Imaging features of marginal ulcers on multidetector CT

• Published in: Clinical radiology Vol. 78; no. 3; pp. 227 - 233
• Main Authors: Zulfiqar, M., Ludwig, D.R., Strnad, B., McVay, M., Rengarajan, A., Kushnir, V., Mellnick, V.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-03-2023
• Subjects: Humans; Intestine, Small; Multidetector Computed Tomography - methods; Peptic Ulcer; Reproducibility of Results; Retrospective Studies
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/j.crad.2022.10.002

To assess the inter-reader agreement and frequency of various imaging findings of marginal ulcers on computed tomography (CT) in a series of patients with endoscopically or surgically confirmed marginal ulcer disease.
This was a institutional review board-approved retrospective analysis involving a single academic institution. Eighty patients with a gastro-enteric anastomosis with confirmed marginal ulcer on endoscopy or surgery and multidetector (MD)CT performed within a month reviewed by two fellowship-trained abdominal radiologists to assess for the presence or absence of predetermined imaging characteristics categorised under signs of inflammation, signs of penetration, signs of perforation, and signs of obstruction. Inter-rater reliability was assessed using the Cohen kappa test.
Findings of perforation had moderate to substantial agreement, including the presence of extraluminal air, extraluminal fluid, and leakage of oral contrast medium (kappa 0.83 [0.61, 1.05], 0.57 [0.35, 0.79] and 0.75 [0.18, 1.31], respectively) although these were present relatively infrequently (23–26%, 30–43%, 3–4%, respectively). Additional imaging characteristics with moderate agreement were the presence of perienteric fat stranding, a dilated stomach proximal to the anastomosis, and penetration into adjacent organ (kappa 0.45 [0.23, 0.69], 0.47 [0.26, 0.69], and 0.47 [0.25, 0.69], respectively) which were variably present (80–88%, 11–16%, 5%, respectively). Wall thickening and contour abnormalities, although frequently present (61–90% and 60–80%, respectively) had only slight to fair agreement (kappa 0.09 [–0.14, 0.30] and 0.29 [0.07, 0.51]).
Signs of perforation have high inter-reader agreement but occur relatively infrequently. Fat stranding, wall thickening, and contour abnormalities are much more common; however, only fat stranding had moderate agreement.
•Marginal ulcers occur as a late complication after gastro-enteric anastomosis.•CT signs are sorted as inflammation, penetration, obstruction and perforation.•Signs of perforation though infrequent, had high inter-reader agreement.•Signs of inflammation were more common. Only fat stranding had moderate agreement.•Oral contrast when present may help in delineating site of perforation.