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Eur Radiol (2013) 23:388399 DOI 10.1007/s00330-012-2595-y
GASTROINTESTINAL
Helical CT-enteroclysis in the detection of small-bowel tumours: a meta-analysis
Philippe Soyer & Mounir Aout & Christine Hoeffel &
Eric Vicaut & Vinciane Plac & Mourad Boudiaf
Received: 1 May 2012 /Revised: 18 June 2012 /Accepted: 21 June 2012 /Published online: 4 August 2012 # European Society of Radiology 2012
AbstractObjective To perform a meta-analysis to determine sensitivity and specificity estimates of helical CT-enteroclysis in the detection of small-bowel tumours.
Methods A search for relevant articles published from January 1992 to November 2010 was performed. Study design, patient characteristics and 22 contingency tables were recorded for eligible studies. Heterogeneity was assessed with the I2 statistic. A bivariate generalised linear random-effects model was used to summarise sensitivity and specificity estimates for small-bowel tumour detection on a per-patient basis. Sensitivity and specificity estimates were compared in different subgroups.
Results Twelve studies (696 patients) were eligible. The mean small-bowel tumour prevalence was 22.6 % (range7.745.8 %). Inter-study heterogeneity was substantial for sensitivity (I2066.9 %; 95 % CI 28.788.5 %) and low for specificity (I2010.6 %; 95 % CI 0.055.0 %). On a per-
patient basis, pooled sensitivity was 92.8 % (95 % CI 71.398.5 %) and pooled specificity 99.2 % (95 % CI 94.299.9 %) for the diagnosis of small-bowel tumour. Subgroup analysis revealed that small-bowel preparation, more than one imaging pass and large volumes (2 L) of enteral contrast agent did not improve tumour detection. Conclusion Our meta-analysis confirms that helical CT-enteroclysis has high degrees of sensitivity and specificity for small-bowel tumour detection. However, our findings reinforce the need for more standardised individual studies. Key Points Helical CT-enteroclysis is highly sensitive for the diagnosis of small-bowel tumours.
Helical CT-enteroclysis is highly specific for the diagnosis of small-bowel tumours,
Helical CT-enteroclysis can be used as a first-line investigation.
A single enteric phase examination provides optimal tumour detection.
Keywords CT-enteroclysis . Small bowel tumors . Meta-analysis . Systematic review . Diagnostic accuracy
Introduction
Early diagnosis of small-bowel tumours (SBTs) is a diagnostic challenge for both clinicians and radiologists for two main reasons. First, most patients present with non-specific symptoms [1]. Second, the mesenteric small bowel is traditionally the most difficult portion of the gastrointestinal tract to investigate. Therefore, the diagnosis of SBTs...