title: Assessment of Bowel Wall Enhancement for the Diagnosis of Intestinal Ischemia in Patients with Small Bowel Obstruction: Value of Adding Unenhanced CT to Contrast-enhanced CT.
abstract: Purpose To determine whether adding unenhanced computed tomography (CT) to contrast material-enhanced CT improves the diagnostic performance of decreased bowel wall enhancement as a sign of ischemia complicating mechanical small bowel obstruction (SBO). Materials and Methods This retrospective study was approved by the institutional review board, which waived the requirement for informed consent. Two gastrointestinal radiologists independently performed retrospective assessments of 164 unenhanced and contrast-enhanced CT studies from 158 consecutive patients (mean age, 71.2 years) with mechanical SBO. The reference standard was the intraoperative and/or histologic diagnosis (in 80 cases) or results from clinical follow-up in patients who did not undergo surgery (84 cases). Decreased bowel wall enhancement was evaluated with contrast-enhanced images then and both unenhanced and contrast-enhanced images 1 month later. Diagnostic performance of decreased bowel wall enhancement and confidence in the diagnosis were compared between the two readings by using McNemar and Wilcoxon signed rank tests. Interobserver agreement was assessed by using κ statistics and compared with bootstrapping. Results Ischemia was diagnosed in 41 of 164 (25%) episodes of SBO. For both observers, adding unenhanced images improved decreased bowel wall enhancement sensitivity (observer 1: 46.3% [19 of 41] vs 65.8% [27 of 41], P = .02; observer 2: 56.1% [23 of 41] vs 63.4% [26 of 41], P = .45), Youden index (from 0.41 to 0.58 for observer 1 and from 0.42 to 0.61 for observer 2), and confidence score (P < .001 for both). Specificity significantly increased for observer 2 (84.5% [104 of 123] vs 94.3% [116 of 123], P = .002), and interobserver agreement significantly increased, from moderate (κ = 0.48) to excellent (κ = 0.89; P < .0001). Conclusion Adding unenhanced CT to contrast-enhanced CT improved the sensitivity, diagnostic confidence, and interobserver agreement of the diagnosis of ischemia, a complication of mechanical SBO, on the basis of decreased bowel wall enhancement. (©) RSNA, 2016.
authors: From the Department of Radiology (A.M.C., L.C., I.B.C., J.H., M.Z.) and Clinical Research Unit (H.B., G.C.), Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75014 Paris, France; Department of Medical Imaging, CHU Lapeyronie, Montpellier, France (I.M., P.T.); Department of Neuroradiology, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, Faculty of Medicine, Université Paris Est Créteil, Créteil, France (J.H.), and Clinical Research Unit, Hôpital Européen Georges Pompidou, Université René Descartes, Paris, France (G.C.).
authors: Anh Minh
authors: AM
authors: Chuong
authors: From the Department of Radiology (A.M.C., L.C., I.B.C., J.H., M.Z.) and Clinical Research Unit (H.B., G.C.), Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75014 Paris, France; Department of Medical Imaging, CHU Lapeyronie, Montpellier, France (I.M., P.T.); Department of Neuroradiology, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, Faculty of Medicine, Université Paris Est Créteil, Créteil, France (J.H.), and Clinical Research Unit, Hôpital Européen Georges Pompidou, Université René Descartes, Paris, France (G.C.).
authors: Lucie
authors: L
authors: Corno
authors: From the Department of Radiology (A.M.C., L.C., I.B.C., J.H., M.Z.) and Clinical Research Unit (H.B., G.C.), Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75014 Paris, France; Department of Medical Imaging, CHU Lapeyronie, Montpellier, France (I.M., P.T.); Department of Neuroradiology, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, Faculty of Medicine, Université Paris Est Créteil, Créteil, France (J.H.), and Clinical Research Unit, Hôpital Européen Georges Pompidou, Université René Descartes, Paris, France (G.C.).
authors: Hélène
authors: H
authors: Beaussier
authors: From the Department of Radiology (A.M.C., L.C., I.B.C., J.H., M.Z.) and Clinical Research Unit (H.B., G.C.), Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75014 Paris, France; Department of Medical Imaging, CHU Lapeyronie, Montpellier, France (I.M., P.T.); Department of Neuroradiology, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, Faculty of Medicine, Université Paris Est Créteil, Créteil, France (J.H.), and Clinical Research Unit, Hôpital Européen Georges Pompidou, Université René Descartes, Paris, France (G.C.).
authors: Isabelle
authors: I
authors: Boulay-Coletta
authors: From the Department of Radiology (A.M.C., L.C., I.B.C., J.H., M.Z.) and Clinical Research Unit (H.B., G.C.), Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75014 Paris, France; Department of Medical Imaging, CHU Lapeyronie, Montpellier, France (I.M., P.T.); Department of Neuroradiology, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, Faculty of Medicine, Université Paris Est Créteil, Créteil, France (J.H.), and Clinical Research Unit, Hôpital Européen Georges Pompidou, Université René Descartes, Paris, France (G.C.).
authors: Ingrid
authors: I
authors: Millet
authors: From the Department of Radiology (A.M.C., L.C., I.B.C., J.H., M.Z.) and Clinical Research Unit (H.B., G.C.), Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75014 Paris, France; Department of Medical Imaging, CHU Lapeyronie, Montpellier, France (I.M., P.T.); Department of Neuroradiology, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, Faculty of Medicine, Université Paris Est Créteil, Créteil, France (J.H.), and Clinical Research Unit, Hôpital Européen Georges Pompidou, Université René Descartes, Paris, France (G.C.).
authors: Jérôme
authors: J
authors: Hodel
authors: From the Department of Radiology (A.M.C., L.C., I.B.C., J.H., M.Z.) and Clinical Research Unit (H.B., G.C.), Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75014 Paris, France; Department of Medical Imaging, CHU Lapeyronie, Montpellier, France (I.M., P.T.); Department of Neuroradiology, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, Faculty of Medicine, Université Paris Est Créteil, Créteil, France (J.H.), and Clinical Research Unit, Hôpital Européen Georges Pompidou, Université René Descartes, Paris, France (G.C.).
authors: Patrice
authors: P
authors: Taourel
authors: From the Department of Radiology (A.M.C., L.C., I.B.C., J.H., M.Z.) and Clinical Research Unit (H.B., G.C.), Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75014 Paris, France; Department of Medical Imaging, CHU Lapeyronie, Montpellier, France (I.M., P.T.); Department of Neuroradiology, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, Faculty of Medicine, Université Paris Est Créteil, Créteil, France (J.H.), and Clinical Research Unit, Hôpital Européen Georges Pompidou, Université René Descartes, Paris, France (G.C.).
authors: Gilles
authors: G
authors: Chatellier
authors: From the Department of Radiology (A.M.C., L.C., I.B.C., J.H., M.Z.) and Clinical Research Unit (H.B., G.C.), Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75014 Paris, France; Department of Medical Imaging, CHU Lapeyronie, Montpellier, France (I.M., P.T.); Department of Neuroradiology, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, Faculty of Medicine, Université Paris Est Créteil, Créteil, France (J.H.), and Clinical Research Unit, Hôpital Européen Georges Pompidou, Université René Descartes, Paris, France (G.C.).
authors: Marc
authors: M
authors: Zins
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications / Q000000981:diagnostic imaging*; D007421:Intestine, Small / Q000098:blood supply / Q000000981:diagnostic imaging; D007511:Ischemia / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
chemical_list: D003287:Contrast Media