Figure 2

A 25-year-old male patient who visited the ED complaining of abdominal pain. CT images show fluid distension of small bowel loops with transition at the terminal ileum (arrowhead). The contrast among the bowel wall, visceral fat, and intraluminal fluid is more evident in DL-SCE-CT than in NECT. The patient was admitted for management of Crohn’s disease flares. In this case, all of reviewers made the correct diagnosis (small bowel obstruction at terminal ileum) regardless of DL-SCE-CT. However, two more radiologists made correct disposition decision (admission for medical management) after review of DL-SCE-CT. Moreover, with the aid of DL-SCE-CT, the confidence of the diagnosis and disposition decision increased from 4.17 to 4.50 and 4.00 to 4.50, respectively.