Department of General Surgery, Jiujiang No.1 People's Hospital, Jiangxi province, Jiujiang, Jiujiang, China.
Department of Gastrointestinal Surgery, The People's Hospital of Leshan, Sichuan province, Leshan, China.
BMC Med Imaging. 2023 Jun 12;23(1):80. doi: 10.1186/s12880-023-01041-2.
To investigate the diagnostic value of unenhanced CT in mechanical small bowel obstruction (SBO) with small bowel necrosis, and to establish a predictive model.
From May 2017 to December 2021, the patients with mechanical SBO admitted to our hospital were retrospectively collected. Taking pathology-confirmed small bowel necrosis as the gold standard, the experimental group was composed of patients with small bowel necrosis confirmed by pathology, and the control group was composed of patients with no intestinal necrosis confirmed by surgery or successful conservative treatment with no recurrence of intestinal obstruction during 1-month followed-up.
A total of 182 patients were enrolled in this study, 157 patients underwent surgery, of which 35 patients were accompanied with small bowel necrosis and 122 patients were not (33 patients with ischemic findings at surgery without necrosis). Finally, there were 35 patients in the experimental group and 147 patients in the control group. Multivariable logistic regression showed that increased attenuation of small bowel wall (P = 0.002), diffuse mesenteric haziness (P = 0.010), difference of CT value between mesenteric vessel and aorta (P = 0.025) and U-/C-shaped small bowel loop (P = 0.010) were independent risk factors for the diagnosis of mechanical SBO with small bowel necrosis. Through internal verification, the area under curve (AUC) of the predictive model reached 0.886 (95%CI: 0.824-0.947), and the calibration result was moderate.
Multiple features (increased attenuation of small bowel wall; difference of CT values between mesenteric vessel and aorta; diffuse mesenteric haziness; and U-/C-shaped small bowel loop) of unenhanced CT have clinical value in the diagnosis of mechanical SBO with small bowel necrosis. The predictive model based on these four features could achieve satisfactory efficiency.
探讨非增强 CT 对机械性小肠梗阻（SBO）合并小肠坏死的诊断价值，并建立预测模型。
回顾性收集 2017 年 5 月至 2021 年 12 月我院收治的机械性 SBO 患者。以病理证实的小肠坏死为金标准，实验组由病理证实存在小肠坏死的患者组成，对照组由手术证实无肠坏死或经成功保守治疗且在 1 个月随访期间无肠梗阻复发的患者组成。
本研究共纳入 182 例患者，其中 157 例患者接受了手术治疗，其中 35 例患者伴有小肠坏死，122 例患者没有（术中发现缺血但无坏死）。最终，实验组有 35 例患者，对照组有 147 例患者。多变量逻辑回归显示，小肠壁强化程度增加（P=0.002）、弥漫性肠系膜模糊（P=0.010）、肠系膜血管与主动脉 CT 值差值（P=0.025）和 U/C 形小肠袢（P=0.010）是机械性 SBO 合并小肠坏死的独立危险因素。内部验证后，预测模型的曲线下面积（AUC）达到 0.886（95%CI：0.824-0.947），校准结果为中度。
非增强 CT 的多种特征（小肠壁强化程度增加；肠系膜血管与主动脉 CT 值差值；弥漫性肠系膜模糊；U/C 形小肠袢）对机械性 SBO 合并小肠坏死具有临床诊断价值。基于这四个特征的预测模型可以达到令人满意的效率。
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