Direct visualization of perforation sites in patients with a non-traumatic free pneumoperitoneum: added diagnostic value of thin transverse slices and coronal and sagittal reformations for multi-detector CT

The incremental diagnostic value of adding 1.25-mm slices and coronal and sagittal reformatting to 5-mm axial reconstructions for direct visualization of the perforation site in patients with non-traumatic free pneumoperitoneum was assessed. Forty patients with non-traumatic bowel perforation and free pneumoperitoneum underwent computed tomography (CT). The perforation was gastroduodenal in 18 patients and involved the small or large bowel in 22 patients. Transverse scans were reconstructed with 5-mm thick sections at 5-mm intervals and 1.25-mm-thick sections at 1.25-mm intervals. The second data set was reformatted coronally and sagittaly with 3-mm-thick sections at 3-mm intervals. Three independent blinded readers interpreted 5-mm transverse scans, then combined 1.25-mm and 5-mm-transverse scans, and then combined transverse, coronal and sagittal scans. The rate of identification of the perforation site ranged from 43% to 53% with the combined axial, sagittal and coronal scans, from 28% to 48% with the 1.25- and 5-mm transverse scans, and from 5% to 20% only with the 5-mm thick transverse scans. The agreement between readers was significantly higher with thin slices and reformatting. The use of 1.25-mm axial slices and reformations intrinsically contained more useful diagnostic information than 5-mm axial slices alone for diagnosis of the perforation site in patients with pneumoperitoneum.