Lakshmi Ananthakrishnan
AJR Am J Roentgenol . 2024 Mar 6:1. doi: 10.2214/AJR.23.29920. Online ahead of print.
In this retrospective study, Shaish et al. [1] assessed the accuracy of unenhanced CT for identification of the etiology of acute abdominal pain in patients presenting to the emergency department (ED). The study comprised analysis of 201 dual-energy CT examinations of the abdomen and pelvis performed with IV and oral contrast media. Outcomes comprised primary diagnoses (causes of patients' presenting symptoms, such as colitis or pancreatitis) and actionable secondary diagnoses (e.g., indeterminate renal lesions). The reference standard represented the majority opinion of three independent interpretations of the contrast-enhanced scans (the original clinical interpretation and two additional retrospective interpretations). Six additional readers (three fellowship-trained abdominal radiologists and three residents) from three institutions independently interpreted the corresponding virtual unenhanced scan (with subtraction of both IV and oral contrast media) to record primary and actionable secondary diagnoses. The authors calculated accuracy in two ways: simple accuracy, reflecting if the readers correctly identified any primary or secondary diagnosis at the examination level (i.e., best-case scenario), and detailed accuracy, reflecting if readers correctly identified all primary and secondary diagnoses without any false-positive diagnoses.