NYU study involves CT findings in diagnosing cecal volvulus

A recent study conducted by four radiologists at New York University assessed the utility of CT features in the detection and official diagnosis of cecal volvulus. Bari Dane, MD, Nicole Hindman, MD, Evan Johnson, MD, and Andrew B. Rosenkrantz of NYU's Langone Medical Center published the study in the American Journal of Roentgenology.  

The team examined 43 patients scheduled to undergo CT and with surgical and clinical follow-ups. The progression of cecal volvulus, the torsion of the cecum and ascending colon, can lead to myriad complications, though it can be prevented and even treated with surgery.  

The study was conducted by two of the four NYU radiologists, with Reader 1 having 11 years of experience and Reader 2 having one year of experience. CT examinations of the 43 patients were searched for the following conditions: whirl sign, abnormal cecal position, "bird beak" sign, severe cecal distention, mesenteric engorgement, an abnormal appendix position near midline and an overall impression for cecal volvulus.  

The study found 51 percent of the 43 patients tested had cecal volvulus.  

"All CT findings were significantly more common in patients with cecal volvulus other than mesenteric engorgement for Reader 1," according to lead author Bari Dane, MD. "Readers 1 and 2 identified the central appendix sign in 92 percent and 92.3 percent of patients with volvulus versus in 37.5 percent and 31.1 percent of patients without volvulus."  

Additionally, the four radiologists concluded that undergoing a CT displayed high diagnostic performance and very high sensitivity for cecal volvulus.  

"Two independent readers achieved 100 percent sensitivity for overall impression of cecal volvulus with moderate specificity and high interreader concordance," Bane said. "Because volvulus is a potentially life-threatening diagnosis, the readers' high sensitivity is appropriate, indicating a low threshold for rendering this diagnosis in patients with clinical concern for cecal volvulus."  

In addition to the CT performing very well in indicating high sensitivity of cecal volvulus in more than half of the 43 patients examined, the study also concluded that imaging may be more effective in comparison to oral contrast material when diagnosing cecal volvulus. Independent predictors found by Readers 1 and 2 were beneficial for both readers in coming to this conclusion.  

"Oral contrast material often fails to reach the transition point in patients with this diagnosis," Bane concluded.