Imaging features of marginal ulcers on multidetector CT

Aim: 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.

Materials and methods: 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.

Results: 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]).

Conclusion: 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.