Semi-automatic bowel wall thickness measurements on MR enterography in patients with Crohn's disease

To evaluate a semi-automatic method for delineation of the bowel wall and measurement of the wall thickness in patients with Crohn's disease.

53 patients with suspected or proven Crohn's disease were selected. Two radiologists independently supervised the delineation of regions with active Crohn's disease on MRI, yielding manual annotations (Ano1, Ano2). Three observers manually measured the maximal bowel wall thickness of each annotated segment. An active contour segmentation approach semi-automatically delineated the bowel wall. For each active region, two segmentations (Seg1, Seg2) were obtained by independent observers, in which the maximum wall thickness was automatically determined. The overlap between (Seg1, Seg2) was compared with the overlap of (Ano1, Ano2) using Wilcoxon's signed rank test. The corresponding variances were compared using the Brown-Forsythe test. The variance of the semi-automatic thickness measurements was compared with the overall variance of manual measurements through an F-test. Furthermore, the intraclass correlation coefficient (ICC) of semi-automatic thickness measurements was compared with the ICC of manual measurements through a likelihood-ratio test.

Patient demographics: median age, 30 years; interquartile range, 25-38 years; 33 females. The median overlap of the semi-automatic segmentations (Seg1 vs Seg2: 0.89) was significantly larger than the median overlap of the manual annotations (Ano1 vs Ano2: 0.72); p = 1.4 × 10^-5. The variance in overlap of the semi-automatic segmentations was significantly smaller than the variance in overlap of the manual annotations (p = 1.1 × 10^-9). The variance of the semi-automated measurements (0.46 mm²) was significantly smaller than the variance of the manual measurements (2.90 mm², p = 1.1 × 10^-7). The ICC of semi-automatic measurement (0.88) was significantly higher than the ICC of manual measurement (0.45); p = 0.005.

The semi-automatic technique facilitates reproducible delineation of regions with active Crohn's disease. The semi-automatic thickness measurement sustains significantly improved interobserver agreement. Advances in knowledge: Automation of bowel wall thickness measurements strongly increases reproducibility of these measurements, which are commonly used in MRI scoring systems of Crohn's disease activity.