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. 2024 Jun 1;14(6):3939-3950.
doi: 10.21037/qims-23-1530. Epub 2024 May 20.

Role of clinical and multidetector computed tomography (MDCT) features in the prediction of patients with intestinal lipoma developing intussusception

Qiu-Jie Dong #  1   2 , Yi Tang #  1 , Chun-Lai Zhang  2 , Xiao-Guang Li  2 , Xiao Chen  1 , Yi Wang  1
Affiliations

Role of clinical and multidetector computed tomography (MDCT) features in the prediction of patients with intestinal lipoma developing intussusception

Qiu-Jie Dong et al. Quant Imaging Med Surg. .

Abstract

Background: Intestinal lipoma is considered the most common benign tumor that causes intussusception. This retrospective case-control study aimed to present the clinical and multidetector computed tomography (MDCT) features between intestinal lipomas with and without intussusception and examine risk factors that predict intussusception caused by intestinal lipomas.

Methods: We retrospectively analyzed 281 adult patients diagnosed with intestinal lipoma by radiologists using whole-abdominal MDCT between January 2015 and August 2022. Patients were divided into adult intussusception (AI) and non-AI groups based on MDCT images. Univariate logistic regression was performed to identify risk factors for intestinal lipoma-induced intussusception.

Results: A total of 281 patients with intestinal lipomas were included in the study, with an average age of 68.0±11.3 years, and the male to female ratio was about 1:1.4. Among them, 24 patients developed lipoma-induced intussusception. Patients in the AI group presented with more abdominal pain (70.8% vs. 47.1%, P=0.03), nausea/vomiting (37.5% vs. 14.8%, P=0.009), hematochezia/melena (29.2% vs. 11.3%, P=0.02), and abdominal tenderness (66.7% vs. 24.9%, P<0.001). Lipomas were more common in the small bowel (224/281, 79.7%) than the large bowel (57/281, 20.3%). Lipomas in the AI group showed more heterogeneous hypodensity (41.7% vs. 15.6%, P=0.004), longer length (median, 2.2 vs. 1.2 cm, P<0.001), and larger volume (median, 4.1 vs. 0.6 cm3, P<0.001). In the univariate logistic regression, lipoma density [odds ratio (OR) =3.875, 95% confidence interval (CI): 1.609-9.331, P=0.003] and lipoma length (OR =3.216, 95% CI: 1.977-5.231, P<0.001) were risk factors for intestinal lipoma-induced intussusception.

Conclusions: More patients in the AI group have digestive tract symptoms than those in the non-AI group. Lipoma density and length are risk factors for intussusception in patients with intestinal lipoma. In addition, the common site of intestinal lipoma may have changed from the colon to the small intestine.

Keywords: Lipoma; complications; intussusception; multidetector computed tomography (MDCT); risk factors.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-23-1530/coif). The authors declare that the study was supported by the grant from the Clinical Medical Research Project of Army Medical University (No. 2022XLC08). The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Participant selection flowchart. MDCT, multidetector computed tomography; AI, adult intussusception.
Figure 2
Figure 2
Representative images from an intestinal lipoma in the AI group. A 74-year-old woman presented with abdominal pain for 4 days. The unenhanced axial MDCT image (A) showed a round, smoothly outlined, well-defined, and homogeneous hypodensity mass (arrow) in the distal jejunum with a CT value of −70.3 HU. The CT value of this mass (arrow) in the venous phase (B) was −65.8 HU. Contrast-enhanced coronal MDCT image (C) presented an enteric intussusception with intestinal wall thickening (arrows). The pathological examination [(D), HE ×40] of the operative specimen confirmed the diagnosis of lipoma. AI, adult intussusception; MDCT, multidetector computed tomography; CT, computed tomography; HU, Hounsfield unit, HE, hematoxylin and eosin staining.
Figure 3
Figure 3
Representative images from an intestinal lipoma in the non-AI group. A 65-year-old woman complained of abdominal pain for 7 months. Unenhanced (A) and enhanced (B) abdominal axial MDCT images showed an irregular, heterogeneous fat-dense mass with several linear thin septa (arrows). Surgical specimen (C) showed a grayish-yellow mass (arrows). The pathological examination [(D), HE × 40] revealed a jejunal lipoma. AI, adult intussusception; MDCT, multidetector computed tomography; HE, hematoxylin and eosin staining.
Figure 4
Figure 4
Lipomas of different shapes and locations. The unenhanced axial MDCT image (A) showed a drop-shaped mass (arrow) of fat density (−101.0 HU) in the duodenum. The contrast-enhanced axial MDCT image in the venous phase (B) showed an oval fatty mass (−93.5 HU) (arrow) in the jejunum. The unenhanced axial MDCT image (C) showed an oval hypodensity nodule (arrow) in the ileum. The contrast-enhanced axial MDCT image in the arterial phase (D) showed an oval mass (arrow) in the ascending colon. MDCT, multidetector computed tomography; HU, Hounsfield unit.
Figure 5
Figure 5
Representative images from a patient with multiple lipomas. A 72-year-old woman presented with abdominal pain for three days. Unenhanced axial MDCT images (A,B) showed two oval hypodense nodules (arrows), both located in the jejunum. Contrast-enhanced axial (C) and coronal (D) MDCT images showed thickening of the small intestinal wall (arrows). MDCT, multidetector computed tomography.
Figure 6
Figure 6
ROC curves of lipoma density and length for predicting intestinal lipoma-induced intussusception. ROC, receiver operating characteristic.
Figure 7
Figure 7
Scatter plot of the lipoma length in the AI and non-AI groups. The black vertical dashed line indicated the cut-off value of 1.5 cm. AI, adult intussusception.
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