Interobserver Agreement in MR Enterography for Diagnostic Assessment in Patients with Crohn's Disease

Abstract

Purpose: To evaluate the extent to which MRE can be used as an observer-independent, objective imaging method for the diagnosis and evaluation of CD with respect to the detection of inflammatory changes of the small bowel and lymphadenopathy as diagnostic criterion and bowel distension as a quality criterion.

Materials and Methods: MRE scans of 84 patients (42 female, median age 37 years) were evaluated independently by 4 experienced radiologists. Analysis of inflammatory changes of the bowel wall, lymphadenopathy and adequate bowel distension was conducted separately for the jejunum, ileum and terminal ileum. The Kendall’s W-test was used for the statistical comparison of concordance.

Results: In a total of 55 patients, inflammatory activity of the bowel wall was detected and MRE was found to have a high interobserver reproducibility concerning inflammatory changes of the intestinal wall (Kendall’s W 0.527 – 0.823). Concerning lymphadenopathy (31 cases, 36.9 %), a low to moderate consensus could be shown with a Kendall’s W value of 0.402 – 0.505. For the assessment of adequate bowel distension, a moderate concordance between the operators could be found (Kendall’s W 0.497 – 0.581).

Conclusion: MRE has proven high interobserver agreement with respect to the diagnosis of inflammatory disease activity of the bowel as a diagnostic criterion in patients with CD. Concerning adequate bowel distension as a quality criterion of the examination itself and lymphadenopathy as a diagnostic criterion, moderate interobserver agreement could be found. This is thought to have a rather small effect on the diagnostic significance and conclusiveness of the method in the daily routine.

Key Points:

• MR enterography as observer independent diagnostic procedure in patients with Chron's Disease.

• Highest interobserver concordance for the criterion of inflammatory bowel wall affection.

• Moderate interobserver concordance for lymphadenopathy and bowel distension.

Citation Format:

• Schleder S, Pawlik M, Wiggermann P et al. Interobserver Agreement in MR Enterography for Diagnostic Assessment in Patients with Crohn's Disease. Fortsc hr Röntgenstr 2013; 185: 992-997

Zusammenfassung

Ziel: Zu evaluieren, inwieweit die MR-Enterografie (MRE) bezüglich der Beurteilung entzündlicher Dünndarmwandveränderungen und der Lymphadenopathie als Diagnosekriterium und der Darmdistension als Qualitätskriterium eine untersucherunabhängige objektive Methode in der Diagnostik des Morbus Crohn (MC) darstellt.

Material und Methoden: Es wurden die MRE von 84 konsekutiven Patienten (42 weiblich, Median 37 Jahre) von 4 erfahrenen Radiologen unabhängig voneinander analysiert. Dabei wurde von jedem Auswerter für das Jejunum, Ileum und terminale Ileum beurteilt, ob eine entzündliche Darmwanveränderung, eine Lymphadenopathie und eine diagnostisch adäquate Darmdistension vorlagen. Um die Übereinstimmung der Diagnose der einzelnen Radiologen untereinander zu überprüfen, wurde der Kendall-W-Test verwendet.

Ergebnisse: Bei insgesamt 55 Patienten (65,5 %) wurde entzündliche Aktivität festgestellt, die MRE weist bezüglich entzündlicher Darmwandveränderungen eine hohe Untersucherunabhängigkeit (Kendall-W 0,527 – 0,823) auf. Betrachtet man die Lymphadeopathie (31 Fälle, 36,9 %), findet sich eine geringe bis moderate Übereinstimmung mit Kendall-W-Werten 0,402 – 0,505. Eine ebenso moderate Übereinstimmung der Untersucher findet sich für die Darmdistension (Kendall-W 0,497 – 0,581), welche insgesamt als sehr gut bewertet wurde.

Schlussfolgerung: Die MRE stellt beim MC eine Methode mit hoher Interobserver-Übereinstimmung bezüglich der Diagnose entzündlicher Dünndarmabschnitte als Indikator der Diagnosequalität dar. Bezüglich der Darmdistension als Indikator der Untersuchungsqualität sowie der Lymphadenopathie besteht eine lediglich moderate Übereinstimmung, welche in der klinischen Praxis die hohe und objektive Aussagekraft der Methode nicht relevant beeinträchtigen dürfte.

Key words

abdomen - ileum - efficacy studies - inflammation - statistics - MR imaging

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