Preoperative intestine-to-liver CT ratio: useful predictor of resection in strangulated obstruction

The resection group had a longer time from onset to surgery (p = 0.034) and higher leukocyte counts (p = 0.037). CT values of the poorly enhanced intestinal wall and the intestinal-to-liver attenuation ratio were significantly lower in the resection group (p < 0.0001). Multivariate analysis identified time to surgery (OR 5.08; 95% CI 1.106-23.350; p = 0.037) and CT attenuation ratio (OR 15.50; 95% CI 2.622-91.686; p = 0.0025) as independent predictors of resection. When stratified by the median ratio cutoff (< 0.40 vs. ≥ 0.40), resection rates were 92% and 44%, respectively (p = 0.0001). Additionally, CT attenuation ratio had the diagnostic performance (AUROC 0.886; Youden index 0.736; sensitivity 97.1% and specificity 76.5%.) CONCLUSION: An intestinal-to-liver CT attenuation ratio below 0.40 is a strong predictor of intestinal ischemia requiring resection in SBO patients.