Anastomotic leakage after colorectal surgery: diagnostic accuracy of CT.
Eur Radiol
; 25(12): 3543-51, 2015 Dec.
Article
em En
| MEDLINE
| ID: mdl-25925357
ABSTRACT
OBJECTIVES:
To evaluate the diagnostic accuracy of CT in postoperative colorectal anastomotic leakage (AL).METHODS:
Two independent blinded radiologists reviewed 153 CTs performed for suspected AL within 60 days after surgery in 131 consecutive patients, with (n = 58) or without (n = 95) retrograde contrast enema (RCE). Results were compared to original interpretations. The reference standard was reoperation or consensus (a radiologist and a surgeon) regarding clinical, laboratory, radiological, and follow-up data after medical treatment.RESULTS:
AL was confirmed in 34/131 patients. For the two reviewers and original interpretation, sensitivity of CT was 82 %, 87 %, and 71 %, respectively; specificity was 84 %, 84 %, and 92 %. RCE significantly increased the positive predictive value (from 40 % to 88 %, P = 0.0009; 41 % to 92 %, P = 0.0016; and 40 % to 100 %, P = 0.0006). Contrast extravasation was the most sensitive (reviewers, 83 % and 83 %) and specific (97 % and 97 %) sign and was significantly associated with AL by univariate analysis (P < 0.0001 and P < 0.0001). By multivariate analysis with recursive partitioning, CT with RCE was accurate to confirm or rule out AL with contrast extravasation.CONCLUSIONS:
CT with RCE is accurate for diagnosing postoperative colorectal AL. Contrast extravasation is the most reliable sign. RCE should be performed during CT for suspected AL. KEY POINTS ⢠CT accurately diagnosed clinically suspected colorectal AL and showed good interobserver agreement ⢠Contrast extravasation was the most sensitive and specific CT sign ⢠Retrograde contrast enema during CT improved positive predictive value ⢠Retrograde contrast enema decreased false-negative or indeterminate original CT interpretations.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Tomografia Computadorizada por Raios X
/
Cirurgia Colorretal
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Fístula Anastomótica
Tipo de estudo:
Diagnostic_studies
/
Prognostic_studies
Limite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
/
Middle aged
Idioma:
En
Ano de publicação:
2015
Tipo de documento:
Article