TY - JOUR
T1 - Value of multidetector CT in decision making regarding surgery in patients with small-bowel obstruction due to adhesion
AU - Hwang, Ji Young
AU - Lee, Jeong Kyong
AU - Lee, Jee Eun
AU - Baek, Seung Yon
PY - 2009
Y1 - 2009
N2 - The aim of this study was to evaluate the value of use of multidetector CT (MDCT) to predict the need for subsequent surgery in patients with small-bowel obstruction (SBO) due to adhesion. During a 3-year period, 128 patients with an SBO due to adhesion were enrolled in this prospective study. Initially, all patients were treated conservatively. Surgery was performed in patients who developed signs of strangulation or did not improve, despite a conservative treatment for at least 5 days. Of the 128 patients, 37 patients eventually underwent surgery. Two radiologists interpreted MDCT findings regarded as predictive indicators for subsequent surgery in consensus. The findings included degree of SBO, presence of transition zone, and an abnormal vascular course. These findings were statistically compared between the group operated on and the group not operated on. A higher degree of SBO, an abnormal vascular course, and the presence of transition zone were more frequently seen in the group of patients operated on (p<0.001). Sensitivities, specificities, positive and negative predictive values, and risks for the use of MDCT to predict the need for surgery were 100%, 46.1%, 43%, 100%, and 1.9 (1.5≤95% confidence interval (CI)≤2.2) for a high-grade obstruction; 100%, 23%, 34.5%, 100%, and 1.3 (1.2≤95% Cl≤1.5) for the presence of a transition zone; and 70.2%, 90.1%, 74.2%, 88.1%, and 7.1 (3.7≤95% CI≤13.7) for the presence of an abnormal course of the mesenteric vessels, respectively. The presence of a high degree of SBO and an abnormal vascular course around transition zone are useful indicators on MDCT to predict the need for surgery in patients with an SBO due to adhesion.
AB - The aim of this study was to evaluate the value of use of multidetector CT (MDCT) to predict the need for subsequent surgery in patients with small-bowel obstruction (SBO) due to adhesion. During a 3-year period, 128 patients with an SBO due to adhesion were enrolled in this prospective study. Initially, all patients were treated conservatively. Surgery was performed in patients who developed signs of strangulation or did not improve, despite a conservative treatment for at least 5 days. Of the 128 patients, 37 patients eventually underwent surgery. Two radiologists interpreted MDCT findings regarded as predictive indicators for subsequent surgery in consensus. The findings included degree of SBO, presence of transition zone, and an abnormal vascular course. These findings were statistically compared between the group operated on and the group not operated on. A higher degree of SBO, an abnormal vascular course, and the presence of transition zone were more frequently seen in the group of patients operated on (p<0.001). Sensitivities, specificities, positive and negative predictive values, and risks for the use of MDCT to predict the need for surgery were 100%, 46.1%, 43%, 100%, and 1.9 (1.5≤95% confidence interval (CI)≤2.2) for a high-grade obstruction; 100%, 23%, 34.5%, 100%, and 1.3 (1.2≤95% Cl≤1.5) for the presence of a transition zone; and 70.2%, 90.1%, 74.2%, 88.1%, and 7.1 (3.7≤95% CI≤13.7) for the presence of an abnormal course of the mesenteric vessels, respectively. The presence of a high degree of SBO and an abnormal vascular course around transition zone are useful indicators on MDCT to predict the need for surgery in patients with an SBO due to adhesion.
KW - Abdomen
KW - CT
KW - Intestinal obstruction
KW - Small intestine
UR - http://www.scopus.com/inward/record.url?scp=70349863019&partnerID=8YFLogxK
U2 - 10.1007/s00330-009-1424-4
DO - 10.1007/s00330-009-1424-4
M3 - Article
C2 - 19415288
AN - SCOPUS:70349863019
SN - 0938-7994
VL - 19
SP - 2425
EP - 2431
JO - European Radiology
JF - European Radiology
IS - 10
ER -