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CT findings of sigmoid volvulus.
AJR Am J Roentgenol 2010; 194(1):136-43AA

Abstract

OBJECTIVE

The purpose of this study was to evaluate the features of sigmoid volvulus on CT scanograms and cross-sectional images.

MATERIALS AND METHODS

We retrospectively reviewed 21 cases of sigmoid volvulus in 15 men and six women. Three radiologists evaluated scanograms and cross-sectional images for several classic and two novel imaging signs of volvulus: crossing sigmoid transitions (called the X-marks-the-spot sign) and folding of the sigmoid wall by partial twisting (called the split-wall sign). A general impression was assigned to scanograms and cross-sectional images. CT findings suggesting bowel compromise were compared with pathologic and endoscopic findings.

RESULTS

The most sensitive scanogram findings were absence of rectal gas (19 of 21 cases, 90%) and an inverted-U-shaped distended sigmoid (18 of 21 cases, 86%) followed by the coffee bean sign and disproportionate sigmoid enlargement (both 16 of 21 cases, 76%). The most sensitive cross-sectional findings were one sigmoid colon transition point (20 of 21 cases, 95%) and disproportionate enlargement of the sigmoid (18 of 21 cases, 86%). The X-marks-the-spot and split-wall signs were present in nine of 21 (43%) and 11 of 21 (52%) patients, but one of the two signs was present in 18 of 21 patients (86%). Classic radiographic and definitive cross-sectional findings were seen in 11 of 21 (52%) and 16 of 21 (76%) patients. CT findings were definitive in five of seven patients (71%) with indeterminate scanogram findings. Imaging signs suggesting bowel compromise correlated poorly with clinical ischemia, but CT features were present in all three patients with frank necrosis.

CONCLUSION

Sigmoid volvulus has a spectrum of imaging findings. A classic appearance is absent on approximately one half of scanograms and one fourth of CT scans. Use of new signs that model the pathophysiologic characteristics of volvulus (X-marks-the-spot sign for more complete twisting and split-wall sign for less severe twisting) may improve diagnostic confidence.

Authors+Show Affiliations

Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St., Bronx, NY 10467-2490, USA. jlevsky@montefiore.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20028915

Citation

Levsky, Jeffrey M., et al. "CT Findings of Sigmoid Volvulus." AJR. American Journal of Roentgenology, vol. 194, no. 1, 2010, pp. 136-43.
Levsky JM, Den EI, DuBrow RA, et al. CT findings of sigmoid volvulus. AJR Am J Roentgenol. 2010;194(1):136-43.
Levsky, J. M., Den, E. I., DuBrow, R. A., Wolf, E. L., & Rozenblit, A. M. (2010). CT findings of sigmoid volvulus. AJR. American Journal of Roentgenology, 194(1), pp. 136-43. doi:10.2214/AJR.09.2580.
Levsky JM, et al. CT Findings of Sigmoid Volvulus. AJR Am J Roentgenol. 2010;194(1):136-43. PubMed PMID: 20028915.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - CT findings of sigmoid volvulus. AU - Levsky,Jeffrey M, AU - Den,Elana I, AU - DuBrow,Ronelle A, AU - Wolf,Ellen L, AU - Rozenblit,Alla M, PY - 2009/12/24/entrez PY - 2009/12/24/pubmed PY - 2010/1/27/medline SP - 136 EP - 43 JF - AJR. American journal of roentgenology JO - AJR Am J Roentgenol VL - 194 IS - 1 N2 - OBJECTIVE: The purpose of this study was to evaluate the features of sigmoid volvulus on CT scanograms and cross-sectional images. MATERIALS AND METHODS: We retrospectively reviewed 21 cases of sigmoid volvulus in 15 men and six women. Three radiologists evaluated scanograms and cross-sectional images for several classic and two novel imaging signs of volvulus: crossing sigmoid transitions (called the X-marks-the-spot sign) and folding of the sigmoid wall by partial twisting (called the split-wall sign). A general impression was assigned to scanograms and cross-sectional images. CT findings suggesting bowel compromise were compared with pathologic and endoscopic findings. RESULTS: The most sensitive scanogram findings were absence of rectal gas (19 of 21 cases, 90%) and an inverted-U-shaped distended sigmoid (18 of 21 cases, 86%) followed by the coffee bean sign and disproportionate sigmoid enlargement (both 16 of 21 cases, 76%). The most sensitive cross-sectional findings were one sigmoid colon transition point (20 of 21 cases, 95%) and disproportionate enlargement of the sigmoid (18 of 21 cases, 86%). The X-marks-the-spot and split-wall signs were present in nine of 21 (43%) and 11 of 21 (52%) patients, but one of the two signs was present in 18 of 21 patients (86%). Classic radiographic and definitive cross-sectional findings were seen in 11 of 21 (52%) and 16 of 21 (76%) patients. CT findings were definitive in five of seven patients (71%) with indeterminate scanogram findings. Imaging signs suggesting bowel compromise correlated poorly with clinical ischemia, but CT features were present in all three patients with frank necrosis. CONCLUSION: Sigmoid volvulus has a spectrum of imaging findings. A classic appearance is absent on approximately one half of scanograms and one fourth of CT scans. Use of new signs that model the pathophysiologic characteristics of volvulus (X-marks-the-spot sign for more complete twisting and split-wall sign for less severe twisting) may improve diagnostic confidence. SN - 1546-3141 UR - https://www.unboundmedicine.com/medline/citation/20028915/CT_findings_of_sigmoid_volvulus_ L2 - http://www.ajronline.org/doi/full/10.2214/AJR.09.2580 DB - PRIME DP - Unbound Medicine ER -