Moritz Oberparleiter, Jan Vosshenrich, Hanns-Christian Breit, Philippe Kaiser, Paul Hehenkamp, Dorothee Harder, Daniel T Boll, Christoph J Zech, Markus M Obmann
Eur Radiol . 2024 Nov 27. doi: 10.1007/s00330-024-11217-1. Online ahead of print.
Objectives: This study evaluates the advantages in diagnostic accuracy, confidence, and reading time of additional dual-energy CT-derived reconstructions for assessing acute bowel ischemia.
Methods and materials: This retrospective study includes 25 patients with surgically proven acute bowel ischemia and 25 gender- and age-matched controls who underwent biphasic abdominal dual-energy CT. Two fellowship-trained abdominal radiologists and two residents evaluated all cases with and without additional dual-energy CT-derived iodine maps and virtual non-contrast images. Diagnostic confidence was rated on a 10-point Likert scale. Reading time was recorded. The inter-reader agreement was assessed using Fleiss' kappa. Sensitivity and specificity were compared using McNemar's test, reader confidence, and reading times with the Wilcoxon signed-rank test.
Results: For conventional images alone, the inter-reader agreement was moderate (κ = 0.58), with a sensitivity of 77% (95% CI: 67.5-84.8%) and specificity of 90% (95% CI: 82.4-95.1%). Adding dual-energy CT images, inter-reader agreement increased to substantial (κ = 0.69), sensitivity increased significantly to 89% (95% CI: 81.2-94.4%, p = 0.02), while specificity increased non-significantly to 93% (95% CI: 86.1-97.1%, p = 0.51). Diagnostic confidence increased significantly from 8 (IQR: 6-8) to 9 (IQR: 8-9) (p < 0.01). Equivalent diagnostic accuracy and confidence increases were observed for fellowship-trained and resident radiologists. A non-significant increase in mean reading time per case from 196 s to 201 s was observed (p = 0.30).
Conclusion: Additional dual-energy CT reconstructions increase diagnostic accuracy and confidence without increasing reading time when evaluating suspected acute bowel ischemia. Both experienced and resident readers benefit from dual-energy CT images.