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Interobserver variation in the interpretation of magnetic resonance enterography in Crohn's disease
Gauraang Bhatnagar1, Sue Mallett1, Laura Quinn2
1Centre for Medical Imaging, Charles Bell House, University College London, London, UK.
Objectives:
To evaluate interobserver variability for diagnosis of disease presence and extent of small bowel and colonic Crohn's disease using MR enterography (MRE).
Methods:
Data from the first 73 consecutive patients (mean age 32, 33F, 28 new diagnosis, 45 suspected relapse) recruited to a multicentre, prospective diagnostic accuracy trial evaluating MRE for small bowel Crohn's disease were each read independently by three (from a pool of 20) radiologists. Radiologists documented presence and segmental location of small bowel Crohn's disease and recorded morphological mural/extramural parameters for involved segments. Per patient percentage agreement for disease presence and extent were calculated against an outcome-based construct reference standard (averaged between pairs of readers). Prevalence-adjusted bias-adjusted κ (PABAK) was calculated.
Results:
Agreement for small bowel disease presence for new diagnosis/relapsed patients was 68%(κ = 0.36)/ 78% (κ = 0.56) and 43%(κ = 0.14)/ 53% for disease extent (κ = 0.07), respectively. For disease presence, all three radiologists agreed correctly with the reference standard in 41/59 (69%) of patients with small bowel involvement, and in 8/14 (57%) cases of without small bowel disease. Agreement was highest for multisegment disease, greater than 5 cm in length, with mural thickness>6 mm, and increased mural T2 signal. Agreement for colonic disease presence was 61% (κ = 0.21 fair agreement) for new diagnosis/ 60% (κ = 0.20, slight agreement) for relapsed patients.
Conclusion:
There is a reasonable agreement between radiologists for small bowel disease presence using MRE for newly diagnosed Crohn's disease, and patients with suspected relapse, respectively. Agreement is lower for disease extent.
Advances In Knowledge:
There is reasonable agreement between radiologists for small bowel disease presence using MRE for newly diagnosed (68%) Crohn's disease, and patients with suspected relapse (78%). Agreement is lower for disease extent (43% new diagnosis and 53% suspected relapse).
Insights
Radiologists show reasonable agreement in detecting small bowel Crohn's disease using MR enterography (MRE). However, agreement on disease extent is lower, indicating a need for standardized MRE interpretation protocols.
Area of Science:
- Gastroenterology
- Radiology
- Medical Imaging
Background:
- Crohn's disease is a chronic inflammatory bowel disease affecting the small bowel and colon.
- Accurate diagnosis and assessment of disease extent are crucial for effective management.
- MR enterography (MRE) is a non-invasive imaging technique used to evaluate Crohn's disease.
Purpose of the Study:
- To assess interobserver variability in diagnosing the presence and extent of small bowel and colonic Crohn's disease using MRE.
- To quantify agreement among radiologists in MRE interpretation for Crohn's disease.
Main Methods:
- A multicentre prospective trial included 73 consecutive patients with suspected or confirmed Crohn's disease.
- Three radiologists independently reviewed MRE scans, documenting disease presence, location, and morphological parameters.
- Agreement was calculated using percentage agreement and prevalence-adjusted bias-adjusted κ (PABAK) statistics.
Main Results:
- Reasonable agreement was found for the presence of small bowel Crohn's disease (68% for new diagnoses, 78% for relapses).
- Agreement was lower for disease extent (43% for new diagnoses, 53% for relapses).
- Agreement was higher for extensive disease (multisegment, >5 cm length, mural thickness >6 mm, increased mural T2 signal).
Conclusions:
- Interobserver agreement for small bowel Crohn's disease presence using MRE is reasonable.
- Agreement is notably lower for assessing disease extent, highlighting potential challenges in MRE interpretation.
- Further standardization of MRE interpretation may improve diagnostic consistency in Crohn's disease management.
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