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Diagnostic performance of MDCT in identifying closed loop small bowel obstruction

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Abstract

Purpose

To assess the diagnostic performance of MDCT in the diagnosis of closed loop small bowel obstruction.

Materials and methods

One hundred fifty patients with CT reports including “small bowel obstruction (SBO)” between 1/30/2011 and 12/4/2012 were included (65 men, 85 women, mean age 63 years). CT examinations were independently and blindly reviewed by five radiologists to determine the presence of closed loop obstruction (CL-SBO) and to assess findings of bowel ischemia. Clinical records were reviewed to determine management and operative findings. Using operative findings as a gold standard, reader agreement for the diagnosis of and the CT findings associated with CLO was analyzed using Pearson’s correlation (r). Positive predictive value (PPV) and negative predictive value for the diagnosis of CL-SBO and CT signs of bowel ischemia were analyzed.

Results

Eighty-eight of 150 patients underwent operative intervention for SBO and 24/88 were considered CL-SBO operatively. Average reader sensitivity and specificity for CL-SBO was 53 % (95 % CI 44–63 %) and 83 % (95 % CI 79–87 %). Reader agreement on CL-SBO was poor to moderate (K = 0.39–0.63). Reader agreement for CT signs of bowel ischemia resulting in a diagnosis of CL-SBO was weak (r = 0.19–0.32).

Conclusion

The CT diagnosis of CL-SBO is complex and associated imaging findings have variable sensitivity for predicting a closed loop operative diagnosis. CT can be helpful in excluding a closed loop component in patients with SBO.

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References

  1. Barnett RE, Younga J, Harris B, et al. (2013) Accuracy of computed tomography in small bowel obstruction. Am Surg 79:641–643

    PubMed  Google Scholar 

  2. Federle MP Jr, Jeffrey RB, Woodward PJ, Borhani A (2009) Small Bowel Obstruction. Diagnostic Imaging: Abdomen. Philadelphia: Lippincott Williams & Wilkins, pp 44–47

    Google Scholar 

  3. Frager DH, Baer JW, Rothpearl A, Bossart PA (1995) Distinction between postoperative ileus and mechanical small-bowel obstruction: value of CT compared with clinical and other radiographic findings. Am J Roentgenol 164:891–894

    Article  CAS  Google Scholar 

  4. Jaffe TA, Martin LC, Thomas J, et al. (2006) Small-bowel obstruction: coronal reformations from isotropic voxels at 16-section multi-detector row CT. Radiology 238:135–142

    Article  PubMed  Google Scholar 

  5. Khurana B, Ledbetter S, McTavish J, Wiesner W, Ros PR (2002) Bowel obstruction revealed by multidetector CT. AJR Am J Roentgenol 178:1139–1144

    Article  PubMed  Google Scholar 

  6. Miller G, Boman J, Shrier I, Gordon PH (2000) Etiology of small bowel obstruction. Am J Surg 180:33–36

    Article  CAS  PubMed  Google Scholar 

  7. Paulson EK, Thompson WM (2015) Review of small-bowel obstruction: the diagnosis and when to worry. Radiology 275:332–342

    Article  PubMed  Google Scholar 

  8. Rubesin SE, Gore RM (2015) Textbook of gastrointestinal radiology. Philadelphia: Elsevier/Saunders, pp 806–826

    Google Scholar 

  9. Santillan CS (2013) Computed tomography of small bowel obstruction. Radiol Clin North Am 51:17–27

    Article  PubMed  Google Scholar 

  10. Silva AC, Pimenta M, Guimaraes LS (2009) Small bowel obstruction: what to look for 1. Radiographics 29(2):423–439

    Article  PubMed  Google Scholar 

  11. Balthazar EJ, Bauman JS, Megibow AJ (1985) CT diagnosis of closed loop obstruction. J Comput Assist Tomogr 9:953–955

    Article  CAS  PubMed  Google Scholar 

  12. Frager D, Medwid SW, Baer JW, Mollinelli B, Friedman M (1994) CT of small-bowel obstruction: value in establishing the diagnosis and determining the degree and cause. AJR Am J Roentgenol 162:37–41

    Article  CAS  PubMed  Google Scholar 

  13. Frager DH, Baer JW (1995) Role of CT in evaluating patients with small-bowel obstruction. Semin Ultrasound CT MR 16:127–140

    Article  CAS  PubMed  Google Scholar 

  14. Furukawa A, Yamasaki M, Takahashi M, et al. (2003) CT diagnosis of small bowel obstruction: scanning technique, interpretation and role in the diagnosis. Semin Ultrasound CT MR 24:336–352

    Article  PubMed  Google Scholar 

  15. Gazelle GS, Goldberg MA, Wittenberg J, et al. (1994) Efficacy of CT in distinguishing small-bowel obstruction from other causes of small-bowel dilatation. AJR Am J Roentgenol 162:43–47

    Article  CAS  PubMed  Google Scholar 

  16. Ha HK, Kim JS, Lee MS, et al. (1997) Differentiation of simple and strangulated small-bowel obstructions: usefulness of known CT criteria. Radiology 204:507–512

    Article  CAS  PubMed  Google Scholar 

  17. Hodel J, Zins M, Desmottes L, et al. (2009) Location of the transition zone in CT of small-bowel obstruction: added value of multiplanar reformations. Abdom Imaging 34:35–41

    Article  PubMed  Google Scholar 

  18. Maglinte DD, Heitkamp DE, Howard TJ, Kelvin FM, Lappas JC (2003) Current concepts in imaging of small bowel obstruction. Radiol Clin North Am 41:263–283, vi

    Article  PubMed  Google Scholar 

  19. Maglinte DD, Reyes BL, Harmon BH, et al. (1996) Reliability and role of plain film radiography and CT in the diagnosis of small-bowel obstruction. AJR Am J Roentgenol 167:1451–1455

    Article  CAS  PubMed  Google Scholar 

  20. Nicolaou S, Kai B, Ho S, Su J, Ahamed K (2005) Imaging of acute small-bowel obstruction. Am J Roentgenol 185:1036–1044

    Article  Google Scholar 

  21. Sinha R, Verma R (2005) Multidetector row computed tomography in bowel obstruction. Part 1. Small bowel obstruction. Clin Radiol 60:1058–1067

    Article  CAS  PubMed  Google Scholar 

  22. Sinha R, Verma R (2005) Multidetector row computed tomography in bowel obstruction. Part 2. Large bowel obstruction. Clin Radiol 60:1068–1075

    Article  CAS  PubMed  Google Scholar 

  23. Yaghmai V, Nikolaidis P, Hammond NA, et al. (2006) Multidetector-row computed tomography diagnosis of small bowel obstruction: can coronal reformations replace axial images? Emerg Radiol 13:69–72

    Article  PubMed  Google Scholar 

  24. Balthazar EJ, Birnbaum BA, Megibow AJ, et al. (1992) Closed-loop and strangulating intestinal obstruction: CT signs. Radiology 185:769–775

    Article  CAS  PubMed  Google Scholar 

  25. Duda JB, Bhatt S, Dogra VS (2008) Utility of CT whirl sign in guiding management of small-bowel obstruction. AJR Am J Roentgenol 191:743–747

    Article  PubMed  Google Scholar 

  26. Elsayes KM, Menias CO, Smullen TL, Platt JF (2007) Closed-loop small-bowel obstruction: diagnostic patterns by multidetector computed tomography. J Comput Assist Tomogr 31:697–701

    Article  PubMed  Google Scholar 

  27. Jacobs SL, Rozenblit A, Ricci Z, et al. (2007) Small bowel faeces sign in patients without small bowel obstruction. Clin Radiol 62:353–357

    Article  CAS  PubMed  Google Scholar 

  28. Lazarus DE, Slywotsky C, Bennett GL, Megibow AJ, Macari M (2004) Frequency and relevance of the “small-bowel feces” sign on CT in patients with small-bowel obstruction. AJR Am J Roentgenol 183:1361–1366

    Article  PubMed  Google Scholar 

  29. Petrovic B, Nikolaidis P, Hammond NA, Grant TH, Miller FH (2006) Identification of adhesions on CT in small-bowel obstruction. Emerg Radiol 12:88–93 (discussion 94–85)

    Article  PubMed  Google Scholar 

  30. Zalcman M, Sy M, Donckier V, Closset J, Gansbeke DV (2000) Helical CT signs in the diagnosis of intestinal ischemia in small-bowel obstruction. AJR Am J Roentgenol 175:1601–1607

    Article  CAS  PubMed  Google Scholar 

  31. Balthazar EJ, Liebeskind ME, Macari M (1997) Intestinal ischemia in patients in whom small bowel obstruction is suspected: evaluation of accuracy, limitations, and clinical implications of CT in diagnosis. Radiology 205:519–522

    Article  CAS  PubMed  Google Scholar 

  32. Hwang JY, Lee JK, Lee JE, Baek SY (2009) Value of multidetector CT in decision making regarding surgery in patients with small-bowel obstruction due to adhesion. Eur Radiol 19:2425–2431

    Article  PubMed  Google Scholar 

  33. Jang KM, Min K, Kim MJ, et al. (2010) Diagnostic performance of CT in the detection of intestinal ischemia associated with small-bowel obstruction using maximal attenuation of region of interest. AJR Am J Roentgenol 194:957–963

    Article  PubMed  Google Scholar 

  34. Mallo RD, Salem L, Lalani T, Flum DR (2005) Computed tomography diagnosis of ischemia and complete obstruction in small bowel obstruction: a systematic review. J Gastrointest Surg 9:690–694

    Article  PubMed  Google Scholar 

  35. Sheedy SP (2006) Earnest Ft, Fletcher JG, Fidler JL, Hoskin TL. CT of small-bowel ischemia associated with obstruction in emergency department patients: diagnostic performance evaluation. Radiology 241:729–736

    Article  PubMed  Google Scholar 

  36. Taourel PG, Fabre JM, Pradel JA, et al. (1995) Value of CT in the diagnosis and management of patients with suspected acute small-bowel obstruction. AJR Am J Roentgenol 165:1187–1192

    Article  CAS  PubMed  Google Scholar 

  37. Wiesner W, Mortele KJ, Glickman JN, Ji H, Ros PR (2001) Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome. AJR Am J Roentgenol 177:1319–1323

    Article  CAS  PubMed  Google Scholar 

  38. Jh Z (2009) Biostatistical analysis, 5th edn. Upper Saddle River: Prentice Hall

    Google Scholar 

  39. Maglinte D, Herlinger H, Nolan D (1991) Radiologic features of closed loop obstruction: analysis of 25 confirmed cases. Radiology 179:383–387

    Article  CAS  PubMed  Google Scholar 

  40. Nakashima K, Ishimaru H, Fujimoto T, et al. (2014) Diagnostic performance of CT findings for bowel ischemia and necrosis in closed-loop small-bowel obstruction. Abdom imaging 2014:1–7

    Google Scholar 

  41. Scaglione M, Grassi R, Pinto A (2003) et al [Positive predictive value and negative predictive value of spiral CT in the diagnosis of closed loop obstruction complicated by intestinal ischemia]. Radiol Med (Torino) 107:69–77

    Google Scholar 

  42. Millet I, Ruyer A, Alili C, et al. (2014) Adhesive small-bowel obstruction: value of CT in identifying findings associated with the effectiveness of nonsurgical treatment. Radiology 273:425–432

    Article  PubMed  Google Scholar 

  43. Petrovic B, Nikolaidis P, Hammond NA, Grant TH, Miller FH (2006) Identification of adhesions on CT in small-bowel obstruction. Emerg Radiol 12:88–93

    Article  PubMed  Google Scholar 

  44. Paulson EK, Thompson WM (2015). Review of small-bowel obstruction: the diagnosis and when to worry. Radiology 275:332–342

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Radiology, Duke University Medical Center, Box 3808, Durham, 27710, NC, USA

    Ryan A. Makar, Mustafa R. Bashir, Clare M. Haystead, Christine Iseman, Nicholas Mayes, Stuart Hebert, Brian C. Allen, Kingshuk R. Choudhury & Tracy A. Jaffe

  2. Department of Surgery, Duke University Medical Center, Durham, NC, USA

    Syamal D. Bhattacharya

Authors
  1. Ryan A. Makar
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  2. Mustafa R. Bashir
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  3. Clare M. Haystead
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  4. Christine Iseman
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  5. Nicholas Mayes
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  6. Stuart Hebert
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  9. Kingshuk R. Choudhury
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  10. Tracy A. Jaffe
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Corresponding author

Correspondence to Tracy A. Jaffe.

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Conflict of Interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

This retrospective, Health Insurance Portability and Accountability Act-compliant study was approved by the institutional review board of our medical center with a waiver of informed consent.

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Makar, R.A., Bashir, M.R., Haystead, C.M. et al. Diagnostic performance of MDCT in identifying closed loop small bowel obstruction. Abdom Radiol 41, 1253–1260 (2016). https://doi.org/10.1007/s00261-016-0656-4

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