title: Diagnostic performance of MDCT in identifying closed loop small bowel obstruction.
abstract: To assess the diagnostic performance of MDCT in the diagnosis of closed loop small bowel obstruction.
  
  
  
  One hundred fifty patients with CT reports including "small bowel obstruction (SBO)" between 1/30/2011 and 12/4/2012 were included (65 men, 85 women, mean age 63 years). CT examinations were independently and blindly reviewed by five radiologists to determine the presence of closed loop obstruction (CL-SBO) and to assess findings of bowel ischemia. Clinical records were reviewed to determine management and operative findings. Using operative findings as a gold standard, reader agreement for the diagnosis of and the CT findings associated with CLO was analyzed using Pearson's correlation (r). Positive predictive value (PPV) and negative predictive value for the diagnosis of CL-SBO and CT signs of bowel ischemia were analyzed.
  
  
  
  Eighty-eight of 150 patients underwent operative intervention for SBO and 24/88 were considered CL-SBO operatively. Average reader sensitivity and specificity for CL-SBO was 53 % (95 % CI 44-63 %) and 83 % (95 % CI 79-87 %). Reader agreement on CL-SBO was poor to moderate (K = 0.39-0.63). Reader agreement for CT signs of bowel ischemia resulting in a diagnosis of CL-SBO was weak (r = 0.19-0.32).
  
  
  
  The CT diagnosis of CL-SBO is complex and associated imaging findings have variable sensitivity for predicting a closed loop operative diagnosis. CT can be helpful in excluding a closed loop component in patients with SBO.
authors.affiliation: Department of Radiology, Duke University Medical Center, Box 3808, Durham, 27710, NC, USA.
authors.forename: Ryan A
authors.initials: RA
authors.lastname: Makar
authors.affiliation: Department of Radiology, Duke University Medical Center, Box 3808, Durham, 27710, NC, USA.
authors.forename: Mustafa R
authors.initials: MR
authors.lastname: Bashir
authors.affiliation: Department of Radiology, Duke University Medical Center, Box 3808, Durham, 27710, NC, USA.
authors.forename: Clare M
authors.initials: CM
authors.lastname: Haystead
authors.affiliation: Department of Radiology, Duke University Medical Center, Box 3808, Durham, 27710, NC, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Iseman
authors.affiliation: Department of Radiology, Duke University Medical Center, Box 3808, Durham, 27710, NC, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Mayes
authors.affiliation: Department of Radiology, Duke University Medical Center, Box 3808, Durham, 27710, NC, USA.
authors.forename: Stuart
authors.initials: S
authors.lastname: Hebert
authors.affiliation: Department of Radiology, Duke University Medical Center, Box 3808, Durham, 27710, NC, USA.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Allen
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Syamal D
authors.initials: SD
authors.lastname: Bhattacharya
authors.affiliation: Department of Radiology, Duke University Medical Center, Box 3808, Durham, 27710, NC, USA.
authors.forename: Kingshuk R
authors.initials: KR
authors.lastname: Choudhury
authors.affiliation: Department of Radiology, Duke University Medical Center, Box 3808, Durham, 27710, NC, USA. jaffe002@mc.duke.edu.
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Jaffe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging* / Q000601:surgery; D007421:Intestine, Small / Q000000981:diagnostic imaging* / Q000601:surgery; D007479:Iopamidol; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D007479:Iopamidol
keywords: CT; Closed loop; Small bowel obstruction