Multi-slice spiral CT (MSCT) : value of evaluating intestinal ischemia and therapeutic strategy for patients with intestinal obstruction / 中国医师杂志

ABSTRACT

Objective To explore early signs of strangulated bowel with multi-slice spiral CT (MSCT),and the ability of this diagnostic modality to indicate when surgical management is required for intestinal obstruction with ischemia.Methods A total of 746 patients of intestinal obstruction were investigated with MSCT scan.The final diagnosis was confirmed by surgery and/or angiography.According to the final diagnosis,those cases were divided into ischemia groups (n =70) and no ischemia group (n =676).According to surgical findings,the cases in ischemia group was divided into necrosis group (n =31) and no-necrosis group (n =39).The clinical manifestations,CT signs,and surgical/angiography findings were retrospectively evaluated in this study.Results Among the typical MSCT signs for evaluating intestinal ischemia of intestinal obstruction,no enhancement,thickening,and reduced unenhanced attenuation of bowel wall had relatively high sensitivity and specificity.However,intestinal expansion,pneumatosis and effusion was absence of high specificity,and gas in bowel wall or mesenteric vascular was absence of high sensitivity.Mesenteric congestion was another important sign for intestinal ischemia.Filling defect in mesenteric vascular was highly specific to diagnosis intestinal ischemia.The MSCT signs to assess intestinal necrosis in moderate-high risk intestinal obstruction included no enhancement of bowel wall (sensitivity 0.93,specificity 0.69),mesenteric congestion (sensitivity 0.97,specificity 0.64),filling defect in mesenteric vascular (sensitivity 0.78,specificity 0.92),and ascites (sensitivity 0.77,specificity 0.92).Conclusions MSCT is an important non-invasive examination in diagnosing intestinal blood perfusion disorder and intestinal necrosis.It is much more valuable to bowel obstruction assessment than the value of symptom and physical examinations of the patient.It can provide valuable guidance to treatment strategy of bowel obstruction patient.