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Does the CT whirl sign really predict small bowel volvulus?: Experience in an oncologic population.
J Comput Assist Tomogr 2006 Jan-Feb; 30(1):25-32JC

Abstract

The objective of this study was to determine the sensitivity of the CT "whirl sign" for the diagnosis of small bowel volvulus in patients who present with a clinical suspicion of intestinal obstruction. Between January 2002 and September 2004, 1,493 CT scans performed in 1,213 patients suspected of having small bowel obstruction were retrospectively reviewed by one attending radiologist with gastrointestinal subspecialization and one senior radiology resident. Multislice helical CT scans were performed after oral and intravenous contrast administration. All CT scans showing a combined vessel and bowel whirl appearance were identified. Other features recorded included the number of degrees of whirl rotation, direction of rotation, presence of bowel obstruction, and signs of ischemia. Diagnoses were determined at either surgery or clinicoradiographic follow-up. Surgical follow-up was available in 174 of the 1,213 patients. There were 460 males and 753 females ranging in age from 1 to 95 years (mean 59 years). A whirl sign was found in 33 of the 1,493 CT scans by reader 1 and in 13 of the 1,493 CT scans by reader 2. In 11 patients, surgery revealed small bowel volvulus (0.9%). Reader 1 detected 7 of the 11 volvuli (sensitivity 64%, specificity 98%, positive predictive value 21%, negative predictive value 99.7%). Reader 2 detected 3 of the 11 volvuli (sensitivity 27%, specificity 99%, positive predictive value 23%, negative predictive value 99.5%). The CT scans of the four remaining patients with volvulus not initially recognized by either reader were re-reviewed and were felt to contain whirl signs. Most patients with small bowel volvulus can be identified on CT through detection of a whirl sign. However, most whirl signs detected on CT will not prove to be indicative of small bowel volvulus.

Authors+Show Affiliations

Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10023, and Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. gollubM@mskcc.orgNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16365568

Citation

Gollub, Marc J., et al. "Does the CT Whirl Sign Really Predict Small Bowel Volvulus?: Experience in an Oncologic Population." Journal of Computer Assisted Tomography, vol. 30, no. 1, 2006, pp. 25-32.
Gollub MJ, Yoon S, Smith LM, et al. Does the CT whirl sign really predict small bowel volvulus?: Experience in an oncologic population. J Comput Assist Tomogr. 2006;30(1):25-32.
Gollub, M. J., Yoon, S., Smith, L. M., & Moskowitz, C. S. (2006). Does the CT whirl sign really predict small bowel volvulus?: Experience in an oncologic population. Journal of Computer Assisted Tomography, 30(1), pp. 25-32.
Gollub MJ, et al. Does the CT Whirl Sign Really Predict Small Bowel Volvulus?: Experience in an Oncologic Population. J Comput Assist Tomogr. 2006;30(1):25-32. PubMed PMID: 16365568.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does the CT whirl sign really predict small bowel volvulus?: Experience in an oncologic population. AU - Gollub,Marc J, AU - Yoon,Sora, AU - Smith,Lachlan McG, AU - Moskowitz,Chaya S, PY - 2005/12/21/pubmed PY - 2006/2/17/medline PY - 2005/12/21/entrez SP - 25 EP - 32 JF - Journal of computer assisted tomography JO - J Comput Assist Tomogr VL - 30 IS - 1 N2 - The objective of this study was to determine the sensitivity of the CT "whirl sign" for the diagnosis of small bowel volvulus in patients who present with a clinical suspicion of intestinal obstruction. Between January 2002 and September 2004, 1,493 CT scans performed in 1,213 patients suspected of having small bowel obstruction were retrospectively reviewed by one attending radiologist with gastrointestinal subspecialization and one senior radiology resident. Multislice helical CT scans were performed after oral and intravenous contrast administration. All CT scans showing a combined vessel and bowel whirl appearance were identified. Other features recorded included the number of degrees of whirl rotation, direction of rotation, presence of bowel obstruction, and signs of ischemia. Diagnoses were determined at either surgery or clinicoradiographic follow-up. Surgical follow-up was available in 174 of the 1,213 patients. There were 460 males and 753 females ranging in age from 1 to 95 years (mean 59 years). A whirl sign was found in 33 of the 1,493 CT scans by reader 1 and in 13 of the 1,493 CT scans by reader 2. In 11 patients, surgery revealed small bowel volvulus (0.9%). Reader 1 detected 7 of the 11 volvuli (sensitivity 64%, specificity 98%, positive predictive value 21%, negative predictive value 99.7%). Reader 2 detected 3 of the 11 volvuli (sensitivity 27%, specificity 99%, positive predictive value 23%, negative predictive value 99.5%). The CT scans of the four remaining patients with volvulus not initially recognized by either reader were re-reviewed and were felt to contain whirl signs. Most patients with small bowel volvulus can be identified on CT through detection of a whirl sign. However, most whirl signs detected on CT will not prove to be indicative of small bowel volvulus. SN - 0363-8715 UR - https://www.unboundmedicine.com/medline/citation/16365568/Does_the_CT_whirl_sign_really_predict_small_bowel_volvulus:_Experience_in_an_oncologic_population_ L2 - http://Insights.ovid.com/pubmed?pmid=16365568 DB - PRIME DP - Unbound Medicine ER -