Computed tomography of bowel obstructions: The contribution of multi- planar reformations in comparison with axial slices alone in determining the transition zone

Several studies have demonstrated that determining the transition zone could facilitate the diagnosis of bowel obstruction (BO) using multi-detector row computed tomography (MDCT). We aimed to evaluate the contribution of multi-planar reformations (MPR) in comparison with axial slices alone to determine the transition zone. Sixteen-slice MDCT examinations of 66 consecutive patients with mechanical BO were reviewed by an experienced abdominal radiologist who had been blinded to the patients’ clinical diagnoses. The scans were first reviewed using the axial slices alone and later were reviewed using MPR with respect to the assigned four-point confidence scale in a random order. The diagnostic accuracy and mean confidence score were evaluated for both reviewing methods. The accuracy for determining the transition zone using axial slices alone was 92% in patients with small bowel obstruction (SBO) and 93% in those with large bowel obstruction (LBO). The levels of accuracy for MPR were exactly the same with axial slices alone both for SBO and LBO. The mean confidence score for the determination of the transition zone using axial slices alone was 3.59 for SBO and 3.71 for MPR (P=0.057). After evaluating patients with LBO, the mean confidence score using axial slices alone was 3.80, which was identical to that of MPR. Like MPR, axial CT source slices can also provide high levels of accuracy in the determination of the transition zone in patients with BO. However, particularly in SBO, MPR will increase confidence in the diagnosis.

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