分析计算机断层扫描(CT)图像上相对于穿孔位置的游离腹部气体和腹水的量。
我们回顾性纳入172例GIT穿孔患者(93:79=m:f),谁接受了腹部手术(穿孔位置的地面实况)。由4位放射科医生和半自动软件在CT图像上量化了游离空气和腹水的体积。通过Mann-Whitney检验分析了穿孔位置(上/下GIT)与游离空气和腹水量的关系。此外,上部和下部GIT穿孔的最佳体积截止,曲线下面积(AUC),和读者之间的体积协议进行了评估。
有明显更多的腹部腹水与上GIT穿孔(333毫升,范围为5至2000毫升)比具有较低的GIT穿孔(100毫升,范围5到2000毫升,p=0.022)。最大体积的自由空气被发现与胃的穿孔,降结肠和乙状结肠。与上述相比,小肠和升结肠穿孔的自由空气明显减少。腹水体积>333ml与上部GIT穿孔相关,表明AUC为0.63±0.04。
使用基于自由空气和自由流体体积的两步过程可以帮助将穿孔部位定位到上部,中或下胃肠道。
To analyze the amount of free abdominal gas and ascites on computed tomography (CT) images relative to the location of a perforation.
We retrospectively included 172 consecutive patients (93:79 = m:f) with GIT perforation, who underwent abdominal surgery (ground truth for perforation location). The volume of free air and ascites were quantified on CT images by 4 radiologists and a semiautomated software. The relation of the perforation location (upper/lower GIT) and amount of free air and ascites was analyzed by the Mann-Whitney test. Furthermore, best volume cutoff for upper and lower GIT perforation, areas under the curve (AUC), and interreader volume agreement were assessed.
There was significantly more abdominal ascites with upper GIT perforation (333 ml, range 5 to 2000 ml) than with lower GIT perforation (100 ml, range 5 to 2000 ml, p = 0.022). The highest volume of free air was found with perforations of the stomach, descending colon and sigmoid colon. Significantly less free air was found with perforations of the small bowel and ascending colon compared to the aforementioned. An ascites volume > 333 ml was associated with an upper GIT perforation demonstrating an AUC of 0.63 ± 0.04.
Using a two-step process based on the volumes of free air and free fluid can help localizing the site of perforation to the upper, middle or lower GI tract.