† People involved in the organization of the challenge. ‡ People contributing data from their institutions.§ Equal senior authors.

Identification of adhesions on computed tomography (CT) in cases of small-bowel obstruction (SBO) is currently a diagnosis of exclusion. The purpose of this study is to examine whether the presence of findings suggestive of an extraluminal band can be used as a CT sign for adhesive SBO. CT scans of 142 patients with surgically proven SBO performed within 72 h of exploratory surgery were reviewed. The studies were evaluated for the cause of SBO and the presence of extraluminal bands. An extraluminal band was considered present if there was a change in the conformation of the transition zone, suggesting extraluminal compression of the bowel by a linear obstructive band. The presence of extraluminal bands in the area of the transition zone had a high positive predictive value for adhesive SBO. Of the 73 cases in which bands were present, SBO was due to adhesions in 52 instances, with a corresponding positive predictive value of 71% (95% confidence interval 0.60-0.80) and a p value of 0.008. The extraluminal band was 61% sensitive and 63% specific for adhesive SBO. The presence of an extraluminal band on CT in the area of the transition zone in cases of SBO correlates well with a diagnosis of SBO secondary to adhesions. In the absence of a source of SBO, the presence of an extraluminal band can serve as a helpful diagnostic adjunct for adhesive SBO.

Primary sclerosing cholangitis is a chronic, progressive disease of inflammation and fibrosis of the bile ducts. The ability to predict survival is important for appropriate management and treatment decisions. The purpose of this study was to examine the relationship between specific findings on the enhanced magnetic resonance imaging (MRI) examination of the liver and the corresponding magnetic resonance cholangiopancreatogram (MRCP) and a survival model for primary sclerosing cholangitis (PSC), the Mayo Risk Score. During a five-year period, 47 patients with primary sclerosing cholangitis were identified who had a complete MRI/MRCP examination. The extent of anatomical changes of the biliary tree and the degree of peribiliary enhancement in the hepatic parenchyma were compared with the Mayo Risk Score for each patient. Peribiliary enhancement was present to a varying extent in 38 of 47 cases of PSC. Peribiliary enhancement 3 min after gadolinium administration had a weak correlation with the Mayo Risk Score (analysis of variance P<0.01, Pearson correlation r=0.37). No statistically significant relationship between the severity of extrahepatic or intrahepatic duct changes and the Mayo Risk Score was found (analysis of variance P=0.24, P=0.38, respectively). Although biliary tree changes on MRCP aid in the diagnosis of PSC, they do not correlate with survival, as predicted by the Mayo Risk Score. Peribiliary enhancement on MRI of the liver is a finding occurring to a variable extent in primary sclerosing cholangitis but does not correlate significantly with survival.

Feasibility of diagnosing small bowel obstruction on multidetector-row computed tomography (MDCT) using coronal reformations alone is evaluated. Three radiologists with subspecialty training in abdominal imaging reviewed abdominopelvic CT of 67 patients in consensus. Thirty-four patients had surgically proven small bowel obstruction. The remaining 33 patients had CT for other reasons and had no intestinal obstruction. The images were displayed in either axial or coronal planes and were reviewed on separate days . Each CT was evaluated for the presence of small bowel obstruction and its etiology when applicable. Thirty-three (100%) of 33 patients were correctly diagnosed not to have intestinal obstruction on coronal images. Thirty-four (100%) of 34 patients were correctly diagnosed to have small bowel obstruction on both forms of image display. There were five patients where the final surgical diagnosis for the etiology of small bowel obstruction did not agree with the interpretation of either the coronal or axial images; however, in all five patients, the interpretations of axial and coronal images were similar. In only one patient, the etiology of small bowel obstruction based on the coronal images did not agree with that of axial images and the surgical result; however, the site of small bowel obstruction was correctly diagnosed. There were approximately 20% fewer images in the coronal reformation data set, and the radiologists found review of these images to be easier for localizing the zone of transition in small bowel obstruction. Very high diagnostic accuracy can be achieved based on coronal reformations alone, and this form of image display may potentially be substituted for the conventional axial images. Since there are fewer images to review when the studies are displayed in coronal plane, this may positively impact radiologist workflow.

No abstract