Missed diagnosis rate of portal venous system thrombosis in cirrhosis on contrast-enhanced CT scans: Review of radiology reports from a tertiary hospital

Abstract

Portal venous system thrombosis (PVST) negatively influences the outcomes of cirrhotic patients. Its accurate diagnosis is essential for treatment selection and prognostic assessment, but it is usually missed in clinical practice. Overall, 684 contrast-enhanced computed tomography (CE-CT) scans were performed in cirrhotic patients who were consecutively admitted from January 2015 to June 2023, and were retrospectively reviewed by two independent researchers. Weighted-kappa was calculated to estimate the consistency of the two researchers in the diagnosis of PVST. If their conclusions were inconsistent, a senior researcher would be invited to make a final diagnosis. Clinically significant PVST (CSPVST) was further identified. By comparing the researchers' diagnosis with the radiology reports, the missed diagnosis rate of PVST was calculated. The Kappa coefficient was 0.85, indicating almost perfect consistency in the diagnosis of PVST between the two researchers. In total, PVST was diagnosed by the researchers on 278 (40.64%) of the 684 scans; and among them, a diagnosis of PVST was not recorded in 168 radiology reports. Thus, the missed diagnosis rate of PVST was 60.43% (168/278). CSPVST was diagnosed by the researchers on 87 (12.72%) scans; and among them, a diagnosis of PVST was not recorded in 38 radiology reports. Thus, the missed diagnosis rate of CSPVST was 43.68% (38/87). If a diagnosis of PVST was made only according to the radiology reports, a very high proportion of PVST would be missed. Considering a high rate of PVST detection in cirrhosis, the radiologists should pay more attention to the diagnosis of PVST, especially CSPVST.

Keywords: CT; Cirrhosis; Misdiagnosis; Missed diagnosis; Portal vein; Thrombosis.