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Interobserver and intermodality agreement for detection of small bowel Crohn's disease with MR enterography and CT
Michael D Jensen1, Tina Ormstrup, Chris Vagn-Hansen
1Department of Radiology, Lillebaelt Hospital Vejle, Vejle, Denmark. michael.dam.jensen@slb.regionsyddanmark.dk
Background:
Magnetic resonance enterography (MRE) and computed tomography enterography (CTE) visualizes small bowel Crohn's disease (CD) and its complications with high accuracy. The aim of this study was to determine the interobserver and intermodality agreement for detection of small bowel CD.
Methods:
Fifty patients with suspected or known CD were included in the study and all patients underwent MRE and CTE on the same day. Four radiologists with experience in MRE and CTE techniques participated. Observers were blind to patient histories, results of ileocolonoscopies, and other small bowel examinations. Readers assessed the image quality, the presence of small bowel CD, and seven findings consistent with CD.
Results:
The image quality was better with CTE than MRE (P < 0.001) but the diagnostic yields were comparable (P = 0.4). For detection of small bowel CD, the interobserver agreement was substantial in CTE (κ = 0.64) and moderate in MRE (κ = 0.48). The intermodality agreement was fair to substantial (κ = 0.40-0.64) for different observers. Two abscesses were detected and confirmed at subsequent surgery. One abscess was not detected with MRE and only recorded by two observers in CTE. A total of 10 fistulas were detected: three were confirmed at subsequent surgery and four were false-positive findings.
Conclusions:
MRE and CTE have comparable diagnostic yields in patients with suspected or known CD. However, CTE provides better image quality and interobserver agreement. In a substantial number of patients the diagnosis of small bowel CD is observer- and modality-dependent.
Insights
Computed tomography enterography (CTE) and magnetic resonance enterography (MRE) are accurate for small bowel Crohn's disease (CD). CTE offers better image quality and interobserver agreement than MRE, though diagnostic yields are similar.
Area of Science:
- Gastroenterology
- Radiology
- Medical Imaging
Background:
- Small bowel Crohn's disease (CD) diagnosis relies on imaging.
- Magnetic resonance enterography (MRE) and computed tomography enterography (CTE) are key diagnostic tools.
- Assessing interobserver and intermodality agreement is crucial for diagnostic accuracy.
Purpose of the Study:
- To compare the diagnostic performance of MRE and CTE for small bowel CD.
- To evaluate interobserver and intermodality agreement between MRE and CTE.
- To determine the impact of imaging modality on CD diagnosis.
Main Methods:
- Fifty patients with suspected or known CD underwent same-day MRE and CTE.
- Four experienced radiologists independently assessed images, blinded to clinical data.
- Image quality, CD presence, and specific CD findings were evaluated.
Main Results:
- CTE demonstrated superior image quality compared to MRE (P < 0.001).
- Interobserver agreement was substantial for CTE (κ = 0.64) and moderate for MRE (κ = 0.48).
- Intermodality agreement ranged from fair to substantial (κ = 0.40-0.64).
Conclusions:
- MRE and CTE show comparable diagnostic yields for small bowel CD.
- CTE offers improved image quality and interobserver agreement.
- Diagnosis of small bowel CD can be dependent on the observer and imaging modality used.
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