Zarine Ketul Shah MD, Abstract Co-Author: Nothing to Disclose

Nisha Sainani, Presenter: Nothing to Disclose

Raul Nirmal Uppot MD, Abstract Co-Author: Nothing to Disclose

Jennifer A Wargo, Abstract Co-Author: Nothing to Disclose

Peter Florin Hahn MD, PhD, Abstract Co-Author: Nothing to Disclose

Dushyant Vasudeo Sahani MD, Abstract Co-Author: Nothing to Disclose

Assess performance of 16-MDCT using axial and coronal reformatted images for evaluation of small bowel obstruction (SBO) with surgery as “gold standard”. Assess impact of coronal images on reader confidence. Evaluate adequacy of information provided by CT from a surgeon’s perspective.

Clinical and imaging data from 30 patients (M:F 19:11) operated for SBO from Jan.‘03 to Aug.‘05 was reviewed. Enhanced 16-MDCTs (LightSpeed, GE) of the abdomen and pelvis were performed (DC=0.625mm, speed=18.75mm, thickness= 5mm). 2.5mm thickness coronal images were obtained at the CT console. Two readers, blinded to the surgical findings evaluated MDCT data using a pre-designed template for severity of obstruction, transition site, cause and complications. Reader confidence was graded on a 3-point scale (1=low, 2=moderate, 3=high). Axial images were evaluated first followed 2 weeks later by coronal images. MDCT findings were correlated with surgical findings. A blinded review of CT scans was done by a surgeon, who assessed for adequacy of information and value of coronal reformats.

Mild SBO was present in 2, moderate in 12 and severe in 16 patients. Post-operative adhesions (n=10), closed-loop obstruction (n=6), ventral hernia (n=6), inflammatory bowel disease (n=4), mass (n=3) and benign stricture (n=1) were identified as the cause. The transition point was identified in 28/30 cases (93.33%), and cause of obstruction was correctly identified in 27/30 (90%). Addition of coronal reformats enhanced reader confidence in 27/30 patients (70%). Inter-observer agreement was excellent (k0.87). The surgeon found CT scans adequate in 100% of cases and coronal reformats provided additional information in 22/30 (73.33%) cases.

16-MDCT is accurate for diagnosis of SBO and detection of cause and complications. Addition of coronal reformats enables the radiologist to trace small bowel and allows more rapid and confident assessment of the transition site.

Knowledge of site of bowel obstruction, etiology and complications plays a critical role in surgical decision-making and the use of coronal reformats is beneficial to surgeons who are more accustomed

Shah, Z, Sainani, N, Uppot, R, Wargo, J, Hahn, P, Sahani, D, Small Bowel Obstruction: Off-Axial Imaging and the Adequacy of CT from a Surgical Standpoint.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4427867.html