CT Value Study of Small Intestinal Loop Aggregation in Predicting Mesenteric Contracture in Patients with Pseudomyxoma Peritonei

Objective: To investigate the diagnostic value of CT scanning combined with multiplane reconstruction(MPR) and volume reconstruction(VR) for evaluating small intestinal loop aggregation in predicting small mesenteric contracture in patients with pseudomyxoma peritonealis(PMP). Methods: From January 2018 to December 2019, 179 patients with pseudomyxoma peritonei confirmed by surgery and pathology in our hospital were retrospectively analyzed. Among them, 31 cases were confirmed with mesenteric contracture during operation, and 148 cases were without mesenteric contracture. Axial CT, MPR and VR were used to determine the aggregation of small intestinal loops, and to further predict the diagnosis and treatment of mesenteric contracture. Single factor logistic regression, ROC curve and Spearman rank correlation analysis were used to analyze the efficacy, P<0.05 was considered as significant statistical difference. Results: the detection rate of small intestinal loop aggregation was analyzed by univariate logistic regression: VR > coronal > axial > sagittal, and the prediction of diagnostic efficiency of mesangial contracture was VR > coronal > axial > sagittal. ROC curve was used to analyze the diagnostic efficacy of small intestinal loop aggregation in predicting mesenteric contracture: axial sensitivity 58.8%, specificity 79.6%, positive predictive value 46.5%, negative predictive value 86.5%; coronal sensitivity 55.9%, specificity 89.6%, positive predictive value 61.4%, negative predictive value 87.1%; sagittal sensitivity 50.0%, specificity 72.6%, positive predictive value 35.4%, negative predictive value 87.1%, the sensitivity, specificity, positive predictive value and negative predictive value of VR were 76.5%, 78.8%, 52% and 91.8%, respectively. Spearman rank correlation analysis: axial, coronal, sagittal and VR were highly correlated to predict the results of small intestinal mesangial contracture. Conclusion: The single axial CT image has limited effectiveness in the evaluation of small intestinal loop aggregation. Combined with coronal and VR images, it is helpful to improve the accuracy of small intestinal loop aggregation evaluation; There is a high correlation between the small intestinal loop aggregation and the results of predicting mesenteric contracture. The sensitivity and specificity of using the small intestinal loop aggregation to determine mesenteric contracture are limited, so further research is needed to improve the detection rate of preoperative diagnosis of mesenteric contracture.