Radiographic findings in dogs with 360 degrees gastric dilatation and volvulus

Pablo Espinosa Mur, Ryan Appleby, Kathryn L. Phillips, Ameet Singh, Gabrielle Monteith, Lindsey J. Gilmour, Erin Keenihan, Lise Daniaux, Alex zur Linden

Background
Gastric dilatation and volvulus (GDV) is a critical emergency in dogs, with 360-degree GDV (360-GDV) representing a severe form where the stomach rotates fully along its axis. Accurate diagnosis is essential for timely surgical intervention. However, radiographic differentiation between 360-GDV and conditions like simple gastric dilatation (GD) or 180-degree GDV (180-GDV) remains a challenge. This study aimed to evaluate specific radiographic features of 360-GDV and assess interobserver agreement among radiologists.

Methods
A retrospective observational study reviewed radiographs from 16 dogs with surgically or necropsy-confirmed 360-GDV. These were compared with radiographs of dogs diagnosed with GD and 180-GDV. Radiographs were independently evaluated by three board-certified radiologists. Sensitivity, specificity, and interobserver agreement on diagnostic variables were analyzed using statistical methods.

Results
The sensitivity for diagnosing 360-GDV via radiographs was low (43.7%-50%), but specificity was high (84.6%-92.1%). Agreement among radiologists was moderate to substantial (Kappa = 0.623). Key radiographic features of 360-GDV included marked esophageal gas distension (31.2%) and absence of small intestinal dilation (18.7%). The pyloric position in 360-GDV often resembled that in GD, complicating differentiation. Severe gastric distension and reduced peritoneal serosal contrast were more frequently observed in 360-GDV cases.

Limitations
The study’s retrospective nature and small sample size may limit generalizability. Variability in radiograph quality and absence of standardized imaging protocols could impact diagnostic consistency. Additionally, clinical data were not provided to radiologists during evaluation, potentially affecting diagnostic sensitivity.

Conclusions
Radiographic identification of 360-GDV remains challenging due to overlapping features with GD and 180-GDV. While specific findings such as esophageal distension and lack of intestinal dilation can aid diagnosis, clinical context and complementary diagnostics should be considered to improve accuracy.

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