Abstract

Purpose

To evaluate the diagnostic performance of a proposed new CT observation in cecal volvulus, marked hook-like curvature of ileocolic vessels termed “ileocolic vascular curvature.”

Methods

Contrast-enhanced CT scans of 14 patients with diagnoses of cecal volvulus on original CT reports were compared with scans of 40 control patients with dilated cecum but no cecal volvulus on original CT reports, accrued consecutively from January, 2006 through July, 2017. Two independent blinded readers retrospectively evaluated scans for cecal dilatation, ileocolic vascular curvature and seven previously reported CT features of cecal volvulus. Statistical methods included the exact binomial distribution to define 95% confidence intervals (95% CIs), logistic regression, receiver operating characteristic analysis, and the exact McNemar test. Pathology reports and clinical records served as reference standards.

Results

All patients had abdominal pain and cecal distension. All 14 patients with CT diagnoses of cecal volvulus, and no control patients, had cecal volvulus by reference standards. Ileocolic vascular curvature and ectopic cecal location were the only features independently and significantly associated with cecal volvulus in multivariable regression (odds ratio 178, p = 0.014, and 63, p = 0.013, respectively) and also the only features with both sensitivity (12/14 [85.7%, 95% CI 57.2–98.2%] and 13/14 [92.9%, 95% CI 66.1–99.8%], respectively) and specificity (40/40 [100.0%, 95% CI 91.2–100.0%] and 38/40 [95.0%, 95% CI 83.1–99.4%], respectively) that differed significantly from 50.0%.

Conclusions

Ileocolic vascular curvature was independently and significantly associated with cecal volvulus and exhibited both substantial sensitivity and substantial specificity for cecal volvulus, and thus is potentially a valuable new CT finding of cecal volvulus.

中文翻译：

---

回结肠血管弯曲：盲肠扭转的新 CT 发现。

摘要

目的

为了评估建议的盲肠扭转新 CT 观察的诊断性能，回结肠血管的标记钩状弯曲称为“回结肠血管弯曲”。

方法

2006 年 1 月至 2017 年 7 月连续累积的 14 名原始 CT 报告上诊断为盲肠扭转的患者的对比增强 CT 扫描与原始 CT 报告中盲肠扩张但无盲肠扭转的 40 名对照患者的扫描结果进行了比较。两个独立的盲读者回顾性评估了盲肠扩张、回结肠血管弯曲和七个先前报告的盲肠扭转 CT 特征的扫描。统计方法包括定义 95% 置信区间 (95% CI) 的精确二项式分布、逻辑回归、接收器操作特征分析和精确 McNemar 检验。病理报告和临床记录作为参考标准。

结果

所有患者均有腹痛和盲肠扩张。根据参考标准，所有 14 名 CT 诊断为盲肠扭转的患者和无对照患者均患有盲肠扭转。在多变量回归中，回结肠血管弯曲和异位盲肠位置是唯一与盲肠扭转独立且显着相关的特征（比值比分别为 178，p  = 0.014 和 63，p  = 0.013），也是唯一具有这两种敏感性的特征（12/ 14 [85.7%, 95% CI 57.2–98.2%] 和 13/14 [分别为 92.9%, 95% CI 66.1–99.8%]）和特异性（40/40 [100.0%, 95% CI 91.2–100.0%]）和 38/40 [分别为 95.0%、95% CI 83.1–99.4%]）与 50.0% 显着不同。

结论

回结肠血管曲率与盲肠扭转独立且显着相关，并且对盲肠扭转表现出显着的敏感性和显着的特异性，因此可能是盲肠扭转的有价值的新 CT 发现。