title: Interobserver agreement on the diagnosis of bowel ischemia: assessment using dynamic computed tomography of small bowel obstruction.
abstract: OBJECTIVE
  The aim of this study was to evaluate the accuracy and interobserver variability of dynamic computed tomography (CT) for diagnosis of small bowel obstruction.
  
  
  METHODS
  A total of 115 patients with a CT diagnosis of small bowel obstruction were included. Two radiologists and two residents performed blinded, independent, retrospective reviews of CT studies. Attention was focused on the presence of reduced early enhancement of the bowel wall and closed loop obstruction. Results were correlated with surgical findings in 15 cases and clinical follow-up in 100 cases. Sensitivity and specificity were calculated, and kappa statistics were used to analyze interobserver agreement.
  
  
  RESULTS
  In all, 13 cases were surgically confirmed small bowel ischemia. Sensitivity, specificity, positive predictive value, and negative predictive value for the diagnosis of ischemia were 85%, 96%-97%, 73%-79%, and 97%-98%, respectively, for radiologists and 69%-93%, 93%-95%, 63%-64%, and 96%-99%, respectively, for residents. For agreement in the interpretations of reduced early enhancement of bowel wall, closed loop obstruction, and presence of bowel ischemia, the values were 0.62, 0.71, and 0.80, respectively, between radiologists and 0.57-0.70, 0.63-0.74, and 0.56-0.68, respectively, between radiologists and residents.
  
  
  CONCLUSIONS
  There was moderate or substantial agreement for the diagnosis of small bowel ischemia between radiologists and residents. However, there was substantial agreement for the presence of closed loop obstruction.
authors.affiliation: Department of Radiology, Ohtawara Red Cross Hospital, 2-7-3 Sumiyoshi-cho, Ohtawara, 324-8686, Japan. katok357862@sea.plala.or.jp
authors.forename: Koki
authors.initials: K
authors.lastname: Kato
authors.forename: Kimiyoshi
authors.initials: K
authors.lastname: Mizunuma
authors.forename: Munehiro
authors.initials: M
authors.lastname: Sugiyama
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Sugawara
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Suzuki
authors.forename: Makiko
authors.initials: M
authors.lastname: Tomabechi
authors.forename: Toshiya
authors.initials: T
authors.lastname: Kariyasu
authors.forename: Taiki
authors.initials: T
authors.lastname: Fukuda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging*; D007421:Intestine, Small / Q000098:blood supply* / Q000000981:diagnostic imaging*; D007511:Ischemia / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult