Computed tomography of bowel obstructions: The contribution of multiplanar reformations in comparison with axial slices alone in determining the transition zone

Year 2017, Volume: 34 Issue: 2, 123 - 127, 08.09.2017

Fatih Uzunkaya , Ali Ahmetoglu

Abstract

Several studies have demonstrated that determining the transition zone could facilitate

the diagnosis of bowel obstruction (BO) using multi-detector row computed

tomography (MDCT). We aimed to evaluate the contribution of multi-planar

reformations (MPR) in comparison with axial slices alone to determine the

transition zone. Sixteen-slice MDCT examinations of 66 consecutive patients

with mechanical BO were reviewed by an experienced abdominal radiologist

who had been blinded to the patients’ clinical diagnoses. The scans were first

reviewed using the axial slices alone and later were reviewed using MPR with

respect to the assigned four-point confidence scale in a random order. The diagnostic

accuracy and mean confidence score were evaluated for both reviewing

methods. The accuracy for determining the transition zone using axial slices

alone was 92% in patients with small bowel obstruction (SBO) and 93% in

those with large bowel obstruction (LBO). The levels of accuracy for MPR were

exactly the same with axial slices alone both for SBO and LBO. The mean

confidence score for the determination of the transition zone using axial slices

alone was 3.59 for SBO and 3.71 for MPR (P=0.057). After evaluating patients

with LBO, the mean confidence score using axial slices alone was 3.80, which

was identical to that of MPR. Like MPR, axial CT source slices can also provide

high levels of accuracy in the determination of the transition zone in patients

with BO. However, particularly in SBO, MPR will increase confidence in the

diagnosis.

Keywords

Bowel obstruction, MDCT, Multi-planar reformations, Transition zone

References

• Balthazar, E.J., George, W., 1994. Holmes Lecture CT of SBO. Am. J. Roentgenol. 162, 255-261. doi: 10.2214/ajr.162.2.8310906. Caoili, E.M., Paulson, E.K., 2000. CT of small-bowel obstruction: Another perspective using multiplanar reformations. Am. J. Roentgenol. 174, 993-998. doi: 10.2214/ajr.174.4.1740993. Filippone, A., Cianci, R., Grassedonio, E., Di Fabio, F., Storto, M.L., 2007a. Four-section multidetector computed tomographic imaging of bowel obstruction: Usefulness of axial and coronal plane combined reading. J. Comput. Assist. Tomogr. 31, 499- 507. doi: 10.1097/01.rct.0000238013.87802.3c. Filippone A., Cianci R., Storto M.L., 2007b. Bowel obstruction: Comparison between multidetector-row CT axial and coronal planes. Abdom. Imaging. 32, 310-316. doi: 10.1007/s00261-006-9065-4. Furukawa, A., Yamasaki, M., Furuichi, K., Yokoyama, K., Nagata, T., Takahashi, M., Murata, K., Sakamoto, T., 2001. Helical CT in the diagnosis of small bowel obstruction. Radiographics. 21, 341-355. doi: 10.1148/ radiographics.21.2.g01mr05341. Hodel, J., Zins, M., Desmottes, L., Boulay-Coletta, I., Jullès, M.C., Nakache, J.P., Rodallec, M., 2009. Location of the transition zone in CT of small-bowel obstruction: added value of multiplanar reformations. Abdom. Imaging. 34, 35-41. doi: 10.1007/ s00261-007-9348-4. Jaffe, T.A., Martin, L.C., Thomas, J., Adamson, A.R., Delong, D.M., Paulson, E.K., 2006. Small-bowel obstruction: Coronal reformations from isotropic voxels at 16-section multi-detector row CT. Radiology. 238, 135-142. doi:10.1148/ radiol.2381050489. Keoplung, S., Teerasamit, W., Suvannarerg, V., 2013. Diagnosis of bowel obstruction: Added value of multiplanar reformations from multidetector CT in comparison with axial planes alone. J. Med. Assoc. Thai. 96, 1569-1577. Khurana, B., Ledbetter, S., McTavish, J., Wiesner, W., Ros, P.R., 2002. Bowel obstruction revealed by multidetector CT. Am. J. Roentgenol. 178, 1139-1144. doi: 10.2214/ajr.178.5.1781139. Lazarus, D.E., Slywotsky, C., Bennett, G.L., Megibow, A.J., Macari, M., 2004. Frequency and relevance of the “small-bowel feces” sign on CT in patients wtih SBO. Am. J. Roentgenol. 183, 1361-1366. doi: 10.2214/ajr.183.5.1831361. Maglinte, D.D., Gage, S.N., Harmon, B.H., Kelvin, F.M., Hage, J.P., Chua, G.T., Ng, A.C., Graffis R.F., Chernish S.M., 1993. Obstruction of small intestine: Accuracy and role of CT in diagnosis. Radiology. 188, 61-64. doi: 10.1148/ radiology.188.1.8511318. Paulson, E.K., Harris, J.P., Jaffe, T.A., Haugan, P.A., Nelson, R.C., 2005. Acute appendicitis: added diagnostic value of coronal reformations from isotropic voxels at MDCT. Radiology. 235, 879-885. doi: 10.1148/radiol.2353041231. Paulson E.K., Jaffe T.A., Thomas J., Harris J.P., Nelson R.C., 2004. MDCT of patients with acute abdominal pain: A new perspective using coronal reformations from submillimeter isotropic voxel. Am. J. Roentgenol. 183, 899-906. doi: 10.2214/ ajr.183.4.1830899. Sinha, R., Verma, R., 2005a. Multidetector row computed tomography in bowel obstruction. Part1. Small bowel obstruction. Clinical. Radiology. 60, 1058-1067. doi: 10.1016/j.crad.2005.06.002. Sinha, R., Verm, R., 2005b. Multidetector row computed tomography in bowel obstruction. Part2. Large bowel obstruction. Clinical Radiology. 60, 1068-1075. doi: 10.1016/j.crad.2005.06.001. Yaghmai,V., Nikolaidis, P., Hammond, N.A., Petrovic, B., Gore, R.M., Miller, F.H., 2006. Multidetector-row computed tomography diagnosis of small bowel obstruction: Can coronal reformations replace axial images? Am. Soc. Emergency Radiology. 13, 69- 372. doi: 10.1007/s10140-006-0513-9.