Journal Article

Diagnostic utility of CT for small bowel obstruction: Systematic review and meta-analysis

Liu, Xijiao, Song, Bin, Zhang, Ling, Li, Zhengyan, Yuan, Fang

2019

Overview

To perform a systematic review and meta-analysis evaluating the diagnostic performance of computed tomography (CT) for small bowel obstruction (SBO), including diagnostic accuracy, ischemia, predicting surgical intervention, etiology and transition point. PubMed/MEDLINE and related databases were searched for research articles published from their inception through August 2018. Findings were pooled using bivariate random-effects and summary receiver operating characteristic curve models. Meta-regression and subgroup analyses were performed to evaluate whether publication year, patient age, enhanced CT, slice thickness and pathogenesis affected classification accuracy. In total, 45 studies with a total of 4004 patients were included in the analysis. The pooled sensitivity and specificity of CT for SBO were 91% (95% confidence interval [CI]: 84%, 95%) and 89% (95% CI: 81%, 94%), respectively, and there were no differences in the subgroup analyses of age, publication year, enhanced CT and slice thickness. For ischemia, the pooled sensitivity and specificity was 82% (95% CI: 67%, 91%) and 92% (95% CI: 86%, 95%), respectively. No difference was found between enhanced and unenhanced CT based on subgroup analysis; however, high sensitivity was found in adhesive SBO compared with routine causes (96% vs. 78%, P = 0.03). The pooled sensitivity and specificity for predicting surgical intervention were 87% and 73%, respectively. The accuracy for etiology of adhesions, hernia and tumor was 95%, 70% and 82%, respectively. In addition, the pooled sensitivity and specificity for transition point was 92% and 77%, respectively. CT has considerable accuracy in diagnosis of SBO, ischemia, predicting surgical intervention, etiology and transition point.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Accuracy / Bias / Biology and Life Sciences / Bivariate analysis / Collaboration / Computed tomography / Confidence intervals / Diagnostic systems / Diagnostic tests / Etiology / Handbooks / Hernia / Humans / Intestinal obstruction / Intestinal Obstruction - diagnosis / Intestinal Obstruction - diagnostic imaging / Intestinal Obstruction - pathology / Intestine, Small - diagnostic imaging / Intestine, Small - pathology / Ischemia / Ischemia - diagnostic imaging / Medical diagnosis / Medicine and Health Sciences / Meta-analysis / Pathogenesis / Patients / Pediatrics / Performance evaluation / Physical Sciences / Quality standards / Regression analysis / Reproducibility of Results / Research and Analysis Methods / ROC Curve / Sensitivity analysis / Sensitivity and Specificity / Small intestine / Statistical analysis / Studies / Subgroups / Systematic review / Thickness / Tomography, X-Ray Computed - methods / Tomography, X-Ray Computed - standards / Transition points