Published online Oct 28, 2023. doi: 10.4329/wjr.v15.i10.281
Peer-review started: July 28, 2023
First decision: September 14, 2023
Revised: September 26, 2023
Accepted: October 11, 2023
Article in press: October 11, 2023
Published online: October 28, 2023
The effective management of ileus is heavily reliant on prompt and precise diagnosis, as a failure to achieve this may lead to adverse health outcomes and potential loss of life. While conventional radiography (CR) is commonly used as the primary imaging modality for patients with a preliminary diagnosis of ileus, its diagnostic accuracy in identifying the specific site and underlying cause of bowel obstruction (BO) is limited. Due to this constraint, computed tomography (CT) has emerged as the most suitable imaging modality in this particular situation.
CT scenogram images have the potential to assess several entities, encompassing air-related observations such as intestinal gas pattern, pneumoperitoneum, and pneumatosis. However, there are reports showing that scenogram images are omitted from CT scan examinations up to 75% of the time, or alternatively, ignored by the majority of radiologists when interpreting CT examinations. There exists a singular study within the literature that investigates the diagnostic sensitivity of CT scans in detecting BO, specifically considering the varying levels of expertise among different observers. Our intention was to make a scholarly contribution within this particular field of study.
This study aims to determine the presence of acute BO on abdominal CT scenogram images and the accuracy with which its possible location can be determined, taking into account the experience of the observers.
A retrospective screening was performed on a group of 46 people who arrived at the emergency room with acute abdominal pain between January 2021 and January 2022 and were subsequently evaluated for suspected ileus. The patients' abdominal CT images were evaluated at different intervals (1 mo apart) by three radiologists with varying degrees of expertise (1, 3, and 10 years). The assessment focused on establishing the presence or absence of BO as well as the likely location of the obstruction (small bowel or large bowel).
In the first evaluation by 3 radiologists to detect the presence of BO, the rate of detecting the presence of ileus due to mechanical obstruction (MO) was 80.94% and the diagnostic accuracy was 75.35%. Among all observers, the third observer had the highest sensitivity (83.33%), positive predictive value (94.59%), and diagnostic accuracy (80.43%). Considering the segmentation according to the final diagnosis at the first evaluation, the sensitivity (85.71%) and diagnostic accuracy (80.43%) values were highest in the senior observer's correct estimation of the large and small bowel segmentation. In the second evaluation, the senior observer's prediction of the presence of ileus and segmentation was more accurate than the other observers. Compared to the second evaluation, while there was no significant change in the rate of the first observer detecting the presence of ileus, there was an increase in the rate of correctly predicting the segmentation (73.91%). No significant change was detected in the other observers' estimates of the presence of MO and possible localization at different periods.
Our results show that the sensitivity and accuracy of abdominal CT scenogram images in detecting the presence and segmentation of acute MO in relation to seniority is similar to or higher than CR.
Considering the possible contribution of CT scenogram images to the diagnosis of some pathologies such as ileus, more studies are needed to diagnose these and similar pathologies and to narrow down the differential diagnosis.