title: Diagnostic performance of CT findings for bowel ischemia and necrosis in closed-loop small-bowel obstruction.
abstract: OBJECTIVE
  The aim of this study was to investigate the diagnostic performance of contrast-enhanced CT (CECT) findings for bowel ischemia and necrosis in closed-loop small-bowel obstruction (CL-SBO).
  
  
  METHODS
  Thirty-five patients with CL-SBO confirmed by laparotomy (n = 34) or multiplanar reconstruction of thin slice CT images (n = 1) were included. Based on the surgical and clinical findings, these patients were classified into three groups: necrosis group (n = 16), ischemia without necrosis group (n = 11), and no-ischemia group (n = 8). Two blinded radiologists retrospectively reviewed CECT including multiplanar reconstruction images and evaluated 12 CT findings. The sensitivity and specificity of each finding were compared among the three groups, and logistic regression analysis was performed.
  
  
  RESULTS
  High attenuation of the bowel wall, intraperitoneal air, reduced enhancement of the mesenteric arteries, and small-bowel feces signs showed high specificities of 100%, 100%, 89%, and 89% but low sensitivities of 31%, 25%, 44%, and 31%, respectively, for the prediction of bowel necrosis in CL-SBO. According to multivariate logistic regression analysis, reduced bowel-wall enhancement, reduced enhancement of the mesenteric veins, and a lack of engorgement of the mesenteric veins were significant for predicting bowel ischemia or necrosis (P < 0.05).
  
  
  CONCLUSIONS
  Reduced enhancements of bowel wall and mesenteric veins were good indicators of bowel ischemia or necrosis. On the contrary, engorgement of the mesenteric veins was a predictor of a viable bowel.
authors.affiliation: Department of Radiology, National Nagasaki Medical Center, 2-1001-1 Kubara, Omura, 856-8562, Japan, marimori@v101.vaio.ne.jp.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Nakashima
authors.forename: Hideki
authors.initials: H
authors.lastname: Ishimaru
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Fujimoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Mizowaki
authors.forename: Kazunori
authors.initials: K
authors.lastname: Mitarai
authors.forename: Kei
authors.initials: K
authors.lastname: Nakashima
authors.forename: Yohjiro
authors.initials: Y
authors.lastname: Matsuoka
authors.forename: Masataka
authors.initials: M
authors.lastname: Uetani
mesh_terms: D000368:Aged; D003287:Contrast Media; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007410:Intestinal Diseases / Q000150:complications / Q000000981:diagnostic imaging; D007415:Intestinal Obstruction / Q000150:complications / Q000000981:diagnostic imaging*; D007421:Intestine, Small / Q000000981:diagnostic imaging* / Q000473:pathology*; D007511:Ischemia / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D015588:Observer Variation; D011856:Radiographic Image Enhancement; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media