Can the location of the CT whirl sign assist in differentiating sigmoid from caecal volvulus?

AIM: To determine whether the location of the computed tomography (CT) whirl sign can be used to help differentiate caecal from sigmoid volvulus.

MATERIALS AND METHODS: Thirty-one patients (mean age 64.6 years) underwent multidetector CT and had confirmed colonic volvulus. There were 15 patients with caecal volvulus and 16 with sigmoid volvulus. Axial and coronal images were retrospectively evaluated on the picture archiving and communication system (PACS) by two reviewers in consensus without knowledge of the final diagnosis to determine whether a CT whirl sign was present and, if so, was the location to the right of midline or in the midline/left. The location of the twisting at imaging was correlated with whether the patient had caecal or sigmoid volvulus. Fisher's exact test was used to determine whether there was an association between the location of the twist (right versus mid-left) and the location of the colonic volvulus (caecal versus sigmoid). The non contrast CT (NCCT) examinations of 30 additional patients without colonic volvulus were evaluated for the presence or absence of a CT whirl sign.

RESULTS: All 31 patients with colonic volvulus had a CT whirl sign. No patient who underwent NCCT for kidney stones demonstrated a CT whirl sign. According to Fisher's exact test, there was a highly significant association (p<0.0001) between the location of the twist (right versus mid-left) and the location of the colonic volvulus (caecal versus sigmoid). Using the location of the twist as a predictor of whether the volvulus was caecal or sigmoid provided a correct diagnosis for 93.3% (14/15) of the patients with caecal volvulus and 100% (16/16) of those with sigmoid volvulus, yielding an overall diagnostic accuracy of 96.8% (30/31).

CONCLUSION: The location of the mesenteric twist (CT whirl sign) is a highly accurate finding in discriminating caecal from sigmoid volvulus.