Utility of CT Whirl Sign in Guiding Management of Small-Bowel Obstruction

Department of Imaging Sciences, University of Rochester School of Medicine, 601 Elmwood Ave., Box 648, Rochester, NY 14642, USA.
American Journal of Roentgenology (Impact Factor: 2.73). 10/2008; 191(3):743-7. DOI: 10.2214/AJR.07.3386
Source: PubMed


The purpose of this study was to examine the relation between the CT whirl sign and outcome among patients with a clinical and radiologic diagnosis of small-bowel obstruction (SBO).
The cases of 453 patients who underwent abdominal CT because of clinical suspicion of SBO were reviewed retrospectively. Patients with a radiologic diagnosis of SBO were included. Management with surgery or medical therapy was correlated with the presence of the whirl sign and other radiologic findings. Statistical calculations were performed to determine the value of the whirl sign in predicting the type of management needed for SBO.
According to CT criteria, 194 patients received a diagnosis of SBO and were included in the study. The whirl sign was identified on the CT scans of 40 of the 194 patients. Thirty-two of the 40 patients had SBO necessitating surgery, for a positive predictive value of 80%; 133 of 154 patients did not need surgery, for a negative predictive value of 86%. Fifty-three of 194 patients either underwent surgery or died of SBO during conservative therapy. The whirl sign was present on the CT scans of 32 of the 53 patients, for a sensitivity of 60%. One hundred thirty-three of 141 patients did not need surgery and did not have a whirl sign, for a specificity of 94%. The odds ratio for the whirl sign in predicting the presence of SBO necessitating surgery was 25.3 (95% CI, 10.3-62.3).
A patient with the whirl sign on CT is 25.3 times as likely as a patient without the sign to have SBO necessitating surgery. The results suggest an important role of the whirl sign in assessment of treatment options for patients with clinical and radiologic signs of SBO.

19 Reads
  • Source

    Preview · Article · Jun 2009 · QJM: monthly journal of the Association of Physicians
  • [Show abstract] [Hide abstract]
    ABSTRACT: Osteopathic treatment usually aims at enhancing or restoring a state of health in the patient. This study investigates whether osteopathic treatment can be used to increase the athletic performance of healthy hobby runners.Two comparative groups with a defined age limit followed a constant individual training regimen over a period of two months. During this period, the test group received three osteopathic treatments at regular intervals of two weeks. Before each treatment, the personal fitness level was as sessed by means of a PWC 150 ergometer test. One month after the third treatment, the ergometer test was repeated in order to assess a possible sustained effect of treatment. The performance of the control group was measured in the same routine and at similar intervals as that of the test group.The results confirmed that osteopathic treatment is able to enhance performance capability and improves the sustained effect of training.
    No preview · Article · Jun 2009 · Osteopathische Medizin Zeitschrift für ganzheitliche Heilverfahren
  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine whether the location of the computed tomography (CT) whirl sign can be used to help differentiate caecal from sigmoid volvulus. Thirty-one patients (mean age 64.6 years) underwent multidetector CT and had confirmed colonic volvulus. There were 15 patients with caecal volvulus and 16 with sigmoid volvulus. Axial and coronal images were retrospectively evaluated on the picture archiving and communication system (PACS) by two reviewers in consensus without knowledge of the final diagnosis to determine whether a CT whirl sign was present and, if so, was the location to the right of midline or in the midline/left. The location of the twisting at imaging was correlated with whether the patient had caecal or sigmoid volvulus. Fisher's exact test was used to determine whether there was an association between the location of the twist (right versus mid-left) and the location of the colonic volvulus (caecal versus sigmoid). The non contrast CT (NCCT) examinations of 30 additional patients without colonic volvulus were evaluated for the presence or absence of a CT whirl sign. All 31 patients with colonic volvulus had a CT whirl sign. No patient who underwent NCCT for kidney stones demonstrated a CT whirl sign. According to Fisher's exact test, there was a highly significant association (p<0.0001) between the location of the twist (right versus mid-left) and the location of the colonic volvulus (caecal versus sigmoid). Using the location of the twist as a predictor of whether the volvulus was caecal or sigmoid provided a correct diagnosis for 93.3% (14/15) of the patients with caecal volvulus and 100% (16/16) of those with sigmoid volvulus, yielding an overall diagnostic accuracy of 96.8% (30/31). The location of the mesenteric twist (CT whirl sign) is a highly accurate finding in discriminating caecal from sigmoid volvulus.
    No preview · Article · Feb 2011 · Clinical Radiology
Show more