Performance of CT in Detection of Bowel Injury

Performance of CT in Detection of Bowel Injury

The objective of our study was to identify relevant and reliable CT signs of bowel injury, to determine the overall performance of CT in detection of bowel injuries, and to establish the effect of the training level of radiologists on this performance. Abdominal CT scans of 112 patients with blunt a...

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Bibliographic Details
Published in:American journal of roentgenology (1976) Vol. 176; no. 1; pp. 129 - 135
Main Authors: Butela, Shawn T, Federle, Michael P, Chang, Paul J, Thaete, F. Leland, Peterson, Mark S, Dorvault, Christopher J, Hari, Anil K, Soni, Sonal, Branstetter, Barton F, Paisley, Kevin J, Huang, Lynn F
Format: Journal Article Conference Proceeding
Language:English
Published: Leesburg, VA Am Roentgen Ray Soc 01-01-2001
American Roentgen Ray Society
Subjects:
Abdominal Injuries - diagnostic imaging
Adolescent
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Digestive system
Female
Humans
Injuries of the abdomen. Foreign bodies of the digestive system
Intestines - diagnostic imaging
Intestines - injuries
Investigative techniques, diagnostic techniques (general aspects)
Male
Medical sciences
Middle Aged
Observer Variation
Prospective Studies
Radiodiagnosis. Nmr imagery. Nmr spectrometry
Retrospective Studies
ROC Curve
Tomography, X-Ray Computed
Traumas. Diseases due to physical agents
Wounds, Nonpenetrating - diagnostic imaging
Human
Evaluation
Radiodiagnosis
Radiologic sign
Trauma
Retrospective
Abdomen
Colonic disease
Sensitivity
Abdominal disease
Digestive diseases
Medical imagery
Complication
Computerized axial tomography
Diagnosis
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Summary:The objective of our study was to identify relevant and reliable CT signs of bowel injury, to determine the overall performance of CT in detection of bowel injuries, and to establish the effect of the training level of radiologists on this performance. Abdominal CT scans of 112 patients with blunt abdominal trauma were prospectively and retrospectively reviewed. Fifty patients had proven bowel injuries (with or without other visceral injuries), whereas 62 patients had no bowel injury and comprised the comparison or control group. Thirty-one of the 62 patients in the comparison group had surgical proof of abdominal but not bowel or mesenteric injuries. The retrospective review of the 112 CT scans was performed randomly and individually by nine radiologists unaware of the diagnosis, including three faculty abdominal radiologists, three senior residents in training, and three junior residents in training. Individual performance and group performance were evaluated by receiver operating characteristic analysis, and interobserver agreement was tested. Individual CT signs as relevant predictors of bowel injury were identified by logistic regression. Relevant predictors of bowel injury included mesenteric infiltration, bowel wall thickening, extravasation of vascular or enteric contrast agent, and the presence free air. In the retrospective blinded review, CT showed good to excellent interobserver reliability for individual CT signs as well as for diagnosis of bowel and visceral injuries. Faculty radiologists tended to diagnose injuries with greater accuracy and confidence, but they showed significantly better performance than residents only in diagnosing duodenal perforation. For the prospective CT diagnosis of bowel injury, CT had a sensitivity of 64%, an accuracy of 82%, and a specificity of 97%. Bowel injuries are challenging to diagnose on CT. Radiologists with various levels of experience and expertise can achieve accurate and reproducible results using a variety of CT criteria.
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ISSN:0361-803X
1546-3141
DOI:10.2214/ajr.176.1.1760129