Sharon Zahava Adam MD, Presenter: Nothing to Disclose

Arye Blachar MD, Abstract Co-Author: Nothing to Disclose

Michael Peter Federle MD, Abstract Co-Author: Nothing to Disclose

Sophie Dr. Barnes, Abstract Co-Author: Nothing to Disclose

Gad Levy MD, Abstract Co-Author: Nothing to Disclose

Iuliana Weinstein, Abstract Co-Author: Nothing to Disclose

Ronit Precel, Abstract Co-Author: Nothing to Disclose

Jacob Sosna MD, Abstract Co-Author: Consultant, ActiViews Ltd Research grant, Koninklijke Philips Electronics NV

To evaluate the performance of radiologists in the diagnosis of acute intestinal ischemia using specific MDCT findings.

The abdominal CT scans of 90 patients were retrospectively reviewed by 3 radiologists, 2 of which were experienced radiologists, and a senior resident. Forty seven patients had surgically proven intestinal ischemia and comprised the case group, while forty three 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 pathology 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 pathology were decreased or absent bowel wall enhancement, filling defect in the SMA, small bowel pneumatosis, and gas in the portal veins or SMV. For most of these signs there was good inter-observer agreement.

Radiologists’ performance in diagnosing bowel ischemia is good but lower then previously reported, since a significant amount of cases are evaluated using a sub optimal CT technique. Radiologists' experience and expertise have an important impact on their performance.

Many CT scans for suspected bowel ischemia are routine abdominal scans and not mesenteric CTA scans, making the diagnosis challenging, so on call residents should consult with senior staff liberally.

Adam, S, Blachar, A, Federle, M, Barnes, S, Levy, G, Weinstein, I, Precel, R, Sosna, J, Radiologists' Performance in the Diagnosis of Acute Intestinal Ischemia Using MDCT and Specific CT Findings in a Setup Simulating Routine Practice.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9011374.html