Diagnostic Accuracy of Dual-Energy Computed Tomography for Bowel Necrosis in Acute Abdomen With Bowel Ischemia

Introduction Immediate diagnosis of bowel necrosis in acute abdominal conditions is essential for proper treatment. Dual-energy computed tomography (DECT) has recently emerged as a tool to assess intestinal viability in bowel ischemia. However, DECT's diagnostic accuracy for bowel necrosis in clinical practice remains undefined. Methods This single-center retrospective cohort study at a Japanese tertiary care hospital assessed DECT's diagnostic accuracy for bowel necrosis. We included patients who underwent emergency operations for abdominal conditions with bowel ischemia from April 2013 to March 2022. Patients without DECT were excluded. The reference standard was bowel necrosis determined by surgical findings. Four evaluators (two residents and two specialists) independently reviewed DECT images blinded to confirmed diagnoses. We calculated pooled and individual sensitivity, specificity, likelihood ratios, and accuracy. Results Twenty-eight patients were included. Pooled sensitivity and specificity were 0.65 (95% confidence interval (CI), 0.52-0.77) and 0.83 (95% CI, 0.70-0.92), respectively. Residents demonstrated higher sensitivity than specialists. Pooled positive and negative likelihood ratios were 3.76 (95% CI, 2.02-7.00) and 0.42 (95% CI, 0.29-0.61). Overall accuracy was 0.73 (95%CI, 0.64-0.81). Inter-evaluator agreement was moderate (Fleiss' kappa, 0.42). Conclusion DECT demonstrated moderate diagnostic accuracy for bowel necrosis in this Japanese tertiary care setting. While clinically valuable, DECT's diagnostic capability was not definitive. To optimize DECT's potential, future research should employ disease-specific image reconstruction techniques and provide evaluators with specialized DECT interpretation training.