Should radiologists be recommending "fast & repeat" rads?

Serial abdominal radiographs do not significantly increase accuracy of diagnosis of gastrointestinal mechanical obstruction due to occult foreign bodies in dogs and cats

Emily B Elser 1, Wilfried Mai 1, Jennifer A Reetz 1, Vince Thawley 1, Hadley Bagshaw 2, Jantra N Suran 3

Background
The study investigates the clinical utility of serial abdominal radiographs in diagnosing gastrointestinal mechanical obstruction caused by occult foreign bodies in dogs and cats. Initial radiographs are often inconclusive in such cases, leading to recommendations for follow-up imaging. The hypothesis was that combining initial and follow-up radiographs would improve diagnostic accuracy.

Methods
This prospective cohort study was conducted on 57 client-owned dogs and cats with clinical suspicion of mechanical obstruction and inconclusive initial radiographs. Follow-up radiographs were obtained 7–28 hours after the initial imaging, with abdominal ultrasound (performed within 3 hours of follow-up radiographs) serving as the gold standard. Radiographs were evaluated independently by four blinded reviewers, and diagnostic accuracy was assessed via sensitivity, specificity, and ROC analysis.

Results
Participants: 40 dogs and 17 cats were included; 19 of these were confirmed to have mechanical obstruction caused by non-radiopaque foreign bodies.

Findings:
-Combined assessment of initial and follow-up radiographs did not significantly improve diagnostic accuracy across all reviewers (P = 0.058–0.87).
-Ultrasound consistently outperformed radiography in diagnosing obstructions.
-Radiologists exhibited improved sensitivity in combined assessments, but results were not statistically significant.
-Observers showed fair to moderate interobserver agreement for both initial and combined assessments.

Limitations
The study was limited by:
-Selection Bias: Cases included were inherently more challenging as initial radiographs were inconclusive.
-Small Sample Size: The study was underpowered to detect small differences in accuracy.
-Time Constraints: Follow-up imaging was limited to a 28-hour window, potentially insufficient for progressive changes in obstruction to manifest radiographically.
-Restricted Obstruction Types: Only occult foreign bodies were assessed, excluding other causes of obstruction.

Conclusions
Serial abdominal radiographs did not significantly enhance the diagnostic accuracy for gastrointestinal mechanical obstruction in cases where initial radiographs were inconclusive. Abdominal ultrasound is recommended as a more reliable diagnostic tool in such scenarios. Further research with larger sample sizes and extended imaging intervals is suggested.

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