title: Features on MDCT that predict surgery in patients with adhesive-related small bowel obstruction.
abstract: OBJECTIVE
  The purpose of this study was to determine the contribution of multidetector-row computed tomography (MDCT) in the management of adhesion-related small bowel obstruction (SBO) and to identify its predictive value for surgery.
  
  
  METHODS
  We conducted a retrospective review of 151 patients over a 5-year period with the diagnosis of SBO caused by adhesion. These patients were divided into two groups: surgery (n =  63) and observation group (n =  88). Two radiologists blinded to the outcome of the patients evaluated MDCT images retrospectively, recording the bowel diameter, bowel wall thickness, degree of obstruction, air-fluid level, mesenteric fatty stranding, transitional zone, intraperitoneal fluid, close loop, whirl sign, and faeces sign. Statistical analyses were performed using univariate and multivariable analyses.
  
  
  RESULTS
  Multivariable analysis showed that MDCT demonstrated presence of intraperitoneal fluid (Odds ratio, OR, 4.38), high-grade or complete obstruction (OR, 3.19) and mesenteric fatty stranding (OR, 2.81), and absence of faeces sign (OR, 2.11) were the most significant predictors. When all of the four criteria were used in combination, high sensitivity of 98.4% and specificity of 90.9% were achieved for the prediction for surgery.
  
  
  CONCLUSIONS
  MDCT is useful to evaluate adhesion-related SBO and to predict accurately patients who require surgery. Use of the four MDCT features in combination is highly suggestive of the need for early surgical intervention.
authors.affiliation: Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan ; Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Wei-Chou
authors.initials: WC
authors.lastname: Chang
authors.affiliation: Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Kai-Hsiung
authors.initials: KH
authors.lastname: Ko
authors.affiliation: Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Chun-Shu
authors.initials: CS
authors.lastname: Lin
authors.affiliation: Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Hsian-He
authors.initials: HH
authors.lastname: Hsu
authors.affiliation: Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Shih-Hung
authors.initials: SH
authors.lastname: Tsai
authors.affiliation: Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Hsiu-Lung
authors.initials: HL
authors.lastname: Fan
authors.affiliation: Department of Healthcare Administration, Asia University, Taichung, Taiwan.
authors.forename: Ho-Jui
authors.initials: HJ
authors.lastname: Tung
authors.affiliation: Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Guo-Shu
authors.initials: GS
authors.lastname: Huang
authors.affiliation: Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan ; Department of Radiology, Taipei City Hospital, Taipei, Taiwan.
authors.forename: Ran-Chou
authors.initials: RC
authors.lastname: Chen
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000473:pathology