James Lambert Patrick MD, PhD, Presenter: Nothing to Disclose

Greg Kennedy MD, PhD, Abstract Co-Author: Nothing to Disclose

Meghan G. Lubner MD, Abstract Co-Author: Nothing to Disclose

Alejandro Munoz Del Rio PhD, Abstract Co-Author: Research Consultant, Cellectar Biosciences, Inc Reviewer, Wolters Kluwer nv

Perry J. Pickhardt MD, Abstract Co-Author: Co-founder, VirtuoCTC, LLC Stockholder, Cellectar Biosciences, Inc

Small bowel obstruction (SBO) is an important diagnosis and Multi-detector CT (MDCT) plays a critical role in the evaluation of suspected SBO. The purpose of this study is to determine how good MDCT is in predicting the need for surgical intervention (within 72 hours), bowel resection and bowel ischemia. Additionally, to compare the differences between experienced radiologists and newly board-certified radiologists in identifying SBOs that required surgical intervention.

MDCT studies performed at the time of admission for suspected SBO in 85 consecutive adults were systematically reviewed by 12 board-certified radiologists. Six of the radiologists were newly board-certified radiologists. The other six radiologists were experienced radiologists. The examinations were scored for the presence or absence of findings relevant to SBO and associated bowel ischemia. Each reader rated the likelihood: 1) of the need for surgical exploration, 2) that bowel ischemia would be found at surgery, and 3) that bowel resection would be required. A 5-point scale was utilized for each question (1=definitely not; 2=probably not, 3=possibly/unsure, 4=probably, 5=definitely).

The pooled (all 12 radiologists) ROC area-under-the-curve (AUC) for surgical need was 0.802. Pooled ROC AUC for the presence of ischemia and need for bowel resection was 0.795 and 0.783, respectively. Considering a score of 3-5 as positive, pooled sensitivity and specificity for predicting the need for surgery was 86.1% and 65.5%, respectively. AUC for surgical need between the junior and senior radiologists was the same (0.802). The AUC for bowel ischemia between the junior and senior groups was 0.734 and 0.856, respectively. The AUC for bowel resection was 0.808 (junior) and 0.758 (senior).

Radiologist are moderately successful in evaluating the need for patients with suspected SBO to go to surgery based on MDCT findings. There are no significant differences in the abilities of newly board-certified radiologists and experienced radiologists in identifying SBOs that require imminent surgical intervention.

SBO is an important diagnosis and we have shown that radiologists using MDCT findings can be helpful in guiding clinicians to the appropriate diagnosis and treatment.

Patrick, J, Kennedy, G, Lubner, M, Munoz Del Rio, A, Pickhardt, P, Determining the Need for Surgical Intervention for Small Bowel Obstruction Based on MDCT Findings: Multi-reader Study Comparing Experienced Radiologists with Newly Board-certified Radiologists.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14015337.html