Abstract
Purpose
To evaluate the diagnostic performance of a proposed new CT observation in cecal volvulus, marked hook-like curvature of ileocolic vessels termed “ileocolic vascular curvature.”
Methods
Contrast-enhanced CT scans of 14 patients with diagnoses of cecal volvulus on original CT reports were compared with scans of 40 control patients with dilated cecum but no cecal volvulus on original CT reports, accrued consecutively from January, 2006 through July, 2017. Two independent blinded readers retrospectively evaluated scans for cecal dilatation, ileocolic vascular curvature and seven previously reported CT features of cecal volvulus. Statistical methods included the exact binomial distribution to define 95% confidence intervals (95% CIs), logistic regression, receiver operating characteristic analysis, and the exact McNemar test. Pathology reports and clinical records served as reference standards.
Results
All patients had abdominal pain and cecal distension. All 14 patients with CT diagnoses of cecal volvulus, and no control patients, had cecal volvulus by reference standards. Ileocolic vascular curvature and ectopic cecal location were the only features independently and significantly associated with cecal volvulus in multivariable regression (odds ratio 178, p = 0.014, and 63, p = 0.013, respectively) and also the only features with both sensitivity (12/14 [85.7%, 95% CI 57.2–98.2%] and 13/14 [92.9%, 95% CI 66.1–99.8%], respectively) and specificity (40/40 [100.0%, 95% CI 91.2–100.0%] and 38/40 [95.0%, 95% CI 83.1–99.4%], respectively) that differed significantly from 50.0%.
Conclusions
Ileocolic vascular curvature was independently and significantly associated with cecal volvulus and exhibited both substantial sensitivity and substantial specificity for cecal volvulus, and thus is potentially a valuable new CT finding of cecal volvulus.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Anderson JR, Mills JO (1984) Caecal volvulus: a frequently missed diagnosis? Clin Radiol 35 (1):65–69
Ballantyne GH, Brandner MD, Beart RW, Ilstrup DM (1985) Volvulus of the colon. Incidence and mortality. Ann Surg 202 (1):83–92
Halabi WJ, Jafari MD, Kang CY, Nguyen VQ, Carmichael JC, Mills S, Pigazzi A, Stamos MJ (2014) Colonic volvulus in the United States: trends, outcomes, and predictors of mortality. Ann Surg 259 (2):293–301. https://doi.org/10.1097/SLA.0b013e31828c88ac
Rabinovici R, Simansky DA, Kaplan O, Mavor E, Manny J (1990) Cecal volvulus. Dis Colon Rectum 33 (9):765–769
Dane B, Hindman N, Johnson E, Rosenkrantz AB (2017) Utility of CT Findings in the Diagnosis of Cecal Volvulus. AJR Am J Roentgenol 209 (4):762–766. https://doi.org/10.2214/AJR.16.17715
Rosenblat JM, Rozenblit AM, Wolf EL, DuBrow RA, Den EI, Levsky JM (2010) Findings of cecal volvulus at CT. Radiology 256 (1):169–175. https://doi.org/10.1148/radiol.10092112
Jaffe T, Thompson WM (2015) Large-Bowel Obstruction in the Adult: Classic Radiographic and CT Findings, Etiology, and Mimics. Radiology 275 (3):651–663. https://doi.org/10.1148/radiol.2015140916
Peterson CM, Anderson JS, Hara AK, Carenza JW, Menias CO (2009) Volvulus of the gastrointestinal tract: appearances at multimodality imaging. Radiographics 29 (5):1281–1293. https://doi.org/10.1148/rg.295095011
Consorti ET, Liu TH (2005) Diagnosis and treatment of caecal volvulus. Postgrad Med J 81 (962):772–776. https://doi.org/10.1136/pgmj.2005.035311
Gingold D, Murrell Z (2012) Management of colonic volvulus. Clin Colon Rectal Surg 25 (4):236–244. https://doi.org/10.1055/s-0032-1329535
Madiba TE, Thomson SR (2002) The management of cecal volvulus. Dis Colon Rectum 45 (2):264–267
Krajewski K, Siewert B, Eisenberg RL (2009) Colonic dilation. AJR Am J Roentgenol 193 (5):W363–372. https://doi.org/10.2214/AJR.09.3353
Fisher JK (1981) Computed tomographic diagnosis of volvulus in intestinal malrotation. Radiology 140 (1):145–146. https://doi.org/10.1148/radiology.140.1.7244217
Frank AJ, Goffner LB, Fruauff AA, Losada RA (1993) Cecal volvulus: the CT whirl sign. Abdom Imaging 18 (3):288–289
Moore CJ, Corl FM, Fishman EK (2001) CT of cecal volvulus: unraveling the image. AJR Am J Roentgenol 177 (1):95–98. https://doi.org/10.2214/ajr.177.1.1770095
Figiel LS, Figiel SJ (1953) Volvulus of the cecum and ascending colon. Radiology 61 (4):496–515. https://doi.org/10.1148/61.4.496
Vandendries C, Jullès MC, Boulay-Coletta I, Loriau J, Zins M (2010) Diagnosis of colonic volvulus: findings on multidetector CT with three-dimensional reconstructions. Br J Radiol 83 (995):983–990. https://doi.org/10.1259/bjr/35714052
Crewson PE (2005) Reader agreement studies. AJR Am J Roentgenol 184 (5):1391–1397. https://doi.org/10.2214/ajr.184.5.01841391
Heinze G, Schemper M (2002) A solution to the problem of separation in logistic regression. Stat Med 21 (16):2409–2419. https://doi.org/10.1002/sim.1047
Heinze G (2006) A comparative investigation of methods for logistic regression with separated or nearly separated data. Stat Med 25 (24):4216–4226. https://doi.org/10.1002/sim.2687
Gore RM, Silvers RI, Thakrar KH, Wenzke DR, Mehta UK, Newmark GM, Berlin JW (2015) Bowel Obstruction. Radiol Clin North Am 53 (6):1225–1240. https://doi.org/10.1016/j.rcl.2015.06.008
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Wong, M., Brooke Jeffrey, R., Rucker, A.N. et al. Ileocolic vascular curvature: a new CT finding of cecal volvulus. Abdom Radiol 45, 3057–3064 (2020). https://doi.org/10.1007/s00261-020-02491-w
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-020-02491-w