Can CT Predict Surgical Adhesions in Dogs with Abdominal Masses? New Study Explores the Clues

Accuracy of Computed Tomographic Signs for the Detection of Severe Adhesions in Dogs with Abdominal Masses

Lauren A. O’Mara, Anthony J. Fischetti, Daniel I. Spector, Joel G. Weltman

Background

Severe abdominal adhesions complicate surgery by increasing operating time, blood loss, and risk of conversion from laparoscopic to open procedures. In human medicine, computed tomography (CT) features have been used to predict adhesions, but these have been minimally characterized in veterinary patients. The study’s objective was to evaluate the diagnostic accuracy of specific CT imaging signs for detecting surgically confirmed severe adhesions in dogs with abdominal masses, aiming to inform preoperative planning.

Methods

This retrospective diagnostic case-control study reviewed medical records from the Schwarzman Animal Medical Center (2012–2022). Dogs with contrast-enhanced abdominal CT scans performed within 3 months before surgery were included. The adhesion group (n = 43) comprised cases with surgically confirmed severe adhesions, while 43 age- and weight-matched controls had no reported adhesions. A blinded board-certified radiologist evaluated CTs for six imaging signs identified from the human literature:

1. Fat stranding (“misty mesentery”)

2. Fat stranding with vascular enhancement or crowding

3. Loss of fat planes (“properitoneal fat sign”)

4. Focal peritoneal thickening

5. Enhancing peritoneal bands ± visceral contour change

Loculation of peritoneal effusion
Sensitivity and specificity were calculated for each sign, and associations with surgical findings were analyzed.

Results

Three CT signs showed significant association with surgically confirmed adhesions:

-Fat stranding: sensitivity 60.5%, specificity 72.1% (p = 0.004)

-Fat stranding with vascular enhancement: sensitivity 53.5%, specificity 81.3% (p = 0.001)

-Loculation of peritoneal effusion: sensitivity 25.6%, specificity 95.3% (p = 0.014)

-Combining loculated effusion and enhancing vessels increased specificity to 97.7%.

Other signs—loss of fat planes, focal peritoneal enhancement, and enhancing peritoneal bands—were infrequent and not statistically significant. Sensitivity was lower for retroperitoneal masses than peritoneal ones. Most adhesions were associated with the primary mass, and cases with these CT findings often experienced intraoperative complications such as difficult dissections or incomplete resections.

Limitations

As a retrospective study, assessment of adhesion severity relied on subjective surgical reports without a standardized grading system. CT protocols varied in slice thickness (mostly ≥3 mm), potentially reducing detection of thin adhesions. A single radiologist performed all image evaluations, preventing interobserver reliability analysis. Moreover, cases with unreported adhesions might have been misclassified as controls.

Conclusions

CT can help presumptively identify severe abdominal adhesions in dogs with abdominal masses, especially when fat stranding, vascular crowding, and loculated peritoneal effusion are present. Although direct visualization of adhesions is uncommon, these indirect signs—particularly when combined—offer high specificity and can assist in surgical planning. However, absence of CT findings does not rule out adhesions, especially in retroperitoneal regions. Standardized CT protocols with thinner slices and multi-observer evaluations could improve diagnostic accuracy in future studies.

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