Diagnosis of Acute Bowel Ischaemia: Which Computed Tomography Finding Should We Trust?

Full Article

VYK To, WL Poon, CY Lee, WS Wan

Hong Kong J Radiol 2014;17:234-9

DOI: 10.12809/hkjr1414240

Objective: To determine which computed tomography (CT) findings correlate most with acute bowel ischaemia.

Methods: This cross-sectional study included patients attending the Tuen Mun Hospital, Hong Kong between July 2005 and July 2011 who fulfilled one of the following criteria: (1) had undergone CT abdomen for clinical suspicion of bowel ischaemia, (2) CT showed evidence of bowel ischaemia with or without clinical suspicion, or (3) had operative findings of bowel ischaemia and had undergone CT previously. All CT images were reviewed independently by three radiologists who were blinded to the clinical outcome. Six specific CT findings including mural thickness, bowel dilatation, mural enhancement, pneumatosis intestinalis, portal or mesenteric venous gas, and superior mesenteric artery or venous (SMA/SMV) occlusion were documented. Binary logistic regression and adjusted odds ratio were used for statistical analysis. Intraclass correlation coefficient was calculated to determine the interobserver agreement among the three radiologists. The sensitivity, specificity, and positive predictive values were determined.

Results: A total of 148 patients were included, of whom 28 were excluded due to death without confirmed operative findings within the same admission. The remaining 120 patients were included for review. A combined feature of bowel dilatation with mural thinning was found to be the strongest CT indicator of acute bowel ischaemia with an odds ratio of 30.3 (p < 0.001; sensitivity, 73%; specificity, 94%; positive predictive value, 88%). The other significant CT indicator was mural hypoenhancement with an odds ratio of 6.3 (p = 0.001; sensitivity, 63%; specificity, 80%; positive predictive value, 68%). The intraclass correlation coefficient was 0.85 (p < 0.001), indicating a high degree of interobserver agreement in assessing the CT signs of acute bowel ischaemia.

Conclusion: A combined feature of dilatation with mural thinning and mural hypoenhancement are the strongest indicators for diagnosing acute bowel ischaemia.








結果:148個腸道缺血病例中,28個無該次入院的手術結果確診的死亡病例而不被列入研究範圍。餘下的120例列入回顧分析。結果發現腸道擴張伴有腸壁變薄為急性腸道缺血的最強CT診斷指標,其比值比為30.3(p < 0.001;敏感性73%、特異性94%、陽性預測值88%)。另一項指標為腸壁低強化,比值比為6.3(p = 0.001;敏感性63%、特異性80%、陽性預測值68%)。組內相關係數為0.85(p < 0.001),顯示三名放射科醫生在判斷急性腸道缺血的CT特徵具高度一致性。