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Magnetic resonance imaging for suspected perianal Crohn's disease in children: a multi-reader agreement study
Pradipta Debnath1, Michael R Acord2, Christopher G Anton1,3
1Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Insights
Inter-radiologist agreement for pediatric perianal Crohn's disease (CD) MRI interpretation is fair for most features. Moderate to good agreement was found for abscess presence and length, crucial for patient management.
Area of Science:
- Pediatric radiology
- Gastroenterology
- Medical imaging
Background:
- Pelvic MRI is vital for diagnosing and monitoring pediatric perianal Crohn's disease (CD).
- Limited data exists on the consistency of interpretations among radiologists.
Purpose of the Study:
- To evaluate inter-radiologist agreement in interpreting pelvic MRI scans for pediatric perianal CD.
- To identify specific imaging features with varying levels of agreement.
Main Methods:
- Retrospective review of pelvic MRI scans from 46 pediatric patients (<18 years) with newly diagnosed perianal CD.
- 13 fellowship-trained pediatric radiologists assessed images for fistulas, abscesses, and classified findings using established systems.
- Statistical analysis included Fleiss' kappa (κ) and intra-class correlation coefficients (ICC) to measure agreement.
Main Results:
- Fair agreement (κ = 0.21–0.35) was observed for most imaging features.
- Moderate agreement (κ = 0.42–0.52) was noted for fistula length, genital involvement, and abscess presence.
- Good agreement (ICC = 0.81) was achieved for maximum abscess length.
- Radiologists were divided on the added value of postcontrast T1-weighted images over T2-weighted images alone.
Conclusions:
- Inter-radiologist agreement for interpreting pediatric perianal CD pelvic MRI is fair overall.
- Specific features like abscess dimensions show better agreement, which is clinically relevant.
- Improving agreement may require enhanced radiologist education and standardized definitions for imaging features.
Objectives:
We aimed to assess inter-radiologist agreement when interpreting pelvic MRI in children with newly diagnosed perianal Crohn's disease (CD).
Materials And Methods:
In this retrospective multi-reader study, we identified pediatric patients (< 18 years of age) who underwent a pelvic MRI examination for newly diagnosed perianal CD. Images were de-identified and uploaded to a cloud-based image platform for review by 13 fellowship-trained pediatric radiologists The reviewers assessed for the presence of a fistula and abscess, categorization of different imaging findings, and classification using the Parks and St James' University Hospital systems. Fleiss' kappa (κ) statistics and intra-class correlation coefficients (ICC) were used to measure inter-reader agreement, along with 95% confidence intervals (CI).
Results:
Forty-six patients were included in our study (median age = 13.0 years [IQR: 10.5 to 16.0 years]); thirty-five (76.1%) were boys. Most imaging features showed fair agreement (κ = 0.21 to 0.35). There was moderate agreement for categorical fistula length (κ = 0.42 [95% CI: 0.32 to 0.53]), involvement of the genitalia (κ = 0.45 [95% CI: 0.26 to 0.63]), and presence of an abscess/collection (κ = 0.52 [95% CI: 0.31 to 0.73]). Maximum abscess/collection length had good agreement (ICC = 0.81 [95% CI: 0.41, 1.00]). There was an almost equal split (yes vs. no: 50.7% vs. 49.3%) regarding whether postcontrast T1-weighted images added value compared to T2-weighted images alone across all radiologists and examinations.
Conclusion:
Inter-radiologist agreement when interpreting pelvic MRI for perianal CD in children is fair for most imaging features, with fewer features demonstrating moderate or good agreement.
Key Points:
Question Pelvic magnetic resonance imaging (MRI) is used for diagnosing and monitoring children with perianal Crohn's disease (CD). Limited information is known about inter-radiologist agreement. Findings Agreement between pediatric radiologists when interpreting MRI for perianal CD in children is only fair for most imaging features (κ = 0.21 to 0.35). Clinical relevance Understanding MRI inter-radiologist agreement is crucial to improve the reliability of pelvic MRI in children with perianal Crohn's disease since it may affect patient management (e.g., surgery); further radiologist education and improved imaging feature definitions may help improve inter-radiologist agreement.
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