Original Article
Use of Multidetector Computed Tomography for Locating the Site of Gastrointestinal Tract Perforations
Utilidad de la tomografía computarizada multidetector para identificar la localización de las perforaciones gastrointestinales
Laura Cadenas Rodríguez
, Milagros Martí de Gracia, Nuria Saturio Galán, Virginia Pérez Dueñas, Leopoldo Salvatierra Arrieta, Gonzalo Garzón Moll
Corresponding author
Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, Spain
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A) corte axial de TCMD con contraste i.v. y oral que muestra gas extraluminal y contraste oral extravasado (flecha gruesa), una intensa trabeculación de la grasa (*) adyacente y un engrosamiento de las asas de intestino delgado (flecha fina). B) reconstrucción sagital de la TMD donde se observa el contraste oral extravasado (flecha) formando un nivel; y latrabeculación de la grasa (*); también se observa una LOE hepática (flecha curva). La intervención quirúrgica confirmó la perforación en intestino delgado y la anatomía patológica, la presencia de un carcinoma de célula grande de íleon distal con infiltración al mesenterio y metástasis hepática.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Laura Cadenas Rodríguez, Milagros Martí de Gracia, Nuria Saturio Galán, Virginia Pérez Dueñas, Leopoldo Salvatierra Arrieta, Gonzalo Garzón Moll" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Laura" "apellidos" => "Cadenas Rodríguez" ] 1 => array:2 [ "nombre" => "Milagros" "apellidos" => "Martí de Gracia" ] 2 => array:2 [ "nombre" => "Nuria" "apellidos" => "Saturio Galán" ] 3 => array:2 [ "nombre" => "Virginia" "apellidos" => "Pérez Dueñas" ] 4 => array:2 [ "nombre" => "Leopoldo" "apellidos" => "Salvatierra Arrieta" ] 5 => array:2 [ "nombre" => "Gonzalo" "apellidos" => "Garzón Moll" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173507713001634" "doi" => 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=> "lauracadenasrodriguez@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Milagros" "apellidos" => "Martí de Gracia" ] 2 => array:2 [ "nombre" => "Nuria" "apellidos" => "Saturio Galán" ] 3 => array:2 [ "nombre" => "Virginia" "apellidos" => "Pérez Dueñas" ] 4 => array:2 [ "nombre" => "Leopoldo" "apellidos" => "Salvatierra Arrieta" ] 5 => array:2 [ "nombre" => "Gonzalo" "apellidos" => "Garzón Moll" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de la tomografía computarizada multidetector para identificar la localización de las perforaciones gastrointestinales" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 553 "Ancho" => 1514 "Tamanyo" => 117081 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">37-Year-old male with perforation of the small intestine by birdshot pellets: (A) MDCT with IV contrast showing an axial slice of the upper abdomen with pneumoperitoneum (bold arrow); (B) axial slice of the same patient with multiple intraabdominal birdshot pellets (arrow). The perforation of the small intestine was identified during surgery.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The finding of pneumoperitoneum in a patient with acute abdominal pain is the main diagnostic sign of gastrointestinal (GI) perforation,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> which usually requires surgical treatment. GI tract perforation is a disruption in the integrity of the gastrointestinal wall that may be caused by various etiologies. Classically, simple standing chest radiography including the diaphragm is the first imaging test that is done in order to identify the presence of extraluminal gas, although it is sometimes difficult to establish the diagnosis because the symptoms are non-specific and pneumoperitoneum is only observed on 30%–59% of simple radiographs.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Several studies have demonstrated that computed tomography (CT) is the best technique for detecting free intraperitoneal air and for the diagnosis of GI perforation.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The pre-operative localization of the intestinal perforation site can help the surgeon in the therapeutic approach. For the surgical treatment of GI tract perforations, less-aggressive laparoscopic procedures are currently preferred over open laparotomy<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> but in lower GI tract perforations, laparotomy is usually required.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Thus, it is useful for the surgeon to know the location of the perforation before initiating the surgical procedure.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Multidetector CT (MDCT) provides multiplanar reconstruction (MPR) with optimal spatial resolution and high quality, which increases the sensitivity of CT for detecting the site of the perforation.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> In recent years, several papers have been published with MDCT that have analyzed the value of different radiological signs in identifying the perforation site.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9–11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The objective of our study is to analyze the capacity of MDCT to identify the site of GI perforations and to determine which radiological signs, either direct or indirect,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> are the most predictive. We will also analyze the interobserver agreement for both diagnosis and identification of the localization.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients</span><p id="par0020" class="elsevierStylePara elsevierViewall">This is a retrospective study carried out in the emergency radiology area at Hospital Universitario La Paz for a period of 28 months (April 2007 to August 2009). We analyzed all the MDCT exams in our database of patients who came to the emergency room with acute abdominal symptoms and were later diagnosed with pneumoperitoneum or GI perforation on CT. In all patients, the presence of gastrointestinal perforation was confirmed during surgery.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Excluded from the study were those patients who had undergone surgery within the previous 15 days and those cases in which the exact site of the perforation was not confirmed during surgery.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Procedure</span><p id="par0030" class="elsevierStylePara elsevierViewall">The studies were done with an MDCT (Toshiba Asteion) using the following parameters: FOV 400, cut thickness 0.5<span class="elsevierStyleHsp" style=""></span>mm, Pitch 3.00, 120<span class="elsevierStyleHsp" style=""></span>kV, and 180<span class="elsevierStyleHsp" style=""></span>mA. In most cases, the studies were done after the administration of IV contrast, except in those cases in which the use of iodine was contraindicated. The patients were administered 120<span class="elsevierStyleHsp" style=""></span>mL at 2.5<span class="elsevierStyleHsp" style=""></span>mL/s with an injection pump and a 60-s delay.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Oral/rectal contrasts were not administered systematically because in some cases this would have delayed the completion of the test. In our study, 90% of the patients received only IV contrast, 7% received IV and oral/rectal contrast, and in 2% no IV contrast was used.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Image Analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">The images were reviewed at a workstation (Vitrea<span class="elsevierStyleSup">®</span>). Two expert radiologists, with no previous knowledge of the clinical histories or the surgical or histological results, evaluated the axial images and the multiplanar reconstruction.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The two radiologists independently analyzed the images and determined the presence of the following radiological signs and the affected segment:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1)</span><p id="par0050" class="elsevierStylePara elsevierViewall">Extravasation of oral contrast.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2)</span><p id="par0055" class="elsevierStylePara elsevierViewall">Intestinal wall focal defects.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3)</span><p id="par0060" class="elsevierStylePara elsevierViewall">Free air in the supramesocolic compartment.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4)</span><p id="par0065" class="elsevierStylePara elsevierViewall">Free air in the inframesocolic compartment.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5)</span><p id="par0070" class="elsevierStylePara elsevierViewall">Free air in supra- and inframesocolic compartments.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6)</span><p id="par0075" class="elsevierStylePara elsevierViewall">Gas bubbles adjacent to the intestinal wall.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7)</span><p id="par0080" class="elsevierStylePara elsevierViewall">Localized extraluminal fluid.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8)</span><p id="par0085" class="elsevierStylePara elsevierViewall">Segmental wall thickening (>3<span class="elsevierStyleHsp" style=""></span>mm).</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9)</span><p id="par0090" class="elsevierStylePara elsevierViewall">Perivisceral fat stranding.</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10)</span><p id="par0095" class="elsevierStylePara elsevierViewall">Abscesses.</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">11)</span><p id="par0100" class="elsevierStylePara elsevierViewall">Sagittal and coronal MPR to view the focal wall defect.</p></li></ul></p><p id="par0105" class="elsevierStylePara elsevierViewall">Signs 1, 2, and 11 were considered direct signs, meaning that they are signs that indicate where there is a discontinuity in the GI wall. The remainder were indirect signs of the location of the GI perforation: some indicate the distribution of the extraluminal gas (signs 3, 4, 5, and 6) and others indicate inflammatory changes (signs 8, 9, and 10) that help estimate the affected GI segment.</p><p id="par0110" class="elsevierStylePara elsevierViewall">For the localization of the site of the perforation, the following segments of the digestive tract were considered:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">1)</span><p id="par0115" class="elsevierStylePara elsevierViewall">Stomach/duodenum.</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">2)</span><p id="par0120" class="elsevierStylePara elsevierViewall">Jejunum and ileum.</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">3)</span><p id="par0125" class="elsevierStylePara elsevierViewall">Appendix.</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">4)</span><p id="par0130" class="elsevierStylePara elsevierViewall">Ascending, transverse, and descending colon.</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">5)</span><p id="par0135" class="elsevierStylePara elsevierViewall">Sigma/rectum.</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">6)</span><p id="par0140" class="elsevierStylePara elsevierViewall">Undetermined (site not identified).</p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical Analysis</span><p id="par0145" class="elsevierStylePara elsevierViewall">The Kappa correlation coefficient was determined between the two radiologists for detecting the perforation site and for the identification, presence or absence of each sign analyzed. For the remainder of the statistical analysis, the data from radiologist 1 were chosen and the Kappa correlation coefficient was calculated between the predicted location of the perforation site detected by MDCT and the actual site revealed during surgery, which is considered the reference procedure.</p><p id="par0150" class="elsevierStylePara elsevierViewall">The results were considered to be in agreement when the perforation site identified by MDCT was the same as what was identified during surgery (true positive) or when the perforation site was not recognized in either of the two procedures (true negative). Results were considered to be in disagreement when the MDCT did not identify the perforation site (false negative) or defined the origin of the perforation to be different from that found during surgery (false positive).</p><p id="par0155" class="elsevierStylePara elsevierViewall">The frequency of appearance was calculated for each sign and for each radiologist. The data from radiologist 1 were used to calculate the sensitivity (S), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) for each sign in the prediction of the perforation site. A <span class="elsevierStyleItalic">Kappa</span> correlation coefficient greater than 0.4 was considered acceptable; while greater than 0.6 was good and greater than 0.8 was excellent.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0160" class="elsevierStylePara elsevierViewall">The study included 98 patients, 46 of whom were men and 52 women, with a mean age of 59 (range 15–97).</p><p id="par0165" class="elsevierStylePara elsevierViewall">The Kappa correlation coefficient between radiologists for predicting the localization of the GI perforation was 0.919. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the Kappa index between the two radiologists for each radiological sign for gastrointestinal perforation.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">The perforation sites found by radiologist 1 on the MDCT in the 98 patients were: 14 (14.3%) stomach or duodenum; 15 (15.3%) small intestine; 14 (14.3%) appendix; 11 (11.2%) ascending, transverse or descending colon; 40 (40.8%) sigma/rectum; and in four patients (4.1%) the site was not determined. For radiologist 2, the perforation sites identified on MDCT for the 98 patients were: 13 (12.7%) stomach or duodenum; 15 (14.7%) small intestine; 14 (13.7%) appendix; 10 (9.8%) ascending, transverse or descending colon; 40 (39.2%) sigma/rectum; and in six patients (5.8%) the site was not determined.</p><p id="par0175" class="elsevierStylePara elsevierViewall">The locations of the perforations found during surgery in the 98 patients were: 20 (20.4%) stomach or duodenum; 16 (16%) small intestine; 15 (15.3%) appendix; 14 (14.3%) ascending, transverse or descending colon; and 33 (33.7%) sigma/rectum.</p><p id="par0180" class="elsevierStylePara elsevierViewall">The prediction of the perforation site in the gastrointestinal tract by means of MDCT coincided with the surgical findings (true positive) in 80 (80.4%, Kappa 0.804) out of 98 patients. In 18 patients, the prediction did not concur with the findings. In 14 (14.3%) cases, MDCT identified an incorrect perforation site (false positive) and in four (4.1%) out of 98 patients, MDCT did not identify the location of the GI perforation (false negative). The frequency for each sign is shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. The S, Sp, PPV, and NPV for each sign for predicting the perforation site are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0185" class="elsevierStylePara elsevierViewall">Several authors have demonstrated the utility of CT, and especially MDCT, in localizing GI perforations (<span class="elsevierStyleItalic">S</span>=86%).<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,11</span></a> In our study, we have retrospectively analyzed the capacity to detect the perforation site, which was 80%. In explorations with conventional CT, the S for detecting the GI perforation site was low (36%).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> The recent introduction of MDCT has provided faster imaging study acquisition, thinner slices, and MPR reconstructions.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> These factors have led to not only better and easier identification of minimal quantities of extraluminal air (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) but also the possibility to detail the diagnosis and determine where the gas had leaked, the etiology, and the perforation site (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). A correct preoperative diagnosis of the perforated GI region can be very useful for surgeons.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0190" class="elsevierStylePara elsevierViewall">The Kappa correlation coefficient between radiologists for predicting the localization of the perforation in our study is 0.919, which is excellent. Once again, this supports the fact that CT is an objective test for the diagnosis of GI perforation.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In a recent study, Kim et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> have also obtained excellent interobserver agreement.</p><p id="par0195" class="elsevierStylePara elsevierViewall">The three most frequent signs observed in our study are: free extraluminal air in the inframesocolic compartment, stranding of adjacent fat, and gas bubbles adjacent to the wall (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0200" class="elsevierStylePara elsevierViewall">The three most sensitive signs in our study for detecting the perforation site were the presence of gas bubbles adjacent to the wall (<span class="elsevierStyleItalic">S</span>=91%), free extraluminal air in the inframesocolic compartment (<span class="elsevierStyleItalic">S</span>=90%), and stranding of adjacent fat (<span class="elsevierStyleItalic">S</span>=88%). All three are indirect signs (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). Hainaux et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> determined that the most sensitive signs were: fat stranding (92%), concentration of extraluminal bubbles (89%), and free fluid (67%). Oguro et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> analyzed the <span class="elsevierStyleItalic">S</span> of the direct and indirect signs for detecting upper or lower GI perforation, concluding that the direct signs are more sensitive (95.5%) than the indirect signs (50%) for detecting upper gastrointestinal perforations. Meanwhile, for lower gastrointestinal perforations, indirect signs (78.9%) were more sensitive than direct signs (63.2%).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0205" class="elsevierStylePara elsevierViewall">The most specific signs in our study were extravasation of the oral contrast (94%), observation of a wall defect (72%), and the presence of abscesses (77%). Extravasation of oral and rectal contrast is infrequent in several studies and is considered a sign of perforation. In closed abdominal trauma with perforation of hollow viscera, it has shown an <span class="elsevierStyleItalic">S</span> of 19%–42%,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and in penetrating abdominal trauma with GI perforation it has been observed with a frequency of 15%.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Due to the limited number of studies (seven out of 98 patients) with oral contrast, the presence of the direct sign of contrast extravasation was found in three cases with low <span class="elsevierStyleItalic">S</span> but high Sp at 94%. In our study, the MDCT were revised retrospectively and oral/rectal contrast was not administered systematically because it depended on the criteria of the radiologist and the state of the patient (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>). Oral contrast should be administered approximately 60<span class="elsevierStyleHsp" style=""></span>min before the test, which delays the timing of the study, and most patients with acute abdominal symptoms cannot wait that long.</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0210" class="elsevierStylePara elsevierViewall">The frequency of the direct visualization of the perforation site presents much variability, as seen in our bibliographic review, which depends on the type of CT used, collimation, and experience of the radiologist. We have found percentages ranging from 0% to 43%–53%, and reaching up to 72% in upper GI perforations. Greater percentages of visualization of this sign were obtained with MDCT (8- and 16-detector), using fine axial reconstructions (1.25<span class="elsevierStyleHsp" style=""></span>mm) and coronal and sagittal MPR reconstructions compared with the 5<span class="elsevierStyleHsp" style=""></span>mm cuts.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> In our study, we also wanted to analyze this sign in the reconstructions that the MDCT provides automatically in coronal and sagittal views. The sign analyzed is “visualization of the wall defect on MPR”, present in 21% of the patients on axial images. With the MPR reconstructions, the detection rate did not increase.</p><p id="par0215" class="elsevierStylePara elsevierViewall">In a series with MDCT (64 detectors) in 41 patients, Cho et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> correctly diagnosed the perforation site by recognizing the focal wall defect in 80% (2-mm thick axial images and 1<span class="elsevierStyleHsp" style=""></span>mm MPR); this direct sign was more sensitive and precise in upper GI perforations (S 95.5%).</p><p id="par0220" class="elsevierStylePara elsevierViewall">In our study, the signs with a PPV for identifying the GI perforation site are: segmental wall thickening (90%), the presence of abscesses (87%), and gas bubbles adjacent to the wall (86%) (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>). Hainaux et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> determined that the signs with greater PPV are: the concentration of extraluminal air bubbles adjacent to an intestinal loop, segmental intestinal wall thickening, and a focal defect in the wall of the intestine.</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0225" class="elsevierStylePara elsevierViewall">One of the main limitations of our study is that it is a retrospective study, and each test was used according to the criteria of the radiologist. Another limitation is that the CT that we have available in our emergency department is only a 2-detector scanner, which provides MPR reconstructions but not with the higher quality offered by the latest MDCT models.</p><p id="par0230" class="elsevierStylePara elsevierViewall">MDCT is able to locate gastrointestinal perforation sites with a high sensitivity and excellent interobserver correlation. The radiological signs that identify GI perforation sites with the highest sensitivity were the presence of gas bubbles adjacent to the wall, extraluminal free air in the inframesocolic compartment, and adjacent fat stranding. The most specific were the extravasation of oral contrast, the observation of a wall defect, and the presence of abscesses.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflict of Interests</span><p id="par0235" class="elsevierStylePara elsevierViewall">The authors declare having no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres293521" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction" 2 => "Material and methods" 3 => "Results" 4 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec277461" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres293520" "titulo" => array:5 [ 0 => "Resumen" 1 => "Introducción" 2 => "Material y métodos" 3 => "Resultados" 4 => "Conclusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec277460" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and Methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Procedure" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Image Analysis" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical Analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of Interests" ] 9 => array:2 [ "identificador" => "xack68425" "titulo" => "Acknowledgements" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-11-19" "fechaAceptado" => "2012-06-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec277461" "palabras" => array:4 [ 0 => "Gastrointestinal perforation" 1 => "Pneumoperitoneum" 2 => "Multidetector computed tomography" 3 => "Acute abdomen" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec277460" "palabras" => array:4 [ 0 => "Perforación gastrointestinal" 1 => "Neumoperitoneo" 2 => "Tomografia computarizada multidetector" 3 => "Abdomen agudo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The purpose of this study was to evaluate the accuracy of multidetector computed tomography (MDCT) for locating the site of gastrointestinal tract perforations and to determine the most predictive signs in this diagnosis.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A total of 98 patients with pneumoperitoneum on MDCT were retrospectively analyzed. Two experienced radiologists reviewed the presence or absence of direct signs (extravasation of oral contrast, focal defect in the bowel wall, focal defect with multiplanar reformations images), and indirect signs (free air in supramesocolic, inframesocolic, supramesocolic, and inframesocolic compartments, concentration of extraluminal air bubbles adjacent to the bowel wall, extraluminal fluid, segmental bowel-wall thickening, perivisceral fat stranding, abscess) to identify the site of the perforation. The Kappa index was evaluated between radiologists to determine the site of perforation and for each predictive sign, as well as Kappa index between the site of perforation detected with MDCT and the site proven at surgery. The frequency, sensitivity, specificity, and positive and negative predictive value (PPV and NPV, respectively) were calculated.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The perforation site was identified correctly in 80.4% of cases. Kappa index between radiologists to identify the site was excellent (0.919), varying between 0.5 and 1.0 for each radiological sign. The most frequent site of perforation at surgery (33.7%) and in MDCT (40.82%) was the sigmoid colon/rectum. Concentration of extraluminal air bubbles adjacent to the bowel wall was the most sensitive (91%) sign and “segmental bowel-wall thickening” had the highest PPV (90%).</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">MDCT is useful for locating the site of GI perforation, with a high sensitivity (80%) and an excellent agreement between radiologists.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Valorar la capacidad de la tomografia computarizada multidetector (TCMD) para identificar la localización de la perforación gastrointestinal (GI).</p> <span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Análisis retrospectivo de 98 pacientes con neumoperitoneo en la TCMD. Dos radiólogos expertos evaluaron la presencia o ausencia de signos radiológicos directos (extravasación del contraste oral; defecto focal de la pared; defecto focal en reconstrucciones multiplanares) e indirectos (aire libre supramesocólico; inframesocólico; supra- e inframesocólico; burbujas de gas adyacentes a la pared; líquido libre; engrosamiento parietal segmentario; trabeculación de la grasa; abscesos) de perforación para identificar su ubicación. Se determinó la concordancia <span class="elsevierStyleItalic">kappa</span> entre los radiólogos para identificar el lugar de la perforación y la presencia o ausencia de cada uno de los signos radiológicos; así como la correlación <span class="elsevierStyleItalic">kappa</span> de la localización detectada mediante TCMD y su confirmación o no en la intervención quirúrgica. Se calculó para cada signo radiológico su frecuencia, sensibilidad, especificidad, valor predictivo positivo (VPP) y negativo (VPN).</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se diagnóstico correctamente el sitio de la perforación en un 80% de los casos. El índice <span class="elsevierStyleItalic">kappa</span> entre radiólogos para la localización fue excelente (0,919), variando para cada signo radiológico entre 0,5 y 1. La localización más frecuente de la perforación en la intervención quirúrgica (33,7%) y en la TCMD (40,8%) fue colon sigmoideo/recto. “Burbujas de gas adyacentes a la pared” fue el signo con mayor S (91%) y el “engrosamiento parietal segmentario” el que tuvo un mayor VPP (90%).</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La TCMD permite localizar las perforaciones gastrointestinales con una alta sensibilidad (80%) y excelente correlación interobservador.</p>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Cadenas Rodríguez L, Martí de Gracia M, Saturio Galán N, Pérez Dueñas V, Salvatierra Arrieta L, Garzón Moll G. Utilidad de la tomografía computarizada multidetector para identificar la localización de las perforaciones gastrointestinales. Cir Esp. 2013;91:316–323.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">This paper was presented as an electronic poster at the 30 Congreso Nacional de la SERAM in La Coruña, Spain on 27 May, 2010.</p>" ] ] "multimedia" => array:9 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 553 "Ancho" => 1514 "Tamanyo" => 117081 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">37-Year-old male with perforation of the small intestine by birdshot pellets: (A) MDCT with IV contrast showing an axial slice of the upper abdomen with pneumoperitoneum (bold arrow); (B) axial slice of the same patient with multiple intraabdominal birdshot pellets (arrow). The perforation of the small intestine was identified during surgery.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 738 "Ancho" => 1536 "Tamanyo" => 140450 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">46-Year-old woman with pneumoperitoneum due to a perforated ulcer: (A) on MDCT with IV contrast, an important perihepatic and periportal pneumoperitoneum is identified (thin arrows), suggesting upper gastrointestinal perforation; (B) coronal reconstruction was able to confirm the defect in the anterior wall of the gastric antrum (bold arrow), which was also observed in axial slice A. Surgery confirmed the presence of a perforation in the gastric antrum.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 739 "Ancho" => 1517 "Tamanyo" => 142788 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">82-Year-old woman with pneumoperitoneum: (A) MDCT axial slice with IV contrast showing multiple extraluminal gas bubbles and a 7<span class="elsevierStyleHsp" style=""></span>cm collection (arrow) with irregular wall, adjacent to the jejunum; (B) coronal reconstruction demonstrating an abscess (arrow) and jejunum. The pathology report confirmed perforated GIST of the small intestine.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 712 "Ancho" => 1551 "Tamanyo" => 167322 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">48-Year-old woman with perforated acute appendicitis: (A) MDCT demonstrating an abscess (arrow) and free liquid in the pelvis, without identification of the appendix; (B) coronal reconstruction of the same patient with a collection of gas (arrow) in the pelvis. Anatomic pathology confirmed perforated appendicitis.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 703 "Ancho" => 1550 "Tamanyo" => 154570 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">44-Year-old male with pneumoperitoneum: (A) MDCT axial slice with oral and IV contrast showing extraluminal gas and extravasation of oral contrast (bold arrow), intense adjacent fat stranding (*), and thickening of the small bowel loops (thin arrow); (B) sagittal reconstruction showing the extravasation of oral contrast (arrow) and fat stranding (*); an SOL in the liver is also observed (curved arrow). Surgery confirmed perforation of the small intestine, while pathology confirmed the presence of a large-cell carcinoma in the distal ileum with infiltration in the mesentery and hepatic metastasis.</p>" ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Fig. 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 576 "Ancho" => 1446 "Tamanyo" => 122055 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">54-Year-old woman with acute abdominal symptoms and pneumoperitoneum seen on MDCT: (A) MDCT axial slice with IV contrast of the pelvis revealing asymmetrical thickening of the sigma wall (thin arrow), free fluid, and an adjacent abscess with air-fluid level (bold arrow); (B) axial slice at a more cranial level where a pathologic retroperitoneal lymphadenopathy is observed (17<span class="elsevierStyleHsp" style=""></span>mm). The pathology study confirmed a perforated adenocarcinoma of the sigma with positive retroperitoneal lymph nodes.</p>" ] ] 6 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">MPR, multiplanar reconstructions.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Sign \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Kappa coefficient \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral contrast extravasation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.795 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Focal wall defect \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.502 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Free supramesocolic air \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.912 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Free inframesocolic air \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Free supra- and inframesocolic air \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.938 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gas bubbles adjacent to the wall \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.680 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Localized free fluid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.757 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Segmental wall thickening \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.693 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Localized fat stranding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.717 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abscesses \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.826 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sagittal and coronal MPR (wall defect) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.550 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab427240.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Kappa Correlation Coefficient for Each Sign of Gastrointestinal Perforation Between the 2 Radiologists.</p>" ] ] 7 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">MPR, multiplanar reconstructions; R1, radiologist 1; R2, radiologist 2.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Sign \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">R1 frequency (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">R2 frequency (%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral contrast extravasation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3/7 (42.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2/7 (28.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Focal wall defect \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21/98 (21.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16/98 (16.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Free supramesocolic air \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62/98 (63.3). \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62/98 (63.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Free inframesocolic air \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86/98 (87.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86/98 (87.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Free supra- and inframesocolic air \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52/98 (53.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53/98 (54.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gas bubbles adjacent to the wall \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84/98 (85.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87/98 (88.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Localized free liquid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70/98 (71.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77/98 (78.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Segmental wall thickening \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72/98 (73.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77/98 (78.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Localized fat stranding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82/98 (83.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85/98 (86.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abscesses \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32/98 (32.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40/98 (40.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sagittal and coronal MPR (wall defect) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20/98 (21.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15/98 (15.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab427242.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Frequency of Each Radiological Sign.</p>" ] ] 8 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">MPR, multiplanar reconstructions; NPV, negative predictive value; PPV, positive predictive value; S, sensitivity; Sp, specificity.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Sign \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">S</span> % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Sp % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">PPV % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">NPV % \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral contrast extravasation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.5 (2/80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94 (17/18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66 (2/3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (17/95) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Focal wall defect \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 (16/80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72 (13/18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76 (16/21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (13/77) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Free supramesocolic air \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60 (48/80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (4/18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77 (48/62) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (4/36) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Free inframesocolic air \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90 (72/80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (4/18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83 (72/86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 (4/12) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Free supra- and inframesocolic air \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52 (42/80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 (8/18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80 (42/52) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (8/46) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gas bubbles adjacent to the wall \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91 (73/80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 (7/18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86 (73/84) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 (7/14) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Localized free fluid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75 (60/80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 (8/18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85 (60/70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 (8/28) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Segmental wall thickening \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83 (67/80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61 (11/18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90 (67/74) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 (11/24) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Localized fat stranding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88 (71/80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 (7/18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86 (71/82) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 (7/16) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abscesses \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 (28/80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77 (14/18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87 (28/32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 (14/66) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sagittal and coronal MPR (wall defect) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 (16/80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66 (12/18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80 (16/20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (12/76) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab427241.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Sensitivity, Specificity, Positive Predictive Value, and Negative Predictive Value of Each Radiological Sign.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Value of computed tomography in detecting occult gastrointestinal perforation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.B. Jeffrey" 1 => "M.P. Federle" 2 => "S. Wall" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Comput Assist Tomogr" "fecha" => "1983" "volumen" => "7" "paginaInicial" => "825" "paginaFinal" => "827" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6886134" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute perforation of the colon" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.A. Lozon" 1 => "J.H. Duff" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Can J Surg" "fecha" => "1976" "volumen" => "19" "paginaInicial" => "48" "paginaFinal" => "51" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1245007" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis of pneumoperitoneum on supine abdominal radiographs" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.S. Levine" 1 => "J.D. Scheiner" 2 => "S.E. Rubesin" 3 => "I. Laufer" 4 => "H. Herlinger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2214/ajr.156.4.2003436" "Revista" => array:6 [ "tituloSerie" => "AJR" "fecha" => "1991" "volumen" => "156" "paginaInicial" => "731" "paginaFinal" => "735" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2003436" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis of pneumoperitoneum: abdominal CT vs upright chest film" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.C. Stapakis" 1 => "D. Thickman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Comput Assist Tomogr" "fecha" => "1992" "volumen" => "16" "paginaInicial" => "713" "paginaFinal" => "716" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1522261" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Laparoscopic treatment of perforated peptic ulcer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Mouret" 1 => "Y. Francois" 2 => "J. Vignal" 3 => "X. Barth" 4 => "R. Lombardplatet" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Br J Surg" "fecha" => "1990" "volumen" => "77" "paginaInicial" => "1006" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2145052" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Randomized clinical trial of laparoscopic versus open repair of the perforated peptic ulcer: the LAMA trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Bertleff" 1 => "J.A. Halm" 2 => "W.A. Bemelman" 3 => "A.C. van der Ham" 4 => "E. van der Harst" 5 => "H.I. Oei" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00268-009-0054-y" "Revista" => array:6 [ "tituloSerie" => "World J Surg" "fecha" => "2009" "volumen" => "33" "paginaInicial" => "1368" "paginaFinal" => "1373" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19430829" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Operative management of diverticular emergencies: strategies and outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W.H. Schwesinger" 1 => "C.P. Page" 2 => "H.V. Gaskill" 3 => "R.M. Steward" 4 => "S. Chopra" 5 => "W.E. Strodel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Surg" "fecha" => "2000" "volumen" => "135" "paginaInicial" => "558" "paginaFinal" => "562" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10807280" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multidetector CT findings suggesting a perforation site in the gastrointestinal tract: analysis in surgically confirmed 155 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Imuta" 1 => "K. Awai" 2 => "Y. Nakayama" 3 => "Y. Murata" 4 => "C. Asao" 5 => "T. Matsukawa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11604-006-0112-4" "Revista" => array:6 [ "tituloSerie" => "Radiat Med" "fecha" => "2007" "volumen" => "25" "paginaInicial" => "113" "paginaFinal" => "118" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17450335" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gastrointestinal tract perforation: MDCT findings according to the perforation sites" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.H. Kim" 1 => "S.S. Shin" 2 => "Y.Y. Jeong" 3 => "S.H. Heo" 4 => "J.W. Kim" 5 => "H.K. Kang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3348/kjr.2009.10.1.63" "Revista" => array:6 [ "tituloSerie" => "Korean J Radiol" "fecha" => "2009" "volumen" => "10" "paginaInicial" => "63" "paginaFinal" => "70" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19182505" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "64-slice multidetector computed tomography evaluation of gastrointestinal tract perforation site: detectability of direct findings in upper and lower GI tract" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Oguro" 1 => "T. Funabiki" 2 => "K. Hosoda" 3 => "Y. Inoue" 4 => "T. Yamane" 5 => "M. Sato" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00330-009-1670-5" "Revista" => array:6 [ "tituloSerie" => "Eur Radiol" "fecha" => "2010" "volumen" => "20" "paginaInicial" => "1396" "paginaFinal" => "1403" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19997849" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Accuracy of MDCT in predicting site of gastrointestinal tract perforation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Hainaux" 1 => "E. Agneessens" 2 => "R. Bertinotti" 3 => "V. de Maertelaer" 4 => "E. Rubesova" 5 => "E. Capelluto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2214/AJR.05.1179" "Revista" => array:6 [ "tituloSerie" => "AJR" "fecha" => "2006" "volumen" => "187" "paginaInicial" => "1179" "paginaFinal" => "1183" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17056902" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Features of perforated peptic ulcers in conventional computed tomography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.H. Chen" 1 => "H.S. Huang" 2 => "C.C. Yang" 3 => "Y.H. Yeh" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Hepatogastroenterology" "fecha" => "2001" "volumen" => "48" "paginaInicial" => "1393" "paginaFinal" => "1396" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11677972" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High-resolution multidetector CT in the preoperative evaluation of patients with renal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Catalano" 1 => "F. Fraioli" 2 => "A. Laghi" 3 => "A. Napoli" 4 => "F. Pediconi" 5 => "M. Danti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2214/ajr.180.5.1801271" "Revista" => array:6 [ "tituloSerie" => "AJR" "fecha" => "2003" "volumen" => "180" "paginaInicial" => "1271" "paginaFinal" => "1277" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12704036" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The accuracy of 64-slice MDCT for determining the perforation site of the gastrointestinal tract: ROC analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.W. Kim" 1 => "S.S. Shin" 2 => "S.H. Heo" 3 => "Y.Y. Jeong" 4 => "H.K. Kang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00261-010-9660-2" "Revista" => array:6 [ "tituloSerie" => "Abdom Imaging" "fecha" => "2011" "volumen" => "36" "paginaInicial" => "503" "paginaFinal" => "508" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20981420" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. Part 2: gastrointestinal tract and retroperitoneal organs" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.D. Becker" 1 => "G. Mentha" 2 => "F. Schmidlin" 3 => "F. Terrier" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Radiol" "fecha" => "1998" "volumen" => "8" "paginaInicial" => "772" "paginaFinal" => "780" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9601964" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Triple contrast helical CT in penetrating torso trauma: a prospective study to determine peritoneal violation and the need for laparotomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K. Shanmuganathan" 1 => "S.E. Mirvis" 2 => "W.C. Chiu" 3 => "K.L. Killeen" 4 => "T.M. Scalea" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2214/ajr.177.6.1771247" "Revista" => array:6 [ "tituloSerie" => "AJR" "fecha" => "2001" "volumen" => "177" "paginaInicial" => "1247" "paginaFinal" => "1256" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11717058" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Direct visualization of perforation sites in patients with a non-traumatic free pneumoperitoneum: added diagnostic value of thin transverse slices and coronal and sagittal reformations for multi-detector CT" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "O. Ghekiere" 1 => "A. Lesnik" 2 => "I. Millet" 3 => "D. Hoa" 4 => "F. Guillon" 5 => "P. Taourel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00330-007-0585-2" "Revista" => array:6 [ "tituloSerie" => "Eur Radiol" "fecha" => "2007" "volumen" => "17" "paginaInicial" => "2302" "paginaFinal" => "2309" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17340104" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Distinction between upper and lower gastrointestinal perforation: usefulness of the periportal free air sign on computed tomography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "H.S. Cho" 1 => "S.E. Yoon" 2 => "S.H. Park" 3 => "H. Kim" 4 => "Y.H. Lee" 5 => "K.H. Yoon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejrad.2007.08.024" "Revista" => array:6 [ "tituloSerie" => "Eur J Radiol" "fecha" => "2009" "volumen" => "69" "paginaInicial" => "108" "paginaFinal" => "113" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17913427" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack68425" "titulo" => "Acknowledgements" "texto" => "<p id="par0240" class="elsevierStylePara elsevierViewall">The authors would like to express their gratitude toward the Departments of Surgery and Statistics at the Hospital Universitario La Paz.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735077/0000009100000005/v1_201311210034/S2173507713001634/v1_201311210034/en/main.assets" "Apartado" => array:4 [ "identificador" => "7417" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735077/0000009100000005/v1_201311210034/S2173507713001634/v1_201311210034/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507713001634?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 0 | 6 |
| 2024 October | 23 | 11 | 34 |
| 2024 September | 60 | 1 | 61 |
| 2024 August | 31 | 4 | 35 |
| 2024 July | 23 | 7 | 30 |
| 2024 June | 28 | 7 | 35 |
| 2024 May | 18 | 9 | 27 |
| 2024 April | 30 | 4 | 34 |
| 2024 March | 63 | 5 | 68 |
| 2024 February | 84 | 16 | 100 |
| 2024 January | 57 | 9 | 66 |
| 2023 December | 59 | 2 | 61 |
| 2023 November | 82 | 13 | 95 |
| 2023 October | 101 | 5 | 106 |
| 2023 September | 54 | 4 | 58 |
| 2023 August | 48 | 0 | 48 |
| 2023 July | 68 | 4 | 72 |
| 2023 June | 56 | 3 | 59 |
| 2023 May | 64 | 4 | 68 |
| 2023 April | 33 | 3 | 36 |
| 2023 March | 50 | 6 | 56 |
| 2023 February | 42 | 7 | 49 |
| 2023 January | 50 | 5 | 55 |
| 2022 December | 75 | 8 | 83 |
| 2022 November | 60 | 8 | 68 |
| 2022 October | 63 | 17 | 80 |
| 2022 September | 78 | 32 | 110 |
| 2022 August | 106 | 23 | 129 |
| 2022 July | 63 | 6 | 69 |
| 2022 June | 47 | 8 | 55 |
| 2022 May | 47 | 11 | 58 |
| 2022 April | 81 | 11 | 92 |
| 2022 March | 79 | 11 | 90 |
| 2022 February | 89 | 5 | 94 |
| 2022 January | 89 | 10 | 99 |
| 2021 December | 75 | 14 | 89 |
| 2021 November | 61 | 17 | 78 |
| 2021 October | 55 | 8 | 63 |
| 2021 September | 49 | 10 | 59 |
| 2021 August | 56 | 8 | 64 |
| 2021 July | 51 | 6 | 57 |
| 2021 June | 41 | 11 | 52 |
| 2021 May | 57 | 11 | 68 |
| 2021 April | 142 | 35 | 177 |
| 2021 March | 61 | 16 | 77 |
| 2021 February | 48 | 9 | 57 |
| 2021 January | 62 | 9 | 71 |
| 2020 December | 47 | 7 | 54 |
| 2020 November | 79 | 11 | 90 |
| 2020 October | 58 | 5 | 63 |
| 2020 September | 32 | 10 | 42 |
| 2020 August | 48 | 13 | 61 |
| 2020 July | 38 | 10 | 48 |
| 2020 June | 47 | 8 | 55 |
| 2020 May | 48 | 15 | 63 |
| 2020 April | 25 | 3 | 28 |
| 2020 March | 57 | 6 | 63 |
| 2020 February | 52 | 4 | 56 |
| 2020 January | 31 | 8 | 39 |
| 2019 December | 47 | 11 | 58 |
| 2019 November | 28 | 12 | 40 |
| 2019 October | 39 | 9 | 48 |
| 2019 September | 37 | 8 | 45 |
| 2019 August | 36 | 2 | 38 |
| 2019 July | 41 | 25 | 66 |
| 2019 June | 70 | 27 | 97 |
| 2019 May | 164 | 33 | 197 |
| 2019 April | 100 | 16 | 116 |
| 2019 March | 20 | 9 | 29 |
| 2019 February | 28 | 8 | 36 |
| 2019 January | 16 | 6 | 22 |
| 2018 December | 12 | 3 | 15 |
| 2018 November | 28 | 1 | 29 |
| 2018 October | 25 | 3 | 28 |
| 2018 September | 41 | 12 | 53 |
| 2018 August | 21 | 2 | 23 |
| 2018 July | 20 | 6 | 26 |
| 2018 June | 9 | 2 | 11 |
| 2018 May | 16 | 4 | 20 |
| 2018 April | 25 | 2 | 27 |
| 2018 March | 22 | 5 | 27 |
| 2018 February | 13 | 2 | 15 |
| 2018 January | 13 | 0 | 13 |
| 2017 December | 13 | 1 | 14 |
| 2017 November | 32 | 0 | 32 |
| 2017 October | 18 | 5 | 23 |
| 2017 September | 18 | 8 | 26 |
| 2017 August | 27 | 8 | 35 |
| 2017 July | 18 | 2 | 20 |
| 2017 June | 32 | 2 | 34 |
| 2017 May | 36 | 2 | 38 |
| 2017 April | 13 | 10 | 23 |
| 2017 March | 32 | 40 | 72 |
| 2017 February | 44 | 2 | 46 |
| 2017 January | 32 | 2 | 34 |
| 2016 December | 39 | 7 | 46 |
| 2016 November | 51 | 4 | 55 |
| 2016 October | 74 | 8 | 82 |
| 2016 September | 43 | 9 | 52 |
| 2016 August | 29 | 5 | 34 |
| 2016 July | 36 | 5 | 41 |
| 2016 June | 35 | 5 | 40 |
| 2016 May | 36 | 13 | 49 |
| 2016 April | 53 | 11 | 64 |
| 2016 March | 58 | 19 | 77 |
| 2016 February | 27 | 9 | 36 |
| 2016 January | 28 | 9 | 37 |
| 2015 December | 33 | 5 | 38 |
| 2015 November | 24 | 3 | 27 |
| 2015 October | 24 | 7 | 31 |
| 2015 September | 38 | 5 | 43 |
| 2015 August | 42 | 8 | 50 |
| 2015 July | 41 | 2 | 43 |
| 2015 June | 18 | 4 | 22 |
| 2015 May | 35 | 8 | 43 |
| 2015 April | 41 | 4 | 45 |
| 2015 March | 31 | 5 | 36 |
| 2015 February | 18 | 7 | 25 |
| 2015 January | 25 | 2 | 27 |
| 2014 December | 40 | 9 | 49 |
| 2014 November | 25 | 5 | 30 |
| 2014 October | 24 | 4 | 28 |
| 2014 September | 22 | 4 | 26 |
| 2014 August | 29 | 6 | 35 |
| 2014 July | 21 | 4 | 25 |
| 2014 June | 29 | 8 | 37 |
| 2014 May | 22 | 0 | 22 |
| 2014 April | 17 | 9 | 26 |
| 2014 March | 12 | 5 | 17 |
| 2014 February | 20 | 5 | 25 |
| 2014 January | 21 | 5 | 26 |
| 2013 December | 12 | 1 | 13 |
| 2013 November | 5 | 3 | 8 |
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