Low-dose CT for diagnosing intestinal obstruction and pneumoperitoneum; need for retakes and diagnostic accuracy

Larsen, Nis Elbrønd; Mikkelsen, E.; Knudsen, Aage; Larsen, Lars

doi:10.1177/2058460121989313

Cited by 3 publications

(2 citation statements)

References 14 publications

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“…Currently, with a sensitivity and specificity of 94% and 96%, respectively, for the diagnosis of intestinal obstruction [21], multi-slice spiral CT(MSCT) imaging has been widely applied in clinical practice. Moreover, broad consensus has been reached on the value of CT imaging in assessing whether intestinal obstruction requires surgical intervention [22][23][24][25][26][27][28]. e comprehensive sensitivity and specificity are 87% and 73%, respectively, while two imaging signs are pivotal for determining whether it is necessary to perform surgical intervention, namely, local ischemia and complex signs [29].…”

Section: Discussionmentioning

confidence: 99%

Imaging Signs for Determining Surgery Timing of Acute Intestinal Obstruction

Shi²,

Zhang³

et al. 2022

Contrast Media & Molecular Imaging

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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.

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Section: Discussionmentioning

confidence: 99%

Imaging Signs for Determining Surgery Timing of Acute Intestinal Obstruction

Shi²,

Zhang³

et al. 2022

Contrast Media & Molecular Imaging

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“…In adults, perforated viscus is the leading cause of pneumoperitoneum, representing 85-95% of cases, and among these, surgical pneumoperitoneum comprises 85-90% 1,2 . Diagnostic tools for identifying pneumoperitoneum include plain radiographs, ultrasound, and Computed Tomography (CT) scan, with the latter remaining the gold standard, exhibiting reported sensitivity levels of approximately 96-100% 3 . Timely diagnosis of pneumoperitoneum is crucial, as delayed recognition can lead to sepsis and result in increased mortality and morbidity 4,5 .…”

Section: Introductionmentioning

confidence: 99%

PACT-3D, a Deep Learning Algorithm for Pneumoperitoneum Detection in Abdominal CT Scans

Chiu,

Huang,

Kuo

2024

Preprint

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Pneumoperitoneum, necessitates surgical intervention in 85-90% of cases, relies heavily on CT scans for diagnosis. Delay or misdiagnosis in detecting pneumoperitoneum can significantly increase mortality and morbidity. Our study introduced PACT-3D, a deep learning model developed to identify pneumoperitoneum in CT images. In this single hospital study, we retrospectively reviewed abdominal CT scans from January 2012 to December 2021, excluded CT of image acquisition error and without reports to form the development dataset for training the model. We evaluated the PACT- 3D model using a simulated test set of 14,039 scans and a prospective test set of 6,351 scans, collected from December 2022 to May 2023 at the same center. PACT-3D achieved a sensitivity of 0.81 and a specificity of 0.99 in retrospective testing, with prospective validation yielding a sensitivity of 0.83 and a specificity of 0.99. Sensitivity improved to 0.95 and 0.98 when excluding cases with a small amount of free air (total volume < 10ml) in simulated and prospective test sets, respectively. By delivering accurate and consistent patient-level predictions and providing segmented masks, PACT- 3D holds significant potential for assisting rapid decision-making in emergency care, thereby potentially improving patient outcomes.

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