Imaging features of marginal ulcers on multidetector CT.

Area of Science:

• Radiology
• Gastroenterology
• Surgical Pathology

Background:

• Marginal ulcers are a complication of gastro-enteric anastomosis surgery.
• Accurate imaging assessment of marginal ulcers is crucial for timely diagnosis and management.
• Computed tomography (CT) is frequently used to evaluate post-surgical complications.

Purpose of the Study:

• To evaluate the inter-reader agreement among radiologists for various computed tomography (CT) imaging findings associated with marginal ulcer disease.
• To determine the frequency of these imaging findings in patients with confirmed marginal ulcers.

Main Methods:

• Retrospective analysis of 80 patients with confirmed marginal ulcers.
• Review of multidetector computed tomography (MDCT) scans by two abdominal radiologists.
• Assessment of predetermined imaging characteristics categorized under inflammation, penetration, perforation, and obstruction.
• Inter-rater reliability analysis using the Cohen kappa test.

Main Results:

• Signs of perforation (extraluminal air, fluid, contrast leakage) showed moderate to substantial agreement (kappa 0.57-0.83) but were infrequent (3-43%).
• Perienteric fat stranding and penetration into adjacent organs had moderate agreement (kappa 0.45-0.47) and variable prevalence (5-88%).
• Wall thickening and contour abnormalities were common (60-90%) but had only slight to fair agreement (kappa 0.09-0.29).

Conclusions:

• Computed tomography (CT) demonstrates high inter-reader agreement for signs of perforation in marginal ulcer disease, despite their low frequency.
• Common CT findings such as fat stranding, wall thickening, and contour abnormalities have variable agreement, with only fat stranding achieving moderate reliability.