Optimized protocol of multiple post-processing techniques improves diagnostic accuracy of multidetector computed tomography in assessment of small bowel obstruction compared with conventional axial and coronal reformations

Table 3 Average confidence scores among three protocols for assessment of small bowel obstruction (n = 106)

Assessment parameter	Protocol 1			Protocol 2			Protocol 3			P-value
	Reader 1	Reader 2	P-value	Reader 1	Reader 2	P-value	Reader 1	Reader 2	P-value
Presence or absence of SBO
Presence	4.8 ± 0.5	4.7 ± 0.6	0.070	4.8 ± 0.4	4.9 ± 0.3	0.103	4.9 ± 0.4	4.8 ± 0.4	0.184	0.110
Absence	4.6 ± 0.7	4.8 ± 0.6	0.270	4.9 ± 0.3	4.8 ± 0.4	0.164	4.7 ± 0.5	4.9 ± 0.3	0.188	0.341
Severity of obstruction
No	4.6 ± 0.7	4.8 ± 0.6	0.270	4.9 ± 0.3	4.8 ± 0.4	0.164	4.7 ± 0.5	4.9 ± 0.3	0.188	0.341
Mild	4.4 ± 0.7	4.5 ± 0.7	0.162	4.8 ± 0.5	4.7 ± 0.5	0.428	4.7 ± 0.6	4.6 ± 0.6	0.666	0.753
Moderate	4.8 ± 0.4	4.7 ± 0.4	0.323	4.8 ± 0.4	4.8 ± 0.4	0.710	4.7 ± 0.6	4.8 ± 0.4	0.133	0.418
Severe	4.9 ± 0.4	4.8 ± 0.4	0.326	4.9 ± 0.4	4.9 ± 0.4	1.000	4.9 ± 0.3	4.9 ± 0.4	0.663	0.872
Obstruction site
Proximal	4.4 ± 0.7	4.4 ± 0.5	1.000	4.8 ± 0.4	4.9 ± 0.3	0.594	4.7 ± 0.5	4.8 ± 0.4	0.681	0.323
Middle	4.2 ± 0.9	4.3 ± 0.8	0.054	4.6 ± 0.5	4.7 ± 0.5	0.058	4.4 ± 0.7	4.6 ± 0.6	0.710	0.004b
Distal	4.4 ± 1.0	4.5 ± 0.9	0.083	4.7 ± 0.5	4.7 ± 0.5	0.570	4.6 ± 0.6	4.6 ± 0.6	0.660	0.221
Cause
Adhesions	3.6 ± 0.8	3.7 ± 0.8	0.083	4.7 ± 0.5	4.8 ± 0.4	0.428	4.5 ± 0.6	4.6 ± 0.6	0.163	0.001b
Neoplasms	4.1 ± 0.7	4.2 ± 0.6	0.341	4.9 ± 0.3	4.8 ± 0.4	0.588	4.7 ± 0.5	4.6 ± 0.5	0.588	0.001b
Intussusception
Neoplasms	4.1 ± 1.1	4.2 ± 1.0	0.594	4.9 ± 0.3	4.8 ± 0.4	0.594	4.7 ± 0.5	4.6 ± 0.5	0.594	0.019a
Nonneoplasms	4.2 ± 0.8	4.0 ± 0.7	0.374	4.8 ± 0.4	4.8 ± 0.4	1.000	4.6 ± 0.5	4.8 ± 0.4	0.374	0.029a
Volvulus	4.4 ± 0.7	4.5 ± 0.8	0.351	5.0 ± 0.0	4.9 ± 0.4	0.351	4.6 ± 0.5	4.8 ± 0.5	0.598	0.041a
Hernias
Internal hernias	3.3 ± 1.4	3.5 ± 1.0	0.611	4.7 ± 0.5	4.8 ± 0.4	0.611	4.3 ± 0.8	4.5 ± 0.5	0.695	0.002b
External hernias	4.7 ± 0.5	4.6 ± 0.7	0.347	4.9 ± 0.3	5.0 ± 0.0	0.347	4.9 ± 0.3	4.9 ± 0.3	1.000	0.054
Bezoars/stones	4.6 ± 0.5	4.7 ± 0.5	0.356	5.0 ± 0.0	4.9 ± 0.4	0.356	4.9 ± 0.4	4.7 ± 0.5	0.356	0.492
Vascular lesions	3.2 ± 1.3	3.3 ± 1.1	0.594	4.7 ± 0.5	4.6 ± 0.5	0.594	4.4 ± 0.5	4.3 ± 0.5	0.681	0.001b
Inflammatory lesions	3.9 ± 1.3	4.1 ± 1.1	0.356	4.7 ± 0.5	4.4 ± 0.5	0.172	4.3 ± 1.0	4.4 ± 0.5	0.604	0.581
Findings of secondary bowel ischemia
Increased bowel wall attenuation	4.4 ± 0.5	4.5 ± 0.5	0.539	4.7 ± 0.5	4.7 ± 0.5	1.000	4.7 ± 0.5	4.6 ± 0.5	0.664	0.819
Decreased bowel wall enhancement	4.5 ± 0.5	4.4 ± 0.5	0.572	4.6 ± 0.5	4.7 ± 0.5	0.536	4.6 ± 0.5	4.7 ± 0.5	0.721	0.282
Vascular embolus/thrombosis	4.0 ± 0.9	4.1 ± 1.0	0.598	4.9 ± 0.4	4.8 ± 0.5	0.598	4.6 ± 0.5	4.5 ± 0.5	0.598	0.010a
Vascular stenosis/occlusion	3.8 ± 0.8	3.9 ± 0.9	0.503	4.8 ± 0.4	4.7 ± 0.5	0.265	4.4 ± 0.5	4.5 ± 0.6	0.574	0.001b
Pneumatosis/portomesenteric gas	4.1 ± 0.3	4.3 ± 0.7	0.447	4.4 ± 0.5	4.7 ± 0.4	0.081	4.6 ± 0.5	4.7 ± 0.5	0.681	0.814
Bowel wall thickening	4.5 ± 0.5	4.6 ± 0.5	0.321	4.6 ± 0.5	4.7 ± 0.5	0.109	4.6 ± 0.5	4.7 ± 0.5	0.254	0.059
Increased bowel wall enhancement	4.6 ± 0.5	4.8 ± 0.4	0.231	4.7 ± 0.5	4.8 ± 0.4	0.161	4.8 ± 0.4	4.7 ± 0.5	0.536	0.441
Mesenteric haziness/fluid	4.3 ± 0.6	4.3 ± 0.6	0.571	4.7 ± 0.5	4.8 ± 0.4	0.292	4.6 ± 0.5	4.7 ± 0.5	0.571	0.003b
Mesenteric vascular engorgement	4.2 ± 0.6	4.1 ± 0.6	0.748	4.8 ± 0.4	4.9 ± 0.4	0.494	4.7 ± 0.5	4.8 ± 0.4	0.716	0.001b
Small-bowel feces sign	4.4 ± 0.5	4.6 ± 0.6	0.329	4.7 ± 0.5	4.6 ± 0.5	0.576	4.5 ± 0.5	4.6 ± 0.6	0.428	0.748
Ascites	4.7 ± 0.5	4.6 ± 0.5	0.583	4.9 ± 0.4	4.8 ± 0.4	0.671	4.8 ± 0.4	4.7 ± 0.5	0.583	0.848

^aP < 0.05,

^bP < 0.01. SBO: Small bowel obstruction.