| Objective:Diagnosis of intestinal obstruction mainly rely on imaging examination at present. The objective of this study do a comparative imageology research on digital radiography(DR)and MSCT examination, In order to select the appropriate imaging examination for clinical diagnosis and treatment,DR and MSCT characteristics were discussed. Method:358 cases of suspected intestinal obstruction patients were retrospectively analyzed from January 2010 to June 2015 in third affiliated hospital of Qiqihar medical college.All patients were examined in DR and MSCT. There were full of DR and MSCT examination information and surgical pathologic results.Among them, 303 cases of confirmed obstruction for surgery, 55 cases of pseudo obstruction. According to the examine results, each type of intestinal obstruction was observed by DR and MSCT imaging. All patient data with surgery as the gold standard, calculate the DR and MSCT examination of validity, DR and MSCT to evaluate intestinal obstruction diagnostic accuracy, DR are compared with those of MSCT in diagnosis of intestinal obstruction of their respective advantages. Results:1.272 patients were diagnosed with intestinal obstruction in DR. Classification by obstruction sites, 198(72.8%)cases were small intestinal obstruction; Junction obstruction were 74 cases(27.2%). Classification the nature of the obstruction, mechanical intestinal obstruction were 201 cases(73.9%); Paralytic ileus were 5 cases(1.8%); 61 cases were closed loops/strangulation obstruction(22.4%); Blood supply ileus were 1 case(0.4%), Intussusception were 4 cases(1.5%). Complete intestinal obstruction were 113 cases(41.5%); Incomplete intestinal obstruction were159 cases(58.5%).2.285 patients were diagnosed with intestinal obstruction in MSCT. Classification by obstruction sites, 206 cases(72.3%) were small intestinal obstruction; Junction obstruction were 79 cases(27.7%). Classification the nature of the obstruction, including mechanical intestinal obstruction were 203 cases(71.2%); Paralytic ileu were 9 cases(3.2%); 63 cases were closed loops/strangulation obstruction(22.1%); Blood supply ileus were 5 cases(1.8%); Intussusception were 5 cases(1.8%). Classification the degree of obstruction,complete intestinal obstruction were107 cases(32.5%); Incomplete intestinal obstruction were178 cases(62.5%).3.303 cases of patient were confirmed intestinal obstruction on surgery. Classification by obstruction sites, 209 cases(69.0%) were small intestinal obstruction; Junction obstruction were 94 cases(31.0%). Classification the nature of the obstruction, mechanical intestinal obstruction were 206 cases(68.0%); Paralytic ileus were12 cases(4.0%), 68 cases(22.4%) were closed loops/strangulation obstruction; Blood supply ileus were 9 cases(3.0%); Intussusception were 8 cases,(2.6%). Classification the degree of obstruction, incomplete intestinal obstruction were 116 cases(38.3%); Incomplete intestinal obstruction were 187 cases( 61.7%).4.With surgical results as the gold standard, the sensitivity of DR diagnosis of intestinal obstruction was 87.1%, false negative rate( missed diagnosis) was 12.9%, the specific degree was 85.5%, false positive rate was 14.5%, crude agreement was 86.9%, consistency of the Kappa value was 0.6, positive predictive value was 97.1%, negative predictive value was 55.8%, positive likelihood ratio was 6.0, the negative likelihood ratio was 0.2.5.With surgical results as the gold standard, the sensitivity of MSCT diagnosis of intestinal obstruction was 92.1%, false negative rate( missed diagnosis) was 7.9%, the specific degree was 89.1%, false positive rate was10.9%, crude agreement was 91.6%, consistency of the Kappa value was 0.716, positive predictive value was 97.9%, negative predictive value was 67.1%, positive likelihood ratio was 8.5, the negative likelihood ratio was 0.09.6.Compared with the accuracy of DR and MSCT in the diagnosis of intestinal obstruction, difference was significant(2c =4.206,P <0.05).7.Compared with intestinal canal expansion detection rate of DR and surgery in the diagnosis of intestinal obstruction,difference was significant(2c =9.82,P <0.05).8.Compared with intestinal canal expansion detection rate of MSCT and surgery in the diagnosis of intestinal obstruction,there was no significant difference(2c =3.37,P> 0.05).9.Compared with intestinal canal expansion detection rate of DR and MSCT in the diagnosis of intestinal obstruction,there was no significant difference(2c =2.38,P> 0.05).10.Compared with bowel effusion detection rate of DR and surgery in the diagnosis of intestinal obstruction,difference was significant(2c =53.41,P <0.05).11.Compared with bowel effusion detection rate of MSCT and surgery in the diagnosis of intestinal obstruction,difference was significant(2c =17.45,P <0.05).12.Compared with bowel effusion detection rate of DR and MSCT in the diagnosis of intestinal obstruction,difference was significant(2c =12.19,P <0.05).Conclusion:1.DR is easy operation, low cost, the advantages of small dose of radiation, the important means of clinical preliminary screening can be used as intestinal obstruction. Combined two checks can provide important basis for clinical treatment.2. When the blind expansion of obvious, DR with MSCT in the diagnosis of intestinal obstruction without too big difference, DR patients only need to do.3. The sensitivity of intestinal obstruction diagnosis and specific degree of MSCT are higher than DR.4. Compared with intestinal canal expansion detection rate of DR and MSCT in the diagnosis of intestinal obstruction,there was no significant difference.5.The bowel effusion detection rate of DR is lower than MSCT, it shows that MSCT checks the degree of obstruction is better than DR. |
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