测肠壁缺血有一定价值，其中肠壁增厚和肠系膜水肿的特异度较高，而鱼牙征的灵敏度较高。肠壁缺血预测价值由高到低依次为鱼牙征、肠壁增厚、肠系膜水肿。
