Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Oct 28, 2023; 15(10): 281-292
Published online Oct 28, 2023. doi: 10.4329/wjr.v15.i10.281
Does the use of computed tomography scenogram alone enable diagnosis in cases of bowel obstruction?
Ozlem Kadirhan, Volkan Kızılgoz, Sonay Aydin, Esra Bilici, Ekrem Bayat, Mecit Kantarci
Ozlem Kadirhan, Volkan Kızılgoz, Sonay Aydin, Esra Bilici, Ekrem Bayat, Mecit Kantarci, Department of Radiology, Erzincan Binali Yıldırım University, Faculty of Medicine, Erzincan 24000, Turkey
Mecit Kantarci, Department of Radiology, Ataturk University, Faculty of Medicine, Erzurum 25000, Turkey
Author contributions: Kadirhan O, Kızılgoz V, Aydin S, Bilici E, Bayat E, Kantarci M contributed to conceptualization, validation, formal analysis, resources, data curation; Kadirhan O, Kızılgoz V, and Aydin S contributed to methodology, investigation, writing – original draft preparation, writing – review & editing, visualization, supervision; Kadirhan O and Aydin S contributed to project administration.
Institutional review board statement: The research undertaken in this study received approval from the Erzincan University Ethics Committee (Decision no: E-21142744 804.01-128338 Date: 07/12/ 2021) and was carried out in compliance with the principles outlined in the Declaration of Helsinki.
Informed consent statement: As the study was designed retrospectively, no written informed consent form was obtained from patients.
Conflict-of-interest statement: All the authors have no conflicts of interest to declare.
Data sharing statement: Participants approved publication of their data after anonymization.
Open-Access: This article 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 NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sonay Aydin, MD, Associate Professor, Department of Radiology, Erzincan Binali Yıldırım University, Faculty of Medicine, Haci Ali Akin cd., Erzincan 24000, Turkey. sonay.aydin@erzincan.edu.tr
Received: July 28, 2023
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
Processing time: 87 Days and 17.8 Hours
Abstract
BACKGROUND

Ileus is a pathological condition of the abdomen that presents as a medical emergency. It is characterized by potential complications such as perforation and ischemia, which can lead to significant morbidity and mortality if not promptly addressed. The successful management of ileus relies heavily on the timely and precise identification of the condition. While conventional radiography (CR) is commonly used as the primary diagnostic tool, its accuracy in identifying obstructions ranges from 46% to 80%. Furthermore, the diagnostic accuracy of identifying the location and etiology of intestinal obstruction by CR is limited, therefore making computed tomography (CT) the ideal imaging modality in this regard.

AIM

To determine the presence of acute bowel obstruction (BO) on abdominal CT scenogram images and the accuracy of determining its possible location, taking into account the experience of the observers.

METHODS

A retrospective screening was conducted on an ensemble of 46 individuals who presented to the emergency department between January 2021 and January 2022 with severe abdominal pain and were subsequently monitored for suspected ileus. The abdominal CT scans of these patients were assessed by three radiologists with varying levels of experience (1, 3, and 10 years) at different intervals (1 mo apart). The evaluation focused on determining the presence or absence of BO, as well as identifying the potential location of the obstruction (small bowel or large bowel). The study employed Kappa statistics to assess inter-observer variances, while the McNamer test was used to evaluate obstruction and segmentation discrepancies between observations. A significance level of P < 0.05 was determined to indicate statistical significance.

RESULTS

Out of the total sample size of 46 patients, 15 individuals (32.6%) were identified as female, while the remaining 31 individuals (67.4%) were identified as male. The ultimate diagnosis of 42 instances (91.3%) indicated ileus resulting from mechanical obstruction (MO). Among these patients, 14 (33%) experienced obstruction in the large bowel (LB), while 28 (66%) experienced obstruction in the small bowel (SB). The initial evaluation yielded sensitivity rates of 76.19%, 83.31%, and 83.33%, and diagnostic accuracy rates of 69.56%, 76.08%, and 80.43% for the detection of BO among the three observers. The initial study revealed that the average sensitivity of three observers in detecting the presence of ileus caused by MO was 80.94%, while the diagnostic accuracy was 75.35%. Based on the first evaluation, the senior observer demonstrated the highest sensitivity (85.71%), negative predictive value (92.60%), and diagnostic accuracy (80.43%) when accurately estimating the thick and thin segmentation, as per the final diagnosis. There was no statistically significant disparity observed in the sensitivities pertaining to the identification of ileus during the second assessment, as well as the precise determination of the segment level inside the LB or SB, when comparing the second and third observers. Nevertheless, although there was no statistically significant alteration in the detection rate of ileus by the first observer, there was a notable rise in the accuracy rate of segment estimating (73.91%). The senior assessor had a higher level of accuracy in assessing the existence of ileus and segmentation compared to the other evaluators in both evaluations.

CONCLUSION

The findings of our study indicate that the sensitivity and accuracy rates of abdominal CT scenogram scans in diagnosing acute MOs are similar to or greater than those of CR. Additionally, the study revealed that radiologists with more experience demonstrated a higher likelihood of accurately predicting the existence and potential localization of MO compared to their less experienced counterparts.

Keywords: Ileus; Computed tomography; Scenogram scan; Radiography

Core Tip: This retrospective study aims to determine the accuracy of detecting the presence and possible location of obstruction on computed tomography (CT) scenogram images of the abdomen, which can be used as the primary imaging method in the diagnosis of acute bowel obstruction, taking observer experience into account. The experienced observer had the highest sensitivity (83.33%), positive predictive value (94.59%), and diagnostic accuracy (80.43%) for detecting mechanical obstruction (MO). The diagnostic accuracy of the same observer in estimating the segmentation of a MO was 80.43%. These findings show that CT scenogram images alone can demonstrate high diagnostic accuracy and sensitivity in relation to years of experience in diagnosing ileus.