Use of Ultrasound in the Diagnostic Work-Up of Adult Intussusception – A Multicenter Retrospective Analysis

Abstract

Purpose To evaluate the use of ultrasound (US) in the diagnostic work-up of adult intussusception (AI).

Methods This multicenter study includes 26 consecutive patients diagnosed with AI between January 2010 and November 2017. A retrospective chart analysis was conducted with a focus on abdominal US findings and diagnostic accuracy of different imaging modalities (ultrasound, computed tomography (CT), magnetic resonance imaging). If available, surgical and pathological findings served as the gold standard (76.9 %). US examiners certified according to DEGUM grade 2 or 3 were classified as experts. Otherwise, they were regarded to have basic skills.

Results During diagnostic work-up, 92.3 % underwent abdominal US. US was the first-line imaging modality in 88.5 % of cases. The accuracy regarding the detection of AI (85 %), correct localization (95 %) and detection of complications (100 %) was excellent and comparable with CT (81 %, 90.5 %, and 91.7 %) when performed by experts. 72.7 % of tumorous lead points were detected by experienced examiners. In contrast, AI was detected in only 45.5 % of cases by examiners with basic skills. AI was diagnosed prior to surgery in all patients.

Conclusion US is reliable in the diagnostic work-up of AI when performed by experienced examiners with high-quality equipment. US, CT and MRI should be used in a complementary fashion since combination provides excellent sensitivity regarding the detection and correct localization of AI as well as the detection of complications. The impact of real-time imaging is illustrated by supplementary videos.

Zusammenfassung

Ziel Evaluation des diagnostischen Nutzens des transabdominalen Ultraschalls (US) in der Abklärung einer intestinalen Invagination bei erwachsenen Patienten.

Methode Diese multizentrische Studie schließt 26 konsekutive Patienten ein, bei denen von Januar 2010 bis November 2017 eine Invagination diagnostiziert wurde. Es erfolgte eine retrospektive Auswertung von Patientenakten. Hierbei lag der Fokus auf US-Befunden und der diagnostischen Genauigkeit verschiedener Schnittbildverfahren (US, Computertomografie (CT), Kernspintomografie (MRT)). Falls vorhanden (76,9 %) dienten Operationsberichte und histologische Befunde als Goldstandard. Ultraschall-Untersucher der DEGUM-Stufen 2 und 3 wurden als Experten klassifiziert. Bei allen anderen Untersuchern wurden Basiskenntnisse angenommen.

Ergebnisse Während der diagnostischen Abklärung erhielten 92,3 % eine US-Untersuchung. US war die Erstlinien-Bildgebung bei 88,5 %. Die diagnostische Genauigkeit bezüglich Vorliegen einer Invagination (85 %), korrekter Lokalisation (95 %) und Nachweis von Komplikationen (100 %) war exzellent und vergleichbar der CT (81 %, 90,5 %, 91,7 %), wenn die US-Untersuchung von Experten durchgeführt wurde. Erfahrene Untersucher erkannten zudem 72,7 % der auslösenden Tumoren. US-Untersucher mit Basiskenntnissen hingegen stellten nur in 45,5 % die korrekte Diagnose einer Invagination. Bei allen Patienten wurde die Invagination bereits präoperativ diagnostiziert.

Schlussfolgerungen Der abdominelle US ist in der Hand von erfahrenen Untersuchern eine zuverlässige Methode zur diagnostischen Abklärung einer Invagination bei erwachsenen Patienten. US, CT und MRT sollten komplementär eingesetzt werden, da die Kombination eine exzellente Sensitivität in Hinblick auf Erkennung, Lokalisation und Nachweis von Komplikationen der Invagination hat. Die Stärke der Echtzeit-Untersuchung beim US wird durch Videobeispiele verdeutlicht.

Key words

adult intussusception - small bowel - tumor - emergency - gastrointestinal tract

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