Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2019; 25(9): 1100-1115
Published online Mar 7, 2019. doi: 10.3748/wjg.v25.i9.1100
Optimized protocol of multiple post-processing techniques improves diagnostic accuracy of multidetector computed tomography in assessment of small bowel obstruction compared with conventional axial and coronal reformations
Lian-Qin Kuang, Wei Tang, Ran Li, Cheng Cheng, Shuang-Yue Tang, Yi Wang
Lian-Qin Kuang, Wei Tang, Ran Li, Cheng Cheng, Shuang-Yue Tang, Yi Wang, Department of Radiology, Army Medical Center of PLA, Army Medical University, Chongqing 400042, China
Wei Tang, Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
Author contributions: Wang Y and Kuang LQ contributed to study conception and design; all authors contributed to data acquisition; Kuang LQ and Tang W contributed to data analysis and interpretation; Li R contributed to statistical analysis; Wang Y and Kuang LQ obtained funding; Cheng C and Tang SY contributed to technical or material support; Wang Y contributed to study supervision; all authors were involved in manuscript drafting or revision for important intellectual content, and final version approval; Wang Y contributed to manuscript editing.
Supported by the National Natural Science Foundation of China, No. 81671943.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee at Army Medical Center of PLA, Army Medical University, China.
Informed consent statement: Patients were not required to provide informed consent for the study because the analysis used anonymous clinical data that were obtained after the completion of treatment.
Conflict-of-interest statement: None of the authors have conflicts of interest that are related to the work submitted for consideration for publication. There are no commercial, personal, intellectual, political, or religious interests by any of the authors.
Data sharing statement: No additional data are available.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yi Wang, MD, PhD, Assistant Professor, Department of Radiology, Army Medical Center of PLA, Army Medical University, No. 10, Changjiangzhilu Daping, Yuzhong District, Chongqing 400042, China. ywhxl@qq.com
Telephone: +86-23-68757622 Fax: +86-23-68757620
Received: December 11, 2018
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
Processing time: 86 Days and 15.4 Hours
Abstract
BACKGROUND

Axial and coronal reformations have been a widely used image post-processing protocol for the ordinary multidetector computed tomography (MDCT) examination of patients with small bowel obstruction (SBO) or other abdominal diseases. The diagnostic accuracy of MDCT for assessing SBO is expected to be further improved through the use of multiple post-processing techniques.

AIM

To systemically evaluate the diagnostic accuracy and efficiency of an optimized protocol using multiple post-processing techniques for MDCT assessment of SBO and secondary bowel ischemia.

METHODS

This retrospective cross-sectional study included 106 patients with clinically suspected SBO. Two readers applied three protocols to image post-processing and interpretation of patients’ MDCT volume data. We compared the three protocols based on time spent, number of images, diagnostic self-confidence, agreement, detection rate, and accuracy of detection of SBO and secondary bowel ischemia.

RESULTS

Protocol 2 resulted in more time spent and number of images than protocols 1 and 3 (P < 0.01), but the results of the two readers using the same protocol were not different (P > 0.05). Using protocol 3, both readers 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. Protocols 2 and 3 had higher total detection rates of obstruction cause and secondary bowel ischemia than protocol 1 (P < 0.01), but no difference was detected between protocols 2 and 3 (P > 0.05). The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of protocols 2 and 3 were superior to those of protocol 1 for evaluating obstruction cause and secondary bowel ischemia.

CONCLUSION

Our optimized protocol of multiple post-processing techniques can both guarantee efficiency and improve diagnostic accuracy of MDCT for assessing SBO and secondary bowel ischemia.

Keywords: Intestine; Intestinal obstruction; Multidetector computed tomography; Diagnostic techniques and procedures

Core tip: Axial and coronal reformations are inadequate for multidetector computed tomography (MDCT) used to identify some causes of small bowel obstruction (SBO) and secondary bowel ischemia. In our study, both integrated and optimized protocols of multiple post-processing techniques can improve the diagnostic accuracy of MDCT for assessing SBO, but the integrated protocol necessitates a longer time spent and increases the workload of radiologists. The optimized protocol can both guarantee the time efficiency and improve the diagnostic accuracy of MDCT for assessing SBO and secondary bowel ischemia. The optimized protocol can be considered as a routine image post-processing approach of MDCT for assessment of patients with SBO.