Samji KB, et al. - The diagnostic performance of CT was examined in the detection of anastomotic leaks in subjects who underwent bowel surgery and a subsequent postoperative CT examination. Among the enrollees, the study group consisted of patients with surgically confirmed anastomotic leaks and the control group included patients without anastomotic leaks. Findings illustrated the highest diagnostic performance of CT due to the use of an intraluminal contrast agent. Hence, meticulous and careful use of an intraluminal contrast agent was significant in this patient cohort.

Methods

• Enrollees included subjects who underwent bowel surgery and a subsequent postoperative CT examination performed particularly for investigating for an anastomotic leak.
• Inclusion criteria consisted of patients with surgically confirmed anastomotic leaks (n = 59), and the control group included patients without anastomotic leaks (n = 48) confirmed by either repeat surgery or uneventful clinical follow-up for at least 6 months.
• An independent review was performed by 2 radiologists and 2 radiology residents of each CT examination for specific CT findings from a set of predetermined imaging predictors.
• For each reader, the sensitivity and specificity for each imaging predictor were estimated.
• With the aid of Cohen kappa coefficient, the interobserver agreement was calculated.
• Diagnostic performance was evaluated through ROC curve analysis.

Results

• As per the data, the most sensitive imaging predictor was intraabdominal free fluid (95.3%).
• Moreover, leakage of intraluminal contrast agent appeared to be a highly specific imaging predictor (96.6%).
• Findings illustrated significant interobserver agreement for intraabdominal free gas (κ = 0.76) and leakage of intraluminal contrast agent (κ = 0.76).
• The range of overall diagnostic performance in correctly identifying surgically confirmed leaks was from 0.76 to 0.86, determined via the area under the ROC curve.
• Higher diagnostic performance was discovered for all readers due to the use of intraluminal contrast agent and reached the anastomosis, with the exception of one reader, whose diagnostic performance remained unchanged.