Diagnostic performance of MDCT in identifying closed loop small bowel obstruction

Area of Science:

• Radiology
• Gastroenterology
• Surgical Imaging

Background:

• Small bowel obstruction (SBO) is a common surgical emergency.
• Accurate diagnosis of closed loop small bowel obstruction (CL-SBO) is crucial for timely intervention.
• MDCT is a primary imaging modality for SBO evaluation.

Purpose of the Study:

• To evaluate the diagnostic performance of MDCT in identifying CL-SBO.
• To assess the accuracy of MDCT findings in predicting operative diagnosis of CL-SBO.
• To analyze reader agreement on MDCT interpretations for CL-SBO.

Main Methods:

• Retrospective review of 150 SBO patients' MDCT scans.
• Independent, blinded review by five radiologists to detect CL-SBO and bowel ischemia.
• Comparison with operative findings as the gold standard.
• Analysis of reader agreement, sensitivity, specificity, and predictive values.

Main Results:

• Operative intervention confirmed CL-SBO in 24 of 150 patients.
• Average reader sensitivity for CL-SBO was 53%, specificity was 83%.
• Reader agreement for CL-SBO diagnosis was poor to moderate (Kappa 0.39-0.63).
• Agreement on CT signs of ischemia was weak (r=0.19-0.32).

Conclusions:

• MDCT diagnosis of CL-SBO is complex with variable sensitivity.
• Associated CT findings have limited predictive value for operative CL-SBO.
• MDCT can be useful in excluding a closed loop component in SBO patients.