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Can CT Features Be Used to Diagnose Surgical Adult Bowel Intussusceptions?

¹ Department of Radiology, University of Michigan Health System, Cardiovascular Center #5481, 1500 E Medical Center Dr., Ann Arbor, MI 48109-5868.
² Present address: The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
³ Present address: Innovative Analytics, Kalamazoo, MI.

OBJECTIVE. The purpose of our study was to identify whether any CT characteristics can be used to diagnose surgical intussusceptions.

MATERIALS AND METHODS. A search of CT reports on adults revealed 118 patients with 136 intussusceptions. Two blinded readers independently reviewed the CT examinations and documented intussusception characteristics. Medical records were reviewed to determine patient outcome. Performance, interobserver agreement (A), and significance of CT characteristics to identify surgical intussusceptions were calculated.

RESULTS. Of 95,223 CT examinations, 0.13% (121/95,223) documented 136 intussusceptions over a 7-year period, of which 88.2% (120/136) were enteroenteric, 3.7% (5/136) were enterocolic, and 4.4% (6/136) were colocolic lesions or in other locations. Eight (5.9%) were surgical and 128 (94.12%) were nonsurgical lesions. Five of eight (63%) surgical lesions involved the colon. Only two of eight surgical lesions had malignant lead points. The mean sensitivity, specificity, positive predictive value, and negative predictive value for diagnosing surgical enteroenteric lesions using a measured lesion length of > 3.5 cm were 100%, 57.3%, 5.7%, and 100% (A = 0.68), respectively. Similar figures using the measured axial diameter > 3 cm were 100%, 32.9%, 3.7% and 100% (A= 0.65), respectively.

CONCLUSION. Surgical intussusceptions in adults are infrequent among the intussusceptions that are detected on CT. Most enteroenteric lesions are nonsurgical lesions, whereas lesions that affect the colon are often surgical. Many nonsurgical enteroenteric intussusceptions are longer than 3.5 cm and thicker than 3 cm, suggesting these CT features may not be useful for diagnosing surgical bowel intussusceptions in adults.

Keywords: abdomen • bowel • CT • gastrointestinal imaging • gastrointestinal tract • intussusceptions

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