Prediction of bowel necrosis by reduced bowel wall enhancement in closed-loop small bowel obstruction: Quantitative methods

•Compared with reduced bowel wall enhancement in arterial phase and portal phase, adjusted reduced bowel wall enhancement in arterial phase and portal phase had better diagnostic performance and interobserver agreement to predict bowel necrosis in CL-SBO.•Adjusted reduced bowel wall enhancement in portal phase had the best diagnostic performance and interobserver agreement to predict bowel necrosis in CL-SBO.•Assessing reduced bowel wall enhancement with plain CT and proximal loop as references in portal phase is more accurate to predict bowel necrosis in CL-SBO. To assess diagnostic performance and reproducibility of reduced bowel wall enhancement evaluated by quantitative methods using CT to identify bowel necrosis among closed-loop small bowel obstruction (CL-SBO) patients. This retrospective single-center study included patients who diagnosed with CL-SBO caused by adhesion or internal hernia during January 2016 and May 2022. Patients were divided into necrotic group (n = 41) and non-necrotic group (n = 67) according to surgical exploration and postoperative pathology. Two doctors independently measured the attenuation of bowel wall and consensus was reached through panel discussion with a third gastrointestinal radiologist. Reduced bowel wall enhancement was assessed by four quantitative methods. Univariate analyses were used to evaluate the association between each method and bowel necrosis, and kappa/intraclass correlation coefficient values were used to assess interobserver agreement. Diagnostic performance parameters were calculated for each method. Reduced bowel wall enhancement in arterial phase (OR 8.98, P