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CT diagnosis of the nature of bowel obstruction: morphological evaluation of the transition point

Diagnosi TC della natura di un’occlusione intestinale: valutazione morfologica del punto di transizione

  • Abdominal Radiology / Radiologia Addominale
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

This study evaluated transition-point morphology for defining the nature of bowel obstructions.

Materials and methods

Computed tomography (CT) examinations of 95 patients affected by severe bowel obstruction (23 neoplastic, 72 nonneoplastic) were retrospectively reviewed.

Results

The transition point was identified in 89 patients (94%); morphology in relation to the proximal loop was concave in 64 cases (68%), linear in five (5%) and convex in 20 (21%). Concave transition-point morphology was indicative of a nonneoplastic condition, with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy values of 89%, 100%, 100%, 74% and 92%, respectively. A linear shape had almost identical incidence among neoplastic (60%) and nonneoplastic (40%) conditions. A convex appearance correlated with neoplastic disease with sensitivity, specificity, PPV, NPV and diagnostic accuracy values of 87%, 100%, 100%, 96% and 97%, respectively.

Conclusions

In the case of bowel obstruction, transitionpoint detection indicates the obstruction site, whereas its morphological evaluation can contribute to defining the nature of the obstruction. A concave morphology indicates a nonneoplastic condition with a high probability; a convex morphology correlates with neoplastic disease, whereas linearity is not significant.

Riassunto

Obiettivo

Scopo del nostro lavoro è stato valutare la morfologia del punto di transizione nella definizione della natura di un’occlusione.

Materiali e metodi

Sono stati valutati retrospettivamente gli esami in tomografia computerizzata (TC) di 95 pazienti affetti da occlusione intestinale di grado severo (23 neoplastiche, 72 non neoplastiche) ed è stata considerata la morfologia del punto di transizione.

Risultati

Il punto di transizione era evidente in 89 pazienti (94%) e la sua morfologia rispetto all’ansa a monte era concava in 64 pazienti (68%); lineare in 5 (5%); convessa in 20 (21%). Una morfologia concava del punto di transizione è risultata indicativa di una condizione non neoplastica, con valori di sensibilità, specificità, valore predittivo positivo (VPP), valore predittivo negativo (VPN) ed accuratezza diagnostica rispettivamente di 89%, 100%, 100%, 74% e 92%. Un aspetto lineare ha presentato incidenza quasi sovrapponibile nei casi di occlusione neoplastica (60%) e non neoplastica (40%). Un aspetto convesso è risultato correlato a patologia neoplastica, con valori di sensibilità, specificità, VPP, VPN ed accuratezza diagnostica rispettivamente di 87%, 100%, 100%, 96% e 97%.

Conclusioni

Nelle occlusioni intestinali il riconoscimento del punto di transizione indica la sede dell’occlusione, mentre la sua valutazione morfologica può contribuire a definirne la natura. Una morfologia concava indica, con elevato grado di probabilità, una condizione non neoplastica; una morfologia convessa, un’occlusione neoplastica, mentre un aspetto lineare non è significativo.

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Authors and Affiliations

  1. Di.M.I.M.P., Sezione di Diagnostica per Immagini, Policlinico Universitario, Piazza Giulio Cesare 11, 70124, Bari, Italy

    G. Angelelli, M. Moschetta, T. Cosmo, F. Binetti, A. Scardapane & A. A. Stabile Ianora

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  1. G. Angelelli
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  2. M. Moschetta
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  3. T. Cosmo
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  4. F. Binetti
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  5. A. Scardapane
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  6. A. A. Stabile Ianora
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Correspondence to G. Angelelli.

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Angelelli, G., Moschetta, M., Cosmo, T. et al. CT diagnosis of the nature of bowel obstruction: morphological evaluation of the transition point. Radiol med 117, 749–758 (2012). https://doi.org/10.1007/s11547-011-0770-x

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  • DOI: https://doi.org/10.1007/s11547-011-0770-x

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