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Radiologists’ performance in the diagnosis of acute intestinal ischemia, using MDCT and specific CT findings, using a variety of CT protocols

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Abstract

The aim of this study was to evaluate the performance of radiologists in the diagnosis of acute intestinal ischemia using specific multi-detector CT findings. The abdominal CT scans of 90 patients were retrospectively reviewed by three radiologists: an abdominal imaging specialist, an experienced general radiologist, and a senior resident. Forty-seven patients had surgically proven intestinal ischemia and comprised the case group, while 43 patients had no evidence of intestinal ischemia at surgery and comprised the control group. Images were reviewed in a random and blinded fashion. Radiologists’ performance in diagnosing bowel ischemia from other bowel pathologies was evaluated. The sensitivity, specificity, and accuracy for diagnosing bowel ischemia were 89%, 67%, and 79% for the abdominal imager; 83%, 67%, and 76% for the general radiologist; and 66%, 83%, and 74% for the senior resident, respectively. The calculated kappa value for inter-observer agreement regarding the presence of bowel ischemia was 0.79. CT findings that significantly distinguished bowel ischemia from other bowel pathologies were decreased or absent bowel wall enhancement, filling defect in the superior mesenteric artery, small bowel pneumatosis, and gas in the portal veins or superior mesenteric vein. For most of these signs, there was good inter-observer agreement. Radiologists’ performance in diagnosing bowel ischemia is good, but lower than previously reported since a significant amount of cases are evaluated using a suboptimal CT technique. Radiologists’ experience and expertise have an important impact on their performance.

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Authors and Affiliations

  1. Department of Radiology, Tel Aviv Sourasky Medical Center, 6 Weitzman Street, Tel Aviv, 64239, Israel

    Arye Blachar, Sophie Barnes, Sharon Z. Adam, Gad Levy, Iuliana Weinstein & Ronit Precel

  2. Tel Aviv Sackler School of Medicine, Tel Aviv, Israel

    Arye Blachar

  3. Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive, Grant Building S-092, Stanford, CA, 94305-5105, USA

    Michael P. Federle

  4. Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, 91120, Israel

    Jacob Sosna

  5. Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Jacob Sosna

Authors
  1. Arye Blachar
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  2. Sophie Barnes
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  3. Sharon Z. Adam
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  4. Gad Levy
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  5. Iuliana Weinstein
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  6. Ronit Precel
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  7. Michael P. Federle
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  8. Jacob Sosna
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Correspondence to Arye Blachar.

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Blachar, A., Barnes, S., Adam, S.Z. et al. Radiologists’ performance in the diagnosis of acute intestinal ischemia, using MDCT and specific CT findings, using a variety of CT protocols. Emerg Radiol 18, 385–394 (2011). https://doi.org/10.1007/s10140-011-0965-4

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  • DOI: https://doi.org/10.1007/s10140-011-0965-4

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