Department of Surgery, University of Rochester Medical Center, Rochester, New York.
Division of Pediatric Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York; Department of Biomedical Engineering, University of Rochester, Rochester, New York.
J Surg Res. 2023 Oct;290:71-82. doi: 10.1016/j.jss.2023.04.011. Epub 2023 May 19.
Short bowel syndrome is the most common cause of intestinal failure, with morbidity and mortality linked to remanent small intestine length. There is no current standard for noninvasive bowel length measurement.
The literature was systematically searched for articles describing measurements of small intestine length from radiographic studies. Inclusion required reporting intestinal length as an outcome and use of diagnostic imaging for length assessment compared to a ground truth. Two reviewers independently screened studies for inclusion, extracted data, and assessed study quality.
Eleven studies met the inclusion criteria and reported small intestinal length measurement using four imaging modalities: barium follow-through, ultrasound, computed tomography, and magnetic resonance. Five barium follow-through studies reported variable correlations with intraoperative measurements (r = 0.43-0.93); most (3/5) reported underestimation of length. US studies (n = 2) did not correlate with ground truths. Two computed tomography studies reported moderate-to-strong correlations with pathologic (r = 0.76) and intraoperative measurements (r = 0.99). Five studies of magnetic resonance showed moderate-to-strong correlations with intraoperative or postmortem measurements (r = 0.70-0.90). Vascular imaging software was used in two studies, and a segmentation algorithm was used for measurements in one.
Noninvasive measurement of small intestine length is challenging. Three-dimensional imaging modalities reduce the risk of length underestimation, which is common with two-dimensional techniques. However, they also require longer times to perform length measurements. Automated segmentation has been trialed for magnetic resonance enterography, but this method does not translate directly to standard diagnostic imaging. While three-dimensional images are most accurate for length measurement, they are limited in their ability to measure intestinal dysmotility, which is an important functional measure in patients with intestinal failure. Future work should validate automated segmentation and measurement software using standard diagnostic imaging protocols.
短肠综合征是肠衰竭最常见的原因，其发病率和死亡率与残留小肠长度有关。目前尚无非侵入性肠长度测量的标准。
系统地检索了描述从放射影像学研究中小肠长度测量的文献。纳入标准为报告肠长度作为结果，并使用诊断成像进行长度评估与真实值进行比较。两名审查员独立筛选纳入的研究，提取数据并评估研究质量。
符合纳入标准的 11 项研究报告了使用四种成像方式（钡剂透视、超声、计算机断层扫描和磁共振）测量小肠长度。五项钡剂透视研究报告了与术中测量的可变相关性（r = 0.43-0.93）；大多数（3/5）报告长度低估。超声研究（n = 2）与真实值无相关性。两项计算机断层扫描研究报告了与病理（r = 0.76）和术中测量的中度至强相关性（r = 0.99）。五项磁共振研究显示与术中或死后测量的中度至强相关性（r = 0.70-0.90）。两项研究使用了血管成像软件，一项研究使用了分割算法进行测量。
小肠长度的非侵入性测量具有挑战性。三维成像方式可降低二维技术常见的长度低估风险。然而，它们也需要更长的时间来进行长度测量。已经尝试了磁共振肠造影术的自动分割，但是这种方法不能直接转化为标准诊断成像。虽然三维图像最适合长度测量，但它们在测量肠动力障碍方面的能力有限，而肠动力障碍是肠衰竭患者的重要功能测量指标。未来的工作应使用标准诊断成像协议验证自动分割和测量软件。
