Inter-reader agreement of CT features of acute mesenteric ischemia

Purpose: To evaluate the inter-reader agreement of the CT features of acute mesenteric ischemia (AMI). Methods: Between 2006 and 2014, 109 patients (57 men, 52%, mean age 50 years old [17-83]) admitted to our institution with a diagnosis of AMI were included. CT scans (42% were initially performed in our institution) were reviewed by two abdominal radiologists. Inter-observer agreement of the imaging features of vascular insufficiency and bowel ischemia was assessed by the percentage of agreement and the kappa value. Results: The final population included, Inter-observer agreement varied according to the different features (x = 0.25-0.98). Inter-observer agreement for decreased/absent bowel wall enhancement was moderate (x = 0.52), but was almost perfect (x = 0.82) in the 47 patients (43%) with both unenhanced and arterial-phase images without positive oral contrast agent and excellent CT images quality. Conclusion: Inter-reader agreement was moderate to substantial for most CT features of AMI. Multiphasic CT scan protocol, including unenhanced, arterial phase and venous phase images, without positive oral contrast agent, and excellent CT images quality improve inter-observer agreement of imaging features of AMI, especially for decreased/absent bowel wall enhancement, and should be performed in patients with suspected AMI.