Interobserver variability in the evaluation of chronic mesenteric ischemia with gadolinium-enhanced MR angiography.
OBJECTIVE
The purpose of this study was to assess interobserver variability in the interpretation of gadolinium-enhanced magnetic resonance (MR) angiograms of splanchnic vessels in patients suspected of having chronic mesenteric ischemia (CMI).


METHODS
Two readers blinded to the initial interpretation retrospectively reviewed gadolinium-enhanced MR angiograms obtained for suspected CMI in 26 patients (20 women and six men; age range, 23-77 years; mean age, 61 years) who also underwent conventional angiography. Each reader graded the degree of stenosis based on the percentage diameter reduction of the celiac artery (CA), superior mesenteric artery (SMA), and inferior mesenteric artery (IMA) by using a five-point ordinal scale: 0, no stenosis: 1, mild stenosis (<50%); 2, moderate stenosis (50%-75%); 3, severe stenosis (>75%); 4, occluded artery. Using the conventional angiogram as a reference standard, authors determined sensitivity and specificity for each observer, assigning two thresholds (grades 2 and 3) as significant stenoses. A kappa statistic (kappa) measured interobserver agreement.


RESULTS
With grade 2 stenosis used as a threshold, cumulative accuracies for detecting significant stenosis were 0.95 (95% confidence interval, 0.86-0.99) for reader A and 0.97 (0.88-1.0) for reader B. Interobserver agreement for grading proximal splanchnic stenosis was 0.90 for CA, 0.92 for SMA, and 0.48 for IMA.


CONCLUSIONS
Gadolinium-enhanced MR angiography is reproducibly accurate for detection of proximal splanchnic artery stenosis, with good to excellent interobserver agreement.
Carlos
R C
RC
Department of Radiology, University of Michigan, Ann Arbor 48109-0030, USA.
Stanley
J C
JC
Stafford-Johnson
D
D
Prince
M R
MR
D000328:Adult; D000368:Aged; D002445:Celiac Artery / Q000473:pathology; D002908:Chronic Disease; D005260:Female; D005682:Gadolinium; D006801:Humans; D007511:Ischemia / Q000175:diagnosis*; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000473:pathology; D017538:Mesenteric Artery, Superior / Q000473:pathology; D008641:Mesenteric Vascular Occlusion / Q000175:diagnosis*; D008875:Middle Aged; D015588:Observer Variation; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013152:Splanchnic Circulation
D005682:Gadolinium