Published online Mar 7, 2019. doi: 10.3748/wjg.v25.i9.1100
Peer-review started: December 11, 2018
First decision: January 23, 2019
Revised: February 13, 2019
Accepted: February 15, 2019
Article in press: February 15, 2019
Published online: March 7, 2019
Acute small bowel obstruction (SBO) is a common clinical syndrome for which effective treatment depends on a rapid and accurate diagnosis. Despite advances in imaging and a better understanding of small bowel pathophysiology, SBO is often diagnosed late or misdiagnosed, resulting in significant morbidity and mortality. Nowadays, multidetector computed tomography (MDCT) with multiple post-processing techniques has shown great potential in assessment of SBO and related complications, and the accuracy and agreement are expected to be further improved.
On the applications of MDCT multiple post-processing techniques in the assessment of SBO, only a few studies on multi-planar reformations have been reported in the current literature. In the MDCT assessment of SBO, how to reasonably apply these post-processing techniques to further improve the diagnostic accuracy is an important issue worth exploring further to radiologists.
This study aimed to integrate and optimize MDCT multiple post-processing techniques, and designed a retrospective cross-sectional study to systemically evaluate diagnostic accuracy and efficiency of the optimized protocol using multiple post-processing techniques on MDCT to assess SBO and secondary bowel ischemia.
This retrospective cross-sectional study was conducted in a single center of China for evaluation of an optimized protocol on multiple post-processing techniques for MDCT assessment of SBO and secondary bowel ischemia. Two radiologists applied three protocols to image post-processing and interpretation for MDCT volume data of 106 patients with clinically suspected SBO. We compared the optimized protocol with the other two protocols based on time spent, number of images, diagnostic self-confidence, agreement, and accuracy of detection of SBO and secondary bowel ischemia.
Using the optimized protocol, two radiologists added multiple post-processing techniques at frequencies of 29.2% and 34.9%, respectively, for obstruction cause, and 32.1% and 30.2%, respectively, for secondary bowel ischemia. The integrated protocol resulted in more time spent and number of images than the conventional and optimized protocols (P < 0.01), for the optimized protocol, the time spent and the number of images were only slightly more than those for the conventional protocol. The integrated and optimized protocols had higher total detection rates of obstruction cause and secondary bowel ischemia than the conventional protocol (P < 0.01), but no difference was detected between the two (P > 0.05). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the integrated and optimized protocols were superior to the conventional protocol for evaluating obstruction cause and secondary bowel ischemia, but these parameters between the two protocols were very close.
This is the first study to establish and evaluate an optimized protocol of the multiple post-processing techniques on MDCT used to assess SBO. The main deficiency of the integrated protocol was that it was inefficient. It took too long to complete and produced more images, which will inevitably increase the workload of radiologists. The optimized protocol can both guarantee the time efficiency and effectively control the number of images, and comprehensively improve the diagnostic self-confidence, agreement, accuracy of MDCT for determining the SBO severity, site and causes, and secondary bowel ischemia, which are critical because these imaging parameters can guide patient care.
Although the present study has several limitations, the optimized protocol can be considered for widespread recommendation in clinical practice of MDCT assessment of SBO and secondary bowel ischemia. Future studies should focus on applying this protocol to prospective, larger-sample clinical trials to further identify its advantages, disadvantages, and indications so that it can be continuously modified and improved.