Abdominal pain: coronal reformations from isotropic voxels with 16-section CT--reader lesion detection and interpretation time.

PURPOSE: To retrospectively assess if reader detection of intraabdominal pathologic findings on coronal reformations from isotropic voxels at 16-section computed tomography (CT) was similar to reader detection on transverse scans. MATERIALS AND METHODS: The institutional review board approved this HIPAA-compliant study, and a waiver of informed consent was obtained. Twenty-nine consecutive patients (12 men, 17 women; mean age, 48 years; age range, 21-93 years) with abdominal pain underwent 16-section CT with coronal reformations. Eight independent readers reviewed randomized scans (transverse and coronal) and identified pathologic findings in multiple organ systems. Timing for each interpretation was recorded. One month later, readers reviewed the scan reformatted in the other imaging plane. Agreement between transverse and coronal scans was measured by using Cohen kappa coefficients. RESULTS: Agreement was moderate to near perfect between transverse and coronal interpretations for intraabdominal anatomic and pathologic findings (kappa=0.59-1.00). For transverse interpretations, more thoracic pathologic findings were noted than for coronal interpretations; for coronal interpretations, more lymph nodes were noted than for transverse interpretations. Mean transverse interpretation time was 4.9 minutes+/-1.1 (standard deviation) (range, 2.9-6.5 minutes); mean coronal interpretation time was 5.1 minutes+/-0.8 (range, 3.3-6.7 minutes). For each reader, there was no statistically significant difference in interpretation time between transverse and coronal scans (P=.06). CONCLUSION: With regard to the presence of intraabdominal pathologic findings, coronal reformations from isotropic voxels are similar to transverse scans in terms of interpretation time and reader agreement.

Review of internal hernias: radiographic and clinical findings.

OBJECTIVE: Internal hernias, including paraduodenal (traditionally the most common), pericecal, foramen of Winslow, and intersigmoid hernias, account for approximately 0.5-5.8% of all cases of intestinal obstruction and are associated with a high mortality rate, exceeding 50% in some series. To complicate matters, the incidence of internal hernias is increasing because of a number of relatively new surgical procedures now being performed, including liver transplantation and gastric bypass surgery. A significant increase in hernias is occurring in patients undergoing transmesenteric, transmesocolic, and retroanastomotic surgical procedures. It is important for radiologists to be familiar with and to understand the various types of internal hernias and their imaging features so that prompt and accurate diagnosis of these conditions can be made. CONCLUSION: This article illustrates the imaging findings of internal hernias, with emphasis placed on the CT findings, especially in transmesenteric, transmesocolic, and retroanastomotic types of internal hernias.

Small-bowel obstruction: coronal reformations from isotropic voxels at 16-section multi-detector row CT.

PURPOSE: To retrospectively assess the added value of coronal reformations of the abdomen and pelvis from isotropic voxels by using 16-section multi-detector row computed tomography (CT) for the diagnosis of small-bowel obstruction (SBO). MATERIALS AND METHODS: This HIPAA-compliant study was approved by the institutional review board of this medical center with a waiver of informed consent. One hundred consecutive patients (40 men and 60 women; mean age, 55 years) suspected of having SBO and abdominal pain underwent 16-section multi-detector row CT with coronal reformations. Twenty-nine patients had a final diagnosis of SBO, and 71 patients did not. Three independent readers blinded to the diagnosis interpreted the CT scout scan, then transverse scans alone, and then transverse plus coronal scans for the presence of SBO and abnormal wall enhancement. Confidence was scored with a 1-5 scale (1 = absent, 5 = present). RESULTS: Mean sensitivity and specificity of CT scout alone, transverse CT alone, and transverse plus coronal CT for the diagnosis of SBO were 88% and 86%, 87% and 87%, and 87% and 90%, respectively (not significant). In patients without SBO, transverse plus coronal CT enhanced confidence in the exclusion of SBO (P = .01). In patients with SBO, transverse plus coronal CT enhanced confidence in the diagnosis of SBO and identification of abnormal wall enhancement (P = .01). CONCLUSION: Transverse 16-section multi-detector row CT data sets are an excellent test for the diagnosis of SBO, while the addition of coronal reformations obtained from these isotropic data sets adds confidence to the diagnosis and exclusion of SBO.