• Kazuaki Nakashima, Hideki Ishimaru, Toshifumi Fujimoto, Takashi Mizowaki, Kazunori Mitarai, Kei Nakashima, Yohjiro Matsuoka, and Masataka Uetani.
• Department of Radiology, National Nagasaki Medical Center, 2-1001-1 Kubara, Omura, 856-8562, Japan, marimori@v101.vaio.ne.jp.
• Abdom Imaging. 2015 Jun 1; 40 (5): 1097-103.

PurposeThe aim of this study was to investigate the diagnostic performance of contrast-enhanced CT (CECT) findings for bowel ischemia and necrosis in closed-loop small-bowel obstruction (CL-SBO).Materials And MethodsThirty-five patients with CL-SBO confirmed by laparotomy (n = 34) or multiplanar reconstruction of thin slice CT images (n = 1) were included. Based on the surgical and clinical findings, these patients were classified into three groups: necrosis group (n = 16), ischemia without necrosis group (n = 11), and no-ischemia group (n = 8). Two blinded radiologists retrospectively reviewed CECT including multiplanar reconstruction images and evaluated 12 CT findings. The sensitivity and specificity of each finding were compared among the three groups, and logistic regression analysis was performed.ResultsHigh attenuation of the bowel wall, intraperitoneal air, reduced enhancement of the mesenteric arteries, and small-bowel feces signs showed high specificities of 100%, 100%, 89%, and 89% but low sensitivities of 31%, 25%, 44%, and 31%, respectively, for the prediction of bowel necrosis in CL-SBO. According to multivariate logistic regression analysis, reduced bowel-wall enhancement, reduced enhancement of the mesenteric veins, and a lack of engorgement of the mesenteric veins were significant for predicting bowel ischemia or necrosis (P < 0.05).ConclusionsReduced enhancements of bowel wall and mesenteric veins were good indicators of bowel ischemia or necrosis. On the contrary, engorgement of the mesenteric veins was a predictor of a viable bowel.

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