Esophagography and chest CT for detection of perforated esophagus: what factors influence accuracy?
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HOLLOW ORGAN GI
Esophagography and chest CT for detection of perforated esophagus: what factors influence accuracy? Martha Terrazas1 · Lauren Marjon2 · Matthew Geter1 · Jess Schwartz3 · William Thompson1
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Purpose To determine: whether the use of both esophagography (EG) and CT is superior to either study alone in the detection of esophageal injuries and perforations. Methods Paired CT and EG performed for suspected perforated or injured native esophagus (NAE) or neo-esophagus (NEOE) were retrospectively identified and independently scored for likelihood of perforation with a Likert scale. Official reports were scored with the same scale. Retrospective study and official interpretations were assessed separately for overall diagnostic accuracy, for diagnosis of contained versus free perforation. Results 110 paired exams performed in 107 patients fulfilled inclusion criteria. Overall, combined CT and EG retrospective study interpretation was greater than EG or CT scans alone. Study EG and combined CT and EG interpretations were less sensitive for contained perforations than for free perforations. Evaluations of NAE and NEOE showed similar sensitivities. Receiver operating characteristic (ROC) curve generated from combined official CT and EG interpretations was superior to ROC from combined retrospective study interpretations. Conclusions Combination of EG and CT can improve sensitivity for detecting perforated intrathoracic viscus, but even with combined studies accurate diagnosis of contained perforations is challenging. Superior performance of official reports suggests that concurrent review using both modalities may improve accuracy. Keywords Esophagus · Esophagography · CT · Esophageal Injuries and Perforations
Introduction * William Thompson [email protected] Martha Terrazas [email protected] Lauren Marjon [email protected] Matthew Geter [email protected] Jess Schwartz [email protected] 1
Department of Radiology, University of New Mexico HSC, MSC10 5530, 1 University of New Mexico, Albuquerque, NM 87131, USA
2
Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
3
Department of Surgery, University of New Mexico HSC, MSC10 5530, 1 University of New Mexico, Albuquerque, NM 87131, USA
Perforation of a viscus within the thorax, the esophagus (NAE) or a neo-esophagus (NEOE) following esophagectomy, is potentially catastrophic if untreated. This mandates a high level of sensitivity in its detection. In response to the high consequence of misdiagnosis of this injury, both fluoroscopic esophagography (EG) and chest CT are frequently obtained when evaluating possible perforation on injury of intrathoracic viscus (NAE or NEOE) [1–3]. Current protocol at our institution is to perform chest CT followed by EG within 24 h. This was instituted in 2016 following the completion of this study. Prior series have reported that chest CT is very sensitive for detecting perforation
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