title: 64-Slice multidetector computed tomography evaluation of gastrointestinal tract perforation site: detectability of direct findings in upper and lower GI tract.
abstract: OBJECTIVE
  To evaluate wall discontinuity, as observed using 64-slice multidetector-row computed tomography (64-MDCT), as a direct finding (DF) indicating the perforation site in patients with gastrointestinal (GI) tract perforations.
  
  
  METHODS
  We retrospectively studied 41 consecutive patients presenting with acute abdomen and exhibiting extraluminal air (EA) on 64-MDCT. Three readers evaluated the distribution of EA, extraluminal faeces, dirty mass, dirty fat sign, extraluminal fluid collection and bowel wall thickening (i.e. conventional findings, CFs) as well as DFs.
  
  
  RESULTS
  Twenty-two cases were surgically or endoscopically confirmed to have upper GI tract perforations, and 19 had lower GI tract perforations. The DFs correctly identified the sites of perforation in 80.5% of patients when 2-mm-thick imaging slices were used. For the detection of upper GI tract perforations, the sensitivity, specificity and accuracy were 95.5%, 94.7% and 95.1% for the DFs and 50.0%, 100% and 73.2% for the CFs, respectively. Significant differences in sensitivity (p < 0.001) and diagnostic accuracy (p < 0.05) were observed between the DFs and CFs for upper GI perforations but not for lower GI tract perforations.
  
  
  CONCLUSIONS
  DFs of the perforation site by using 64-MDCT were more sensitive and accurate than CFs for the detection of upper GI tract perforations.
authors.affiliation: Department of Radiology, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi, Yokohama 230-0012, Japan.
authors.forename: Sota
authors.initials: S
authors.lastname: Oguro
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Funabiki
authors.forename: Koji
authors.initials: K
authors.lastname: Hosoda
authors.forename: Yukio
authors.initials: Y
authors.lastname: Inoue
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamane
authors.forename: Michihiro
authors.initials: M
authors.lastname: Sato
authors.forename: Mitsuhide
authors.initials: M
authors.lastname: Kitano
authors.forename: Masahiro
authors.initials: M
authors.lastname: Jinzaki
mesh_terms: D000006:Abdomen, Acute / Q000000981:diagnostic imaging* / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D041981:Gastrointestinal Tract / Q000000981:diagnostic imaging*; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011027:Pneumoperitoneum / Q000000981:diagnostic imaging* / Q000209:etiology; D015203:Reproducibility of Results; D012421:Rupture / Q000150:complications / Q000000981:diagnostic imaging; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*