Optimized protocol of multiple post-processing techniques improves diagnostic accuracy of multidetector computed tomography in assessment of small bowel obstruction compared with conventional axial and coronal reformations
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摘要
BACKGROUND Axial and coronal reformations have been a widely used image post-processing protocol for the ordinary multidetector computed tomography(MDCT)examination of patients with small bowel obstruction(SBO) or other abdominal diseases. The diagnostic accuracy of MDCT for assessing SBO is expected to be further improved through the use of multiple post-processing techniques.AIM To systemically evaluate the diagnostic accuracy and efficiency of an optimized protocol using multiple post-processing techniques for MDCT assessment of SBO and secondary bowel ischemia.METHODS This retrospective cross-sectional study included 106 patients with clinically suspected SBO. Two readers applied three protocols to image post-processing and interpretation of patients' MDCT volume data. We compared the three protocols based on time spent, number of images, diagnostic self-confidence,agreement, detection rate, and accuracy of detection of SBO and secondary bowel ischemia.RESULTS Protocol 2 resulted in more time spent and number of images than protocols 1 and 3(P < 0.01), but the results of the two readers using the same protocol were not different(P > 0.05). Using protocol 3, both readers added multiple postprocessing techniques at frequencies of 29.2% and 34.9%, respectively, for obstruction cause, and 32.1% and 30.2%, respectively, for secondary bowel ischemia. Protocols 2 and 3 had higher total detection rates of obstruction cause and secondary bowel ischemia than protocol 1(P < 0.01), but no difference was detected between protocols 2 and 3(P > 0.05). The accuracy, sensitivity,specificity, positive predictive value and negative predictive value of protocols 2 and 3 were superior to those of protocol 1 for evaluating obstruction cause and secondary bowel ischemia.CONCLUSION Our optimized protocol of multiple post-processing techniques can both guarantee efficiency and improve diagnostic accuracy of MDCT for assessing SBO and secondary bowel ischemia.
BACKGROUND Axial and coronal reformations have been a widely used image post-processing protocol for the ordinary multidetector computed tomography(MDCT)examination of patients with small bowel obstruction(SBO) or other abdominal diseases. The diagnostic accuracy of MDCT for assessing SBO is expected to be further improved through the use of multiple post-processing techniques.AIM To systemically evaluate the diagnostic accuracy and efficiency of an optimized protocol using multiple post-processing techniques for MDCT assessment of SBO and secondary bowel ischemia.METHODS This retrospective cross-sectional study included 106 patients with clinically suspected SBO. Two readers applied three protocols to image post-processing and interpretation of patients' MDCT volume data. We compared the three protocols based on time spent, number of images, diagnostic self-confidence,agreement, detection rate, and accuracy of detection of SBO and secondary bowel ischemia.RESULTS Protocol 2 resulted in more time spent and number of images than protocols 1 and 3(P < 0.01), but the results of the two readers using the same protocol were not different(P > 0.05). Using protocol 3, both readers added multiple postprocessing techniques at frequencies of 29.2% and 34.9%, respectively, for obstruction cause, and 32.1% and 30.2%, respectively, for secondary bowel ischemia. Protocols 2 and 3 had higher total detection rates of obstruction cause and secondary bowel ischemia than protocol 1(P < 0.01), but no difference was detected between protocols 2 and 3(P > 0.05). The accuracy, sensitivity,specificity, positive predictive value and negative predictive value of protocols 2 and 3 were superior to those of protocol 1 for evaluating obstruction cause and secondary bowel ischemia.CONCLUSION Our optimized protocol of multiple post-processing techniques can both guarantee efficiency and improve diagnostic accuracy of MDCT for assessing SBO and secondary bowel ischemia.
BACKGROUND Axial and coronal reformations have been a widely used image post-processing protocol for the ordinary multidetector computed tomography(MDCT)examination of patients with small bowel obstruction(SBO) or other abdominal diseases. The diagnostic accuracy of MDCT for assessing SBO is expected to be further improved through the use of multiple post-processing techniques.AIM To systemically evaluate the diagnostic accuracy and efficiency of an optimized protocol using multiple post-processing techniques for MDCT assessment of SBO and secondary bowel ischemia.METHODS This retrospective cross-sectional study included 106 patients with clinically suspected SBO. Two readers applied three protocols to image post-processing and interpretation of patients' MDCT volume data. We compared the three protocols based on time spent, number of images, diagnostic self-confidence,agreement, detection rate, and accuracy of detection of SBO and secondary bowel ischemia.RESULTS Protocol 2 resulted in more time spent and number of images than protocols 1 and 3(P < 0.01), but the results of the two readers using the same protocol were not different(P > 0.05). Using protocol 3, both readers added multiple postprocessing techniques at frequencies of 29.2% and 34.9%, respectively, for obstruction cause, and 32.1% and 30.2%, respectively, for secondary bowel ischemia. Protocols 2 and 3 had higher total detection rates of obstruction cause and secondary bowel ischemia than protocol 1(P < 0.01), but no difference was detected between protocols 2 and 3(P > 0.05). The accuracy, sensitivity,specificity, positive predictive value and negative predictive value of protocols 2 and 3 were superior to those of protocol 1 for evaluating obstruction cause and secondary bowel ischemia.CONCLUSION Our optimized protocol of multiple post-processing techniques can both guarantee efficiency and improve diagnostic accuracy of MDCT for assessing SBO and secondary bowel ischemia.
引文
1 Paulson EK,Thompson WM.Review of small-bowel obstruction:the diagnosis and when to worry.Radiology 2015;275:332-342[PMID:25906301 DOI:10.1148/radiol.15131519]
2 Scrima A,Lubner MG,King S,Pankratz J,Kennedy G,Pickhardt PJ.Value of MDCT and Clinical and Laboratory Data for Predicting the Need for Surgical Intervention in Suspected Small-Bowel Obstruction.AJR Am J Roentgenol 2017;208:785-793[PMID:28328258 DOI:10.2214/AJR.16.16946]
3 Millet I,Boutot D,Faget C,Pages-Bouic E,Molinari N,Zins M,Taourel P.Assessment of Strangulation in Adhesive Small Bowel Obstruction on the Basis of Combined CT Findings:Implications for Clinical Care.Radiology 2017;285:798-808[PMID:28759326 DOI:10.1148/radiol.2017162352]
4 Chuong AM,Corno L,Beaussier H,Boulay-Coletta I,Millet I,Hodel J,Taourel P,Chatellier G,Zins M.Assessment of Bowel Wall Enhancement for the Diagnosis of Intestinal Ischemia in Patients with Small Bowel Obstruction:Value of Adding Unenhanced CT to Contrast-enhanced CT.Radiology 2016;280:98-107[PMID:26866378 DOI:10.1148/radiol.2016151029]
5 Jaffe TA,Martin LC,Thomas J,Adamson AR,DeLong DM,Paulson EK.Small-bowel obstruction:coronal reformations from isotropic voxels at 16-section multi-detector row CT.Radiology 2006;238:135-142[PMID:16293807 DOI:10.1148/radiol.2381050489]
6 Yaghmai V,Nikolaidis P,Hammond NA,Petrovic B,Gore RM,Miller FH.Multidetector-row computed tomography diagnosis of small bowel obstruction:can coronal reformations replace axial images?Emerg Radiol 2006;13:69-72[PMID:16941110 DOI:10.1007/s10140-006-0513-9]
7 Dimitriu-Leen AC,van Rosendael AR,Smit JM,van Elst T,van Geloven N,Maaniitty T,Jukema JW,Delgado V,Scholte AJHA,Saraste A,Knuuti J,Bax JJ.Long-Term Prognosis of Patients With Intramural Course of Coronary Arteries Assessed With CT Angiography.JACC Cardiovasc Imaging 2017;10:1451-1458[PMID:28528150 DOI:10.1016/j.jcmg.2017.02.013]
8 Taslakian B,Latson LA,Truong MT,Aaltonen E,Shiau MC,Girvin F,Alpert JB,Wickstrom M,Ko JP.CT pulmonary angiography of adult pulmonary vascular diseases:Technical considerations and interpretive pitfalls.Eur J Radiol 2016;85:2049-2063[PMID:27776659 DOI:10.1016/j.ejrad.2016.09.017]
9 Chan FP,Rubin GD.MDCT angiography of pediatric vascular diseases of the abdomen,pelvis,and extremities.Pediatr Radiol 2005;35:40-53[PMID:15692842 DOI:10.1007/s00247-004-1371-9]
10 Yu AY,Zerna C,Assis Z,Holodinsky JK,Randhawa PA,Najm M,Goyal M,Menon BK,Demchuk AM,Coutts SB,Hill MD.Multiphase CT angiography increases detection of anterior circulation intracranial occlusion.Neurology 2016;87:609-616[PMID:27385749 DOI:10.1212/WNL.0000000000002951]
11 Vargas R,Nino-Murcia M,Trueblood W,Jeffrey RB.MDCT in Pancreatic adenocarcinoma:prediction of vascular invasion and resectability using a multiphasic technique with curved planar reformations.AJR Am J Roentgenol 2004;182:419-425[PMID:14736675 DOI:10.2214/ajr.182.2.1820419]
12 Kim HC,Yang DM,Jin W,Park SJ.Added diagnostic value of multiplanar reformation of multidetector CT data in patients with suspected appendicitis.Radiographics 2008;28:393-405;discussion 405-6[PMID:18349447 DOI:10.1148/rg.282075039]
13 Hodel J,Zins M,Desmottes L,Boulay-Coletta I,Jullès MC,Nakache JP,Rodallec M.Location of the transition zone in CT of small-bowel obstruction:added value of multiplanar reformations.Abdom Imaging 2009;34:35-41[PMID:18172705 DOI:10.1007/s00261-007-9348-4]
14 Memon W,Khattak YJ,Alam T,Sconfienza LM,Awais M,Anwar SS.MDCT of Small Bowel Obstruction:How Reliable Are Oblique Reformatted Images in Localizing Point of Transition?Gastroenterol Res Pract 2014;2014:815802[PMID:24883057 DOI:10.1155/2014/815802]
15 Aufort S,Charra L,Lesnik A,Bruel JM,Taourel P.Multidetector CT of bowel obstruction:value of postprocessing.Eur Radiol 2005;15:2323-2329[PMID:15834573 DOI:10.1007/s00330-005-2733-x]
16 Morse RW,Cole LG.The anatomy of the normal small intestine as observed roentgenographically.Radiology 1927;8:149-153[DOI:10.1148/8.2.149]
17 Wang PY,Wang X,Zhang L,Li HF,Chen L,Wang X,Wang B.Bezoar-induced small bowel obstruction:Clinical characteristics and diagnostic value of multi-slice spiral computed tomography.World JGastroenterol 2015;21:9774-9784[PMID:26361425 DOI:10.3748/wjg.v21.i33.9774]
18 Izuishi K,Sano T,Shiota A,Mori H,Ebara K.Small bowel obstruction caused by endometriosis in a postmenopausal woman.Asian J Endosc Surg 2015;8:205-208[PMID:25913589 DOI:10.1111/ases.12154]
19 Kuang LQ,Zhao DW,Cheng C,Wang Y.Prediction of Small Bowel Obstruction Caused by Bezoars Using Risk Factor Categories on Multidetector Computed Tomographic Findings.Biomed Res Int 2016;2016:6569103[PMID:27403434 DOI:10.1155/2016/6569103]
20 Keoplung S,Teerasamit W,Suvannarerg V.Diagnosis of bowel obstruction:added value of multiplanar reformations from multidetector CT in comparison with axial planes alone.J Med Assoc Thai 2013;96:1569-1577[PMID:24511722]
21 Colon MJ,Telem DA,Wong D,Divino CM.The relevance of transition zones on computed tomography in the management of small bowel obstruction.Surgery 2010;147:373-377[PMID:20004431 DOI:10.1016/j.surg.2009.10.005]
22 Thompson WM,Kilani RK,Smith BB,Thomas J,Jaffe TA,Delong DM,Paulson EK.Accuracy of abdominal radiography in acute small-bowel obstruction:does reviewer experience matter?AJR Am JRoentgenol 2007;188:W233-W238[PMID:17312028 DOI:10.2214/AJR.06.0817]
23 Pongpornsup S,Tarachat K,Srisajjakul S.Accuracy of 64 sliced multi-detector computed tomography in diagnosis of small bowel obstruction.J Med Assoc Thai 2009;92:1651-1661[PMID:20043569]
24 Silva AC,Pimenta M,Guimar?es LS.Small bowel obstruction:what to look for.Radiographics 2009;29:423-439[PMID:19325057 DOI:10.1148/rg.292085514]
25 O'Malley RG,Al-Hawary MM,Kaza RK,Wasnik AP,Platt JF,Francis IR.MDCT findings in small bowel obstruction:implications of the cause and presence of complications on treatment decisions.Abdom Imaging 2015;40:2248-2262[PMID:26070748 DOI:10.1007/s00261-015-0477-x]
26 Millet I,Taourel P,Ruyer A,Molinari N.Value of CT findings to predict surgical ischemia in small bowel obstruction:A systematic review and meta-analysis.Eur Radiol 2015;25:1823-1835[PMID:25850889DOI:10.1007/s00330-014-3440-2]
27 Geffroy Y,Boulay-Coletta I,Jullès MC,Nakache S,Taourel P,Zins M.Increased unenhanced bowel-wall attenuation at multidetector CT is highly specific of ischemia complicating small-bowel obstruction.Radiology 2014;270:159-167[PMID:24029649 DOI:10.1148/radiol.13122654]
28 He B,Gu J,Huang S,Gao X,Fan J,Sheng M,Wang L,Gong S.Diagnostic performance of multi-slice CTangiography combined with enterography for small bowel obstruction and intestinal ischaemia.J Med Imaging Radiat Oncol 2017;61:40-47[PMID:27709810 DOI:10.1111/1754-9485.12514]
29 Nakashima K,Ishimaru H,Fujimoto T,Mizowaki T,Mitarai K,Nakashima K,Matsuoka Y,Uetani M.Diagnostic performance of CT findings for bowel ischemia and necrosis in closed-loop small-bowel obstruction.Abdom Imaging 2015;40:1097-1103[PMID:25542218 DOI:10.1007/s00261-014-0335-2]
2 Scrima A,Lubner MG,King S,Pankratz J,Kennedy G,Pickhardt PJ.Value of MDCT and Clinical and Laboratory Data for Predicting the Need for Surgical Intervention in Suspected Small-Bowel Obstruction.AJR Am J Roentgenol 2017;208:785-793[PMID:28328258 DOI:10.2214/AJR.16.16946]
3 Millet I,Boutot D,Faget C,Pages-Bouic E,Molinari N,Zins M,Taourel P.Assessment of Strangulation in Adhesive Small Bowel Obstruction on the Basis of Combined CT Findings:Implications for Clinical Care.Radiology 2017;285:798-808[PMID:28759326 DOI:10.1148/radiol.2017162352]
4 Chuong AM,Corno L,Beaussier H,Boulay-Coletta I,Millet I,Hodel J,Taourel P,Chatellier G,Zins M.Assessment of Bowel Wall Enhancement for the Diagnosis of Intestinal Ischemia in Patients with Small Bowel Obstruction:Value of Adding Unenhanced CT to Contrast-enhanced CT.Radiology 2016;280:98-107[PMID:26866378 DOI:10.1148/radiol.2016151029]
5 Jaffe TA,Martin LC,Thomas J,Adamson AR,DeLong DM,Paulson EK.Small-bowel obstruction:coronal reformations from isotropic voxels at 16-section multi-detector row CT.Radiology 2006;238:135-142[PMID:16293807 DOI:10.1148/radiol.2381050489]
6 Yaghmai V,Nikolaidis P,Hammond NA,Petrovic B,Gore RM,Miller FH.Multidetector-row computed tomography diagnosis of small bowel obstruction:can coronal reformations replace axial images?Emerg Radiol 2006;13:69-72[PMID:16941110 DOI:10.1007/s10140-006-0513-9]
7 Dimitriu-Leen AC,van Rosendael AR,Smit JM,van Elst T,van Geloven N,Maaniitty T,Jukema JW,Delgado V,Scholte AJHA,Saraste A,Knuuti J,Bax JJ.Long-Term Prognosis of Patients With Intramural Course of Coronary Arteries Assessed With CT Angiography.JACC Cardiovasc Imaging 2017;10:1451-1458[PMID:28528150 DOI:10.1016/j.jcmg.2017.02.013]
8 Taslakian B,Latson LA,Truong MT,Aaltonen E,Shiau MC,Girvin F,Alpert JB,Wickstrom M,Ko JP.CT pulmonary angiography of adult pulmonary vascular diseases:Technical considerations and interpretive pitfalls.Eur J Radiol 2016;85:2049-2063[PMID:27776659 DOI:10.1016/j.ejrad.2016.09.017]
9 Chan FP,Rubin GD.MDCT angiography of pediatric vascular diseases of the abdomen,pelvis,and extremities.Pediatr Radiol 2005;35:40-53[PMID:15692842 DOI:10.1007/s00247-004-1371-9]
10 Yu AY,Zerna C,Assis Z,Holodinsky JK,Randhawa PA,Najm M,Goyal M,Menon BK,Demchuk AM,Coutts SB,Hill MD.Multiphase CT angiography increases detection of anterior circulation intracranial occlusion.Neurology 2016;87:609-616[PMID:27385749 DOI:10.1212/WNL.0000000000002951]
11 Vargas R,Nino-Murcia M,Trueblood W,Jeffrey RB.MDCT in Pancreatic adenocarcinoma:prediction of vascular invasion and resectability using a multiphasic technique with curved planar reformations.AJR Am J Roentgenol 2004;182:419-425[PMID:14736675 DOI:10.2214/ajr.182.2.1820419]
12 Kim HC,Yang DM,Jin W,Park SJ.Added diagnostic value of multiplanar reformation of multidetector CT data in patients with suspected appendicitis.Radiographics 2008;28:393-405;discussion 405-6[PMID:18349447 DOI:10.1148/rg.282075039]
13 Hodel J,Zins M,Desmottes L,Boulay-Coletta I,Jullès MC,Nakache JP,Rodallec M.Location of the transition zone in CT of small-bowel obstruction:added value of multiplanar reformations.Abdom Imaging 2009;34:35-41[PMID:18172705 DOI:10.1007/s00261-007-9348-4]
14 Memon W,Khattak YJ,Alam T,Sconfienza LM,Awais M,Anwar SS.MDCT of Small Bowel Obstruction:How Reliable Are Oblique Reformatted Images in Localizing Point of Transition?Gastroenterol Res Pract 2014;2014:815802[PMID:24883057 DOI:10.1155/2014/815802]
15 Aufort S,Charra L,Lesnik A,Bruel JM,Taourel P.Multidetector CT of bowel obstruction:value of postprocessing.Eur Radiol 2005;15:2323-2329[PMID:15834573 DOI:10.1007/s00330-005-2733-x]
16 Morse RW,Cole LG.The anatomy of the normal small intestine as observed roentgenographically.Radiology 1927;8:149-153[DOI:10.1148/8.2.149]
17 Wang PY,Wang X,Zhang L,Li HF,Chen L,Wang X,Wang B.Bezoar-induced small bowel obstruction:Clinical characteristics and diagnostic value of multi-slice spiral computed tomography.World JGastroenterol 2015;21:9774-9784[PMID:26361425 DOI:10.3748/wjg.v21.i33.9774]
18 Izuishi K,Sano T,Shiota A,Mori H,Ebara K.Small bowel obstruction caused by endometriosis in a postmenopausal woman.Asian J Endosc Surg 2015;8:205-208[PMID:25913589 DOI:10.1111/ases.12154]
19 Kuang LQ,Zhao DW,Cheng C,Wang Y.Prediction of Small Bowel Obstruction Caused by Bezoars Using Risk Factor Categories on Multidetector Computed Tomographic Findings.Biomed Res Int 2016;2016:6569103[PMID:27403434 DOI:10.1155/2016/6569103]
20 Keoplung S,Teerasamit W,Suvannarerg V.Diagnosis of bowel obstruction:added value of multiplanar reformations from multidetector CT in comparison with axial planes alone.J Med Assoc Thai 2013;96:1569-1577[PMID:24511722]
21 Colon MJ,Telem DA,Wong D,Divino CM.The relevance of transition zones on computed tomography in the management of small bowel obstruction.Surgery 2010;147:373-377[PMID:20004431 DOI:10.1016/j.surg.2009.10.005]
22 Thompson WM,Kilani RK,Smith BB,Thomas J,Jaffe TA,Delong DM,Paulson EK.Accuracy of abdominal radiography in acute small-bowel obstruction:does reviewer experience matter?AJR Am JRoentgenol 2007;188:W233-W238[PMID:17312028 DOI:10.2214/AJR.06.0817]
23 Pongpornsup S,Tarachat K,Srisajjakul S.Accuracy of 64 sliced multi-detector computed tomography in diagnosis of small bowel obstruction.J Med Assoc Thai 2009;92:1651-1661[PMID:20043569]
24 Silva AC,Pimenta M,Guimar?es LS.Small bowel obstruction:what to look for.Radiographics 2009;29:423-439[PMID:19325057 DOI:10.1148/rg.292085514]
25 O'Malley RG,Al-Hawary MM,Kaza RK,Wasnik AP,Platt JF,Francis IR.MDCT findings in small bowel obstruction:implications of the cause and presence of complications on treatment decisions.Abdom Imaging 2015;40:2248-2262[PMID:26070748 DOI:10.1007/s00261-015-0477-x]
26 Millet I,Taourel P,Ruyer A,Molinari N.Value of CT findings to predict surgical ischemia in small bowel obstruction:A systematic review and meta-analysis.Eur Radiol 2015;25:1823-1835[PMID:25850889DOI:10.1007/s00330-014-3440-2]
27 Geffroy Y,Boulay-Coletta I,Jullès MC,Nakache S,Taourel P,Zins M.Increased unenhanced bowel-wall attenuation at multidetector CT is highly specific of ischemia complicating small-bowel obstruction.Radiology 2014;270:159-167[PMID:24029649 DOI:10.1148/radiol.13122654]
28 He B,Gu J,Huang S,Gao X,Fan J,Sheng M,Wang L,Gong S.Diagnostic performance of multi-slice CTangiography combined with enterography for small bowel obstruction and intestinal ischaemia.J Med Imaging Radiat Oncol 2017;61:40-47[PMID:27709810 DOI:10.1111/1754-9485.12514]
29 Nakashima K,Ishimaru H,Fujimoto T,Mizowaki T,Mitarai K,Nakashima K,Matsuoka Y,Uetani M.Diagnostic performance of CT findings for bowel ischemia and necrosis in closed-loop small-bowel obstruction.Abdom Imaging 2015;40:1097-1103[PMID:25542218 DOI:10.1007/s00261-014-0335-2]