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Quantitative bowel apparent diffusion coefficient measurements in children with inflammatory bowel disease are not
T Watson1, A Calder1, J L Barber2
1Department of Radiology, Great Ormond Street Hospital for Children, London, UK.
Insights
Quantitative apparent diffusion coefficient (ADC) measurements in pediatric inflammatory bowel disease (IBD) show poor intra-observer and interobserver agreement. These findings suggest current ADC thresholds are unreliable for assessing disease activity in children with IBD.
Area of Science:
- Radiology
- Gastroenterology
- Pediatrics
Background:
- Quantitative apparent diffusion coefficient (ADC) measurements are used in magnetic resonance imaging (MRI) enterography to assess disease activity in pediatric inflammatory bowel disease (IBD).
- Variability in ADC measurements can impact diagnostic accuracy and treatment decisions.
Purpose of the Study:
- To investigate the intra-observer and interobserver variability of quantitative ADC measurements in children with IBD.
- To determine the reliability of ADC values for characterizing disease activity in pediatric IBD.
Main Methods:
- Six MRI enterography cases with known active disease were analyzed by nine readers.
- Readers performed repeat ADC measurements from diseased and unaffected sites at two separate sittings.
- Statistical analysis included Lin's concordance coefficient and Bland-Altman analysis for intra-observer agreement, and intraclass correlation coefficient (ICC) for interobserver agreement.
Main Results:
- Seven readers completed the study.
- Intra-observer agreement for ADC measurements was poor (Lin's coefficient = 0.844).
- Interobserver variability was poor to moderate (ICC = 0.51), although agreement improved between the two best observers (ICC = 0.85).
- The observed variability means a single ADC value could correspond to different disease severities, rendering published thresholds unreliable.
Conclusions:
- Intra-observer and interobserver agreement for quantitative ADC measurements in pediatric IBD is inadequate for accurate disease activity characterization.
- Current ADC thresholds are not reliable for assessing disease severity in children with IBD.
- Qualitative assessment of ADC may be a more reliable alternative for evaluating disease activity in this population.
Aim:
To investigate the intra-observer and interobserver variability of quantitative apparent diffusion coefficient (ADC) measurements in children with inflammatory bowel disease.
Materials And Methods:
Nine readers were recruited. Six magnetic resonance imaging (MRI) enterography cases with known active disease in the jejunum, terminal ileum, or colon were analysed. Readers measured repeat ADC values from the known diseased site and an unaffected site, at two sittings.
Results:
Seven readers completed the study. The Lin concordance coefficient for intra-observer agreement was poor (0.844, 95% confidence interval [CI]: 0.77, 0.896). Bland-Altman limits of agreement for intra-observer agreement were 0.66×10-3 mm2/s (95% CI: 0.46, 0.86), and -0.56×10-3 mm2/s (95% CI: -0.36, -0.76). Therefore, a single measured value would be compatible with no disease, superficial ulceration, or deep ulceration according to published thresholds. Interobserver variability was poor to moderate across all observers (intraclass correlation coefficient [ICC]: 0.51, 95% CI: 0.27, 0.77). Between the two best-agreeing observers, agreement was good using the ICC (ICC 0.85, 95% CI: 0.43, 1.0), but poor using the Lin correlation coefficient (Lin 0.83, 95% CI: 0.65, 0.93), and Bland-Altman.
Conclusion:
The intra-observer and interobserver agreement is inadequate to allow accurate characterisation of disease activity using previously published thresholds. Qualitative ADC assessment may be preferable.
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