The accuracy of multidetector computed tomography in the diagnosis of non-occlusive mesenteric ischaemia in patients after cardiovascular surgery

Abstract

OBJECTIVE: To determine the accuracy of multidetector computed tomography (MDCT) in the diagnosis of nonocclusive mesenteric ischaemia (NOMI) among patients after cardiovascular surgery. DESIGN, SETTING AND PARTICIPANTS: A retrospective review of 38 patients in a cardiothoracic intensive care unit who underwent MDCT examination before laparotomy for suspected NOMI between January 2001 and December 2012. INTERVENTION AND MAIN OUTCOME MEASURES: The MDCT studies were examined independently by three radiologists, who were asked to make a determination on the presence or absence of NOMI. The radiological diagnosis was compared against the surgical and/or histological outcome to determine the diagnostic accuracy of MDCT. RESULTS: The sensitivity and specificity of MDCT in the diagnosis of NOMI were 96% and 33%-60%, respectively. The positive and negative likelihood ratios and diagnostic odds ratio were 1.43-2.39, 0.072-0.13 and 11-33.2, respectively. The inter-rater agreement was 68%, with a Fleiss κ of 0.43. CONCLUSIONS: MDCT has high sensitivity but lacks specificity in the diagnosis of NOMI. Its main value is in selection of patients for non-operative management, at least in the short-to-medium term.