Does the CT whirl sign really predict small bowel volvulus?: Experience in an oncologic population
Marc J Gollub1, Sora Yoon, Lachlan McG Smith
1Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10023, and Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. gollubM@mskcc.org
Journal of Computer Assisted Tomography
|December 21, 2005
Summary
The CT whirl sign can help identify small bowel volvulus, but it is not always present. Most whirl signs on CT scans do not indicate small bowel volvulus.
Area of Science:
- Radiology
- Gastroenterology
- Abdominal Imaging
Background:
- Small bowel volvulus is a rare but serious cause of intestinal obstruction.
- Early diagnosis is crucial for effective treatment and preventing complications.
Purpose of the Study:
- To evaluate the sensitivity of the CT "whirl sign" in diagnosing small bowel volvulus.
- To assess the diagnostic accuracy of the whirl sign in patients with suspected intestinal obstruction.
Main Methods:
- Retrospective review of 1,493 multislice helical CT scans in patients with suspected small bowel obstruction.
- Identification of the "whirl sign" (combined vessel and bowel whirl appearance).
- Correlation of CT findings with surgical or clinicoradiographic diagnoses.
Main Results:
- Small bowel volvulus was confirmed in 11 patients (0.9%).
- Reader 1 detected 7 of 11 volvuli (sensitivity 64%), Reader 2 detected 3 of 11 (sensitivity 27%).
- The whirl sign was found in 33 scans by Reader 1 and 13 by Reader 2, indicating a low positive predictive value.
Conclusions:
- The CT whirl sign is a useful indicator for small bowel volvulus.
- However, the presence of a whirl sign does not definitively confirm small bowel volvulus, necessitating careful interpretation.
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