Optimized Protocol of Multiple Post-Processing Techniques Improves Diagnostic Accuracy of Multi-Detector Computed Tomography for Assessing Small Bowel Obstruction Compared with Conventional Axial and Coronal Reformations

Abstract

Background: To systemically evaluate the diagnostic accuracy and time efficiency of an optimized protocol of multiple post-processing techniques on multi-detector computed tomography (MDCT) used to small bowel obstruction (SBO) and secondary small bowel ischemia. Methods: A total of 106 adults with clinically suspected SBO were included in this institutional review board-approved retrospective study. Two abdominal radiologists performed image post-processing and interpretation for MDCT volume data of patients using three different post-processing protocols at intervals of every other month, respectively. With surgical and/or pathological findings as the gold standard, these protocols were compared regarding relevant time spend, number of images, diagnostic self-confidence, agreement, detection rate, accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of them used to assess SBO and secondary small bowel ischemia. Results: Time spend and number of images for protocol 2 were more than for protocols 1 and 3 (P .05). In the performance of protocol 3, both readers added multiple post-processing techniques at frequencies of 29.2% and 34.9% respectively for obstruction cause, and 32.1% and 30.2% respectively for secondary small bowel ischemia. For the total detection rate of obstruction cause and secondary small bowel ischemia, protocols 2 and 3 were higher (P = .001) than protocol 1, but no difference (P > .05) was detected between protocols 2 and 3. The accuracy, sensitivity, specificity, PPV and NPV of protocols 2 and 3 were superior to protocol 1 for evaluating obstruction cause and secondary small bowel ischemia. Conclusions: Optimized protocol of multiple post-processing techniques can both guarantee time efficiency and improve diagnostic accuracy of MDCT for assessing SBO and secondary small bowel ischemia. Funding: This work was supported in part by a research grant from the National Natural Science Foundation of China (81671943). The funder had no role in study design, data collection, data analysis, data interpretation, or the writing of the manuscript. Declaration of Interest: The authors have no financial conflicts to declare. Ethical Approval: This study was approved by the ethics committee of our hospital. A waiver of informed consent was obtained for this study.