Negaard A, Mulahasanovic A, Reisaeter L A, Aasekjaer K, Sandvik L, Klow N-E
Departments of Radiology, Statistics and Epidemiology, and Cardiovascular Radiology, Ullevål University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway.
Acta Radiol. 2008 Nov;49(9):967-74. doi: 10.1080/02841850802409539.
Magnetic resonance enteroclysis (MRE) is suggested to become the preferred radiological method in small-bowel Crohn's disease (CD). However, the performance of inexperienced readers may influence the diagnostic value of the method and has not been previously investigated.
To compare readings of MRE in small-bowel CD performed by experienced and inexperienced readers before and after training.
One experienced radiologist (observer 1) and two trainees (observers 2 and 3) reviewed 60 MRE examinations. A second reading was performed after training. Bowel wall thickness (BWT), ulcers (BWU), stenosis (BWS), fistulas (FIS), and abscesses (ABS) were evaluated. A reference standard based on clinical records was established.
BWT in the terminal ileum was evaluated with high diagnostic performance (sensitivity: observer 1, 83%; observer 2, 72%; observer 3, 78%). Only BWU was diagnosed with a higher sensitivity by observer 1 (78% vs. 33% and 39%, respectively; P=0.02). False-positive findings for BWT in the jejunum (observer 2: 7; observer 3: 4) and fistulas and abscesses (observer 2: 11/5; observer 3: 5/4) were made by the trainees. Interobserver agreement in the jejunum was poor (observer 1/observer 2: kappa=0.23; observer 1/observer 3: kappa=-0.03) and in the ileum good (observer 1/observer 2: kappa=0.78; observer 1/observer 3: kappa=0.73). After training, evaluation of BWU (observer 2: 56%, P=0.22; observer 3: 44%, P=0.03), BWT (observer 2: 2; observer 3: 2), and interobserver agreement in the jejunum improved (observer 1/observer 2: kappa=0.66; observer 1/observer 3: kappa=0.66). However, the number of diagnosed fistulas and abscesses remained high.
Before training, most findings of Crohn's disease in the terminal ileum were evaluated with high diagnostic performance by all readers. However, the inexperienced readers evaluated BWU with a low sensitivity and overestimated the number of FIS, number of ABS, and increased BWT in the jejunum. After training, evaluation by inexperienced readers of BWU and increased BWT in the jejunum improved.
磁共振小肠造影（MRE）被认为将成为小肠克罗恩病（CD）首选的放射学检查方法。然而，经验不足的阅片者的表现可能会影响该方法的诊断价值，且此前尚未对此进行过研究。
比较经验丰富和经验不足的阅片者在训练前后对小肠CD的MRE阅片情况。
一名经验丰富的放射科医生（观察者1）和两名实习医生（观察者2和3）对60例MRE检查进行了阅片。训练后进行了第二次阅片。对肠壁厚度（BWT）、溃疡（BWU）、狭窄（BWS）、瘘管（FIS）和脓肿（ABS）进行了评估。建立了基于临床记录的参考标准。
对回肠末端BWT的评估具有较高的诊断性能（敏感性：观察者1为83%；观察者2为72%；观察者3为78%）。只有BWU由观察者1诊断时敏感性更高（分别为78%，而观察者2和3分别为33%和39%；P = 0.02）。实习医生对空肠BWT（观察者2：7例；观察者3：4例）以及瘘管和脓肿（观察者2：11/5例；观察者3：5/4例）出现了假阳性结果。空肠的观察者间一致性较差（观察者1/观察者2：kappa = 0.23；观察者1/观察者3：kappa = -0.03），而回肠的观察者间一致性良好（观察者1/观察者2：kappa = 0.78；观察者1/观察者3：kappa = 0.73）。训练后，BWU（观察者2：56%，P = 0.22；观察者3：44%，P = 0.03）、BWT（观察者2：2例；观察者3：2例）的评估以及空肠的观察者间一致性有所改善（观察者1/观察者2：kappa = 0.66；观察者1/观察者3：kappa = 0.66）。然而，诊断出的瘘管和脓肿数量仍然较多。
训练前，所有阅片者对回肠末端克罗恩病的大多数表现评估均具有较高的诊断性能。然而，经验不足的阅片者对BWU评估的敏感性较低，且高估了空肠FIS数量、ABS数量以及BWT增加情况。训练后，经验不足的阅片者对BWU以及空肠BWT增加情况的评估有所改善。
