Can it be any easier?

58 yo M, past h/o hernia repair, presented with abdominal pain and vomiting. Routine conventional CT shows a small bowel obstruction, with a "closed loop". 

On spectral analysis, the dilated loop of bowel has no iodine uptake in the wall. Bowel ischemia from closed loop was diagnosed, and patient takken to the OR emergently.

30 cm of necrotic small bowel was resected, and primary anastomosis done.

By enhancing radiologist confidence in diagnosis of bowel ischemia, use of spectral CT can expedite management.

Oblique coronal image from conventional CT shows radial closed loop with mesenteric edema. Note the central "whirl".

Iodine map shows clearly diminished perfusion in the abnormal loop

Fused image with iodine map shows absent iodine uptake in wall of dilated loop consistent with ischemia