Differentiation Between Surgical and Nonsurgical Intussusception: A Diagnostic Model Using Multi-Detector Computed Tomography

Vo Tan Duc; Phan Cong Chien; Le Duy Mai Huyen; Pham Ngoc Minh Triet; Pham Thai Hung; Tran-Thi Mai Thuy; Thieu-Thi Tra My; Nguyen Minh Duc

doi:10.5455/aim.2021.29.32-37

Differentiation Between Surgical and Nonsurgical Intussusception: A Diagnostic Model Using Multi-Detector Computed Tomography

Acta Inform Med. 2021 Mar;29(1):32-37. doi: 10.5455/aim.2021.29.32-37.

Authors

Vo Tan Duc^{1

2}, Phan Cong Chien¹, Le Duy Mai Huyen¹, Pham Ngoc Minh Triet¹, Pham Thai Hung^{1

3}, Tran-Thi Mai Thuy^{1

2}, Thieu-Thi Tra My⁴, Nguyen Minh Duc^{5

6}

Affiliations

¹ Department of Radiology, University Medical Center, Ho Chi Minh City, Vietnam.
² Department of Radiology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
³ Department of Radiography, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
⁴ Department of Radiology, Hanoi Medical University, Hanoi, Vietnam.
⁵ Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.
⁶ Department of Radiology, Children's Hospital 2, Ho Chi Minh City, Vietnam.

Abstract

Background: The differentiation of surgical from nonsurgical adult intussusception may enable the appropriate selection of management strategies.

Objective: This study aimed to investigate the diagnostic potential of multidetector computed tomography (MCDT) features to differentiate surgical from nonsurgical adult intussusception and develop a diagnostic model.

Methods: A retrospective study was performed on 96 patients with intussusceptions at the University Medical Center Hospital between January 2014 and January 2020. Two radiologists reviewed all images, and intussusception characteristics were documented. The location of intussusception, length, diameter, interposed fat thickness, lead point, and complications were evaluated. Based on the results, a diagnostic tree model was developed to differentiate between surgical and nonsurgical adult intussusception.

Results: A total of 99 intussusceptions in 96 patients (mean age: 53.0 ± 16.5 years), including 35 (35.3%) enteroenteric, 27 (27.3%) enterocolic, and 37 (37.4%) colocolic lesions, were evaluated. Of the enteroenteric intussusceptions, 22 (62.9%) were surgical, including 19 (79.2%) with lead points. Among colon intussusceptions, 63 (98.4%) were surgical, and 100% had lead points. The characteristics used to predict surgical intussusceptions included lead point presence, length ≥ 5.0 cm, diameter ≥ 3.2 cm, interposed fat thickness ≥ 0.5 cm, and complications (p < 0.001). Based on these features, we established a diagnostic tree model that correctly classified 96 (97%) of 99 lesions.

Conclusion: Our study reinforces the importance of MDCT for the diagnosis and guided management of adult intussusceptions. The characteristics that predicted surgical intussusceptions included lead points, length, diameter, interposed fat thickness, and complications. A systematic approach using this diagnostic tree model could be used to distinguish surgical and nonsurgical adult intussusception.

Keywords: CT; adult intussusception; lead point.