Four CT signs could help clinicians predict ischemia in patients with small bowel obstruction (SBO), researchers have reported.
The identified signs “could be prioritized when interpreting CT examinations in patients with SBO to help guide surgical decision-making,” wrote a team led by Paul Le Corre, MD, of the Hôpital Paris Saint-Joseph in Paris, France. The study findings were published April 29 in the American Journal of Roentgeonology.
CT imaging is an established modality for diagnosing SBO, but the performance of individual CT signs for diagnosing ischemia or necrosis remains unclear, the group wrote.
“Although ischemia and necrosis exist on a clinical spectrum that typically warrants surgical intervention, their differentiation remains of paramount importance, [as] reversible ischemia may allow simple adhesiolysis with bowel preservation, whereas necrosis typically mandates bowel resection,” it explained.
Le Corre and colleagues performed a meta-analysis of 19 studies culled from the Medline, Embase, and Web of Science databases from April 2024 regarding the identification of surgically confirmed bowel ischemia and/or pathologically confirmed bowel necrosis in patients with SBO.
The studies reported on 2,453 patients with 2,489 SBO episodes; of these, 30% of patients had ischemia and 37% had necrosis.
The group considered CT imaging signs predictive of these conditions if they showed pooled specificity that exceeded 85% and a diagnostic odds ratio (DOR) that exceeded 10. They were considered to exclude an outcome if they had a negative likelihood ratio (NLR) less than 0.10.
The researchers assessed 14 signs for ischemia, and found the following four to be predictive of the condition:
- Increased unenhanced bowel wall attenuation (specificity 98%, DOR 30.5, sensitivity 36%);
- Reduced bowel wall enhancement (specificity 92%, DOR 15.8, sensitivity 55%);
- Diffuse mesenteric haziness (specificity 89%, DOR 22.3, sensitivity 72%); and
- Closed-loop configuration (specificity 85%, DOR 19.6, sensitivity 75%).
They then evaluated 11 of the 14 signs on CT imaging for necrosis, finding that only one was predictive: increased unenhanced bowel wall attenuation (specificity 92%, DOR 18, sensitivity 55%). Le Corre and colleagues reported that “no sign had sufficiently low NLR to reliably exclude either outcome.”
The study results could help clinicians better triage patients to earlier surgery and possible resection, the authors concluded, noting that “prioritization of the predictive signs may help avoid delayed intervention and associated morbidity in patients with complicated SBO.”
Access the full review here.