European Radiology

, Volume 23, Issue 2, pp 388–399 | Cite as

Helical CT-enteroclysis in the detection of small-bowel tumours: a meta-analysis

  • Philippe Soyer
  • Mounir Aout
  • Christine Hoeffel
  • Eric Vicaut
  • Vinciane Placé
  • Mourad Boudiaf
Gastrointestinal
First Online:
Received:
Revised:
Accepted:

Abstract

Objective

To perform a meta-analysis to determine sensitivity and specificity estimates of helical CT-enteroclysis in the detection of small-bowel tumours.

Methods

A search for relevant articles published from January 1992 to November 2010 was performed. Study design, patient characteristics and 2 × 2 contingency tables were recorded for eligible studies. Heterogeneity was assessed with the I 2 statistic. A bivariate generalised linear random-effects model was used to summarise sensitivity and specificity estimates for small-bowel tumour detection on a per-patient basis. Sensitivity and specificity estimates were compared in different subgroups.

Results

Twelve studies (696 patients) were eligible. The mean small-bowel tumour prevalence was 22.6 % (range 7.7–45.8 %). Inter-study heterogeneity was substantial for sensitivity (I 2 = 66.9 %; 95 % CI 28.7–88.5 %) and low for specificity (I 2 = 10.6 %; 95 % CI 0.0–55.0 %). On a per-patient basis, pooled sensitivity was 92.8 % (95 % CI 71.3–98.5 %) and pooled specificity 99.2 % (95 % CI 94.2–99.9 %) for the diagnosis of small-bowel tumour. Subgroup analysis revealed that small-bowel preparation, more than one imaging pass and large volumes (≥2 L) of enteral contrast agent did not improve tumour detection.

Conclusion

Our meta-analysis confirms that helical CT-enteroclysis has high degrees of sensitivity and specificity for small-bowel tumour detection. However, our findings reinforce the need for more standardised individual studies.

Key Points

• Helical CT-enteroclysis is highly sensitive for the diagnosis of small-bowel tumours.

• Helical CT-enteroclysis is highly specific for the diagnosis of small-bowel tumours,

• Helical CT-enteroclysis can be used as a first-line investigation.

• A single enteric phase examination provides optimal tumour detection.

Keywords

CT-enteroclysis Small bowel tumors Meta-analysis Systematic review Diagnostic accuracy 
This is a preview of subscription content, log in to check access.

References

  1. 1.
    Maglinte DD, O’Connor K, Bessette J, Chernish SM, Kelvin FM (1991) The role of the physician in the late diagnosis of primary malignant tumors of the small intestine. Am J Gastroenterol 86:304–308PubMedGoogle Scholar
  2. 2.
    Ciresi DL, Scholten DJ (1995) The continuing clinical dilemma of primary tumors of the small intestine. Am Surg 61:698–703PubMedGoogle Scholar
  3. 3.
    Serour F, Dona G, Birkenfield S, Balassiano M, Krispin M (1992) Primary neoplasms of the small bowel. J Surg Oncol 49:29–34PubMedCrossRefGoogle Scholar
  4. 4.
    Horton KM, Kamel I, Hofmann L, Fishman EK (2004) Carcinoid tumors of the small bowel: a multitechnique imaging approach. AJR Am J Roentgenol 182:559–667PubMedGoogle Scholar
  5. 5.
    Klöppel R, Thiele J, Bosse J (1992) The Sellink CT method. Rofo 156:291–292PubMedCrossRefGoogle Scholar
  6. 6.
    Soyer P, Boudiaf M, Fishman EK et al (2011) Imaging of malignant neoplasms of the mesenteric small bowel: new trends and perspectives. Crit Rev Oncol Hematol 80:10–30PubMedCrossRefGoogle Scholar
  7. 7.
    Maglinte DD, Sandrasegaran K, Lappas JC (2007) CT enteroclysis: techniques and applications. Radiol Clin North Am 45:289–301PubMedCrossRefGoogle Scholar
  8. 8.
    Sailer J, Peloschek P, Schober E et al (2005) Diagnostic value of CT enteroclysis compared with conventional enteroclysis in patients with Crohn’s disease. AJR Am J Roentgenol 185:1575–1581PubMedCrossRefGoogle Scholar
  9. 9.
    Soyer P, Boudiaf M, Sirol M et al (2010) Suspected anastomotic recurrence of Crohn disease after ileocolic resection: evaluation with CT enteroclysis. Radiology 254:755–764PubMedCrossRefGoogle Scholar
  10. 10.
    Soyer P, Boudiaf M, Dray X et al (2009) CT enteroclysis features of uncomplicated celiac disease: retrospective analysis of 44 patients. Radiology 253:416–424PubMedCrossRefGoogle Scholar
  11. 11.
    Kohli MD, Maglinte DD (2009) CT enteroclysis in small bowel Crohn’s disease. Eur J Radiol 69:398–403PubMedCrossRefGoogle Scholar
  12. 12.
    Kohli MD, Maglinte DD (2009) CT enteroclysis in incomplete small bowel obstruction. Abdom Imaging 34:321–327PubMedCrossRefGoogle Scholar
  13. 13.
    Filippone A, Cianci R, Milano A, Valeriano S, Di Mizio V, Storto ML (2008) Obscure gastrointestinal bleeding and small bowel pathology: comparison between wireless capsule endoscopy and multidetector-row CT enteroclysis. Abdom Imaging 33:398–406PubMedCrossRefGoogle Scholar
  14. 14.
    Johanssen S, Boivin M, Lochs H, Voderholzer W (2006) The yield of wireless capsule endoscopy in the detection of neuroendocrine tumors in comparison with CT enteroclysis. Gastrointest Endosc 63:660–665PubMedCrossRefGoogle Scholar
  15. 15.
    Staunton M (2007) Evidence-based radiology: steps 1 and 2—asking answerable questions and searching for evidence. Radiology 242:23–31PubMedCrossRefGoogle Scholar
  16. 16.
    Berlin JA (1997) Does blinding of readers affect the results of meta-analyses? University of Pennsylvania Meta-analysis Blinding Study Group. Lancet 350:185–186PubMedCrossRefGoogle Scholar
  17. 17.
    Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J (2003) The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 3:25PubMedCrossRefGoogle Scholar
  18. 18.
    Reitsma JB, Glas AS, Rutjes AW, Scholten RJ, Bossuyt PM, Zwinderman AH (2005) Bivariate analysis of sensitivity and specificities produces informative summary measures in diagnostic reviews. J Clin Epidemiol 58:982–990PubMedCrossRefGoogle Scholar
  19. 19.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560PubMedCrossRefGoogle Scholar
  20. 20.
    Menke J (2010) Bivariate random-effects meta-analysis of sensitivity and specificity with SAS PROC GLIMMIX. Methods Inf Med 49:62–64Google Scholar
  21. 21.
    Van Houwelingen HC, Zwinderman KH, Stijnen T (1993) A bivariate approach to meta-analysis. Stat Med 12:2273–2284PubMedCrossRefGoogle Scholar
  22. 22.
    Van Houwelingen HC, Arends LR, Stijnen T (2002) Advanced methods in meta-analysis: multivariate approach and meta-regression. Stat Med 21:589–624PubMedCrossRefGoogle Scholar
  23. 23.
    Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634PubMedCrossRefGoogle Scholar
  24. 24.
    Pilleul F, Penigaud M, Milot L, Saurin JC, Chayvialle JA, Valette PJ (2006) Possible small-bowel neoplasms: contrast-enhanced and water-enhanced multidetector CT enteroclysis. Radiology 241:796–801PubMedCrossRefGoogle Scholar
  25. 25.
    Jain TP, Gulati MS, Makharia GK, Bandhu S, Garg PK (2007) CT enteroclysis in the diagnosis of obscure gastrointestinal bleeding: initial results. Clin Radiol 62:660–667PubMedCrossRefGoogle Scholar
  26. 26.
    Onoda H, Shimizu K, Washida Y et al (2010) Usefulness of computed tomography enteroclysis in the intestinal tract. Jpn J Radiol 28:193–198PubMedCrossRefGoogle Scholar
  27. 27.
    Minordi LM, Vecchioli A, Guidi L, Mirk P, Fiorentini L, Bonomo L (2006) Multidetector CT enteroclysis versus barium enteroclysis with methylcellulose in patients with suspected small bowel disease. Eur Radiol 16:1527–1536PubMedCrossRefGoogle Scholar
  28. 28.
    Minordi LM, Vecchioli A, Mirk P, Bonomo L (2011) CT enterography with polyethylene glycol solution vs CT enteroclysis in small bowel disease. Br J Radiol 84:112–119PubMedCrossRefGoogle Scholar
  29. 29.
    Saurin JC, Pilleul F, Soussan EB et al (2010) Small-bowel capsule endoscopy diagnoses early and advanced neoplasms in asymptomatic patients with Lynch syndrome. Endoscopy 42:1057–1062PubMedCrossRefGoogle Scholar
  30. 30.
    Voderholzer WA, Ortner M, Rogalla P, Beinhölzl J, Lochs H (2003) Diagnostic yield of wireless capsule enteroscopy in comparison with computed tomography enteroclysis. Endoscopy 35:1009–1014PubMedCrossRefGoogle Scholar
  31. 31.
    Khalife S, Soyer P, Alatawi A et al (2011) Obscure gastrointestinal bleeding: preliminary comparison of 64-section CT enteroclysis with video capsule endoscopy. Eur Radiol 21:79–86PubMedCrossRefGoogle Scholar
  32. 32.
    Kamaoui I, De-Luca V, Ficarelli S, Mennesson N, Lombard-Bohas C, Pilleul F (2010) Value of CT enteroclysis in suspected small-bowel carcinoid tumors. AJR Am J Roentgenol 194:629–633PubMedCrossRefGoogle Scholar
  33. 33.
    Orjollet-Lecoanet C, Ménard Y, Martins A, Crombé-Ternamian A, Cotton F, Valette PJ (2000) CT enteroclysis for detection of small bowel tumors. J Radiol 81:618–627PubMedGoogle Scholar
  34. 34.
    Rajesh A, Sandrasegaran K, Jennings SG et al (2009) Comparison of capsule endoscopy with enteroclysis in the investigation of small bowel disease. Abdom Imaging 34:459–566PubMedCrossRefGoogle Scholar
  35. 35.
    Boudiaf M, Jaff A, Soyer P, Bouhnik Y, Hamzi L, Rymer R (2004) Small-bowel diseases: prospective evaluation of multi-detector row helical CT enteroclysis in 107 consecutive patients. Radiology 233:338–344PubMedCrossRefGoogle Scholar
  36. 36.
    Littenberg B, Moses LE (1993) Estimating diagnostic accuracy from multiple conflicting reports: a new meta-analytic method. Med Decis Making 13:313–321PubMedCrossRefGoogle Scholar
  37. 37.
    Moses LE, Shapiro D, Littenberg B (1993) Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations. Stat Med 12:1293–1316PubMedCrossRefGoogle Scholar
  38. 38.
    Rutter CM, Gatsonis CA (1995) Regression methods for meta-analysis of diagnostic test data. Acad Radiol 2:S48–S56PubMedGoogle Scholar
  39. 39.
    Rutter CM, Gatsonis CA (2001) A hierarchical regression approach to meta-analysis of diagnostic test accuracy evaluations. Stat Med 20:2865–2884PubMedCrossRefGoogle Scholar
  40. 40.
    Lijmer JG, Mol BW, Heisterkamp S et al (1999) Empirical evidence of design-related bias in studies of diagnostic tests. JAMA 282:1061–1066PubMedCrossRefGoogle Scholar
  41. 41.
    Niekel MC, Bipat S, Stoker J (2010) Diagnostic imaging of colorectal liver metastases with CT, MR imaging, FDG PET, and/or FDG PET/CT: a meta-analysis of prospective studies including patients who have not previously undergone treatment. Radiology 257:674–684PubMedCrossRefGoogle Scholar
  42. 42.
    Hristova L, Placé V, Nemeth J, Boudiaf M, Laurent V, Soyer P (2012) Small bowel tumors: spectrum of findings on 64-section CT enteroclysis with pathologic correlation. Clin Imaging 36:104–112PubMedCrossRefGoogle Scholar
  43. 43.
    Pelage JP, Soyer P, Boudiaf M et al (1999) Carcinoid tumors of the abdomen: CT features. Abdom Imaging 24:240–245PubMedCrossRefGoogle Scholar
  44. 44.
    Soyer P (2012) Obscure gastrointestinal bleeding: difficulties in comparing CT enterography and video capsule endoscopy. Eur Radiol 22:1167–1171PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Philippe Soyer
    • 1
    • 2
  • Mounir Aout
    • 3
  • Christine Hoeffel
    • 4
  • Eric Vicaut
    • 2
    • 3
  • Vinciane Placé
    • 1
    • 2
  • Mourad Boudiaf
    • 1
  1. 1.Department of Abdominal ImagingHôpital Lariboisière, Assistance Publique-Hôpitaux de ParisParis cedex 10France
  2. 2.Université Paris-DiderotParisFrance
  3. 3.Clinical Research UnitHôpital Lariboisière, Assistance Publique-Hôpitaux de ParisParis cedex 10France
  4. 4.Department of RadiologyHôpital Robert DebréReims CedexFrance

Personalised recommendations