Multidetector CT findings suggesting a perforation site in the gastrointestinal tract: analysis in surgically confirmed 155 patients.
OBJECTIVE
The aim of this study was to investigate how accurately we could diagnose the level of gastrointestinal (GI) tract perforation using multidetector computed tomography (MDCT).


METHODS
We reviewed 155 patients with surgically confirmed GI tract perforation. MDCT scans were obtained with eight-detector CT; 5 mm thick axial images and 2.5 mm thick coronal multiplanar reconstruction (MPR) images were generated for all patients. Contrast enhancement was performed in 44 of the 155 patients. Two board-certified radiologists reviewed the images for direct findings (free air, ruptured GI tract wall) and indirect findings (inflammatory changes, fluid collection, focal thickening of the GI tract wall) and attempted to identify the perforation site in each patient.


RESULTS
Free air was seen in more than 95% of the patients with perforation at sites other than the appendix; free air was seen in 44% of patients with appendicitis. On contrast-enhanced CT performed in 44 patients, rupture of the wall of the GI tract was directly visualized in 14 (32%) on axial images only and in 23 (52%) on axial or MPR images, respectively. The perforation site was correctly diagnosed in 90% of the patients when the radiologists referred to both direct and indirect findings.


CONCLUSIONS
MDCT was valuable for identifying the presence and level of GI tract perforation.
Imuta
Masanori
M
Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan. hamyt@qd5.so-net.ne.jp
Awai
Kazuo
K
Nakayama
Yoshiharu
Y
Murata
Yuka
Y
Asao
Chiaki
C
Matsukawa
Tetsuya
T
Yamashita
Yasuyuki
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000000981:diagnostic imaging* / Q000601:surgery; D007472:Iohexol / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011860:Radiography, Abdominal; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; D007472:Iohexol