Barber Joy L, Zambrano-Perez Alexsandra, Olsen Øystein E, Kiparissi Fevronia, Baycheva Mila, Knaflez Daniela, Shah Neil, Watson Tom A
Department of Paediatric Radiology, Great Ormond Street Hospital NHS Foundation Trust, London, Wc1N 3JH, UK.
Department of Radiology, St. George's Hospital NHS Foundation Trust, London, UK.
Pediatr Radiol. 2018 Jun;48(6):843-851. doi: 10.1007/s00247-018-4084-1. Epub 2018 Apr 13.
Magnetic resonance enterography (MRE) is the current gold standard for imaging in inflammatory bowel disease, but ultrasound (US) is a potential alternative.
To determine whether US is as good as MRE for the detecting inflamed bowel, using a combined consensus score as the reference standard.
We conducted a retrospective cohort study in children and adolescents <18 years with inflammatory bowel disease (IBD) at a tertiary and quaternary centre. We included children who underwent MRE and US within 4 weeks. We scored MRE using the London score and US using a score adapted from the METRIC (MR Enterography or Ultrasound in Crohn's Disease) trial. Four gastroenterologists assessed an independent clinical consensus score. A combined consensus score using the imaging and clinical scores was agreed upon and used as the reference standard to compare MRE with US.
We included 53 children. At a whole-patient level, MRE scores were 2% higher than US scores. We used Lin coefficient to assess inter-observer variability. The repeatability of MRE scores was poor (Lin 0.6). Agreement for US scoring was substantial (Lin 0.95). There was a significant positive correlation between MRE and clinical consensus scores (Spearman's rho = 0.598, P=0.0053) and US and clinical consensus scores (Spearman's rho = 0.657, P=0.0016).
US detects as much clinically significant bowel disease as MRE. It is possible that MRE overestimates the presence of disease when using a scoring system. This study demonstrates the feasibility of using a clinical consensus reference standard in paediatric IBD imaging studies.
磁共振小肠造影（MRE）是目前炎症性肠病成像的金标准，但超声（US）是一种潜在的替代方法。
以联合共识评分作为参考标准，确定超声在检测炎症性肠段方面是否与磁共振小肠造影一样有效。
我们在一家三级和四级医疗中心对18岁以下患有炎症性肠病（IBD）的儿童和青少年进行了一项回顾性队列研究。纳入在4周内接受了磁共振小肠造影和超声检查的儿童。我们使用伦敦评分对磁共振小肠造影进行评分，使用从METRIC（克罗恩病的磁共振小肠造影或超声）试验改编的评分对超声进行评分。四位胃肠病学家评估独立的临床共识评分。使用影像学和临床评分的联合共识评分被确定并用作参考标准，以比较磁共振小肠造影和超声。
我们纳入了53名儿童。在全患者水平上，磁共振小肠造影评分比超声评分高2%。我们使用林氏系数评估观察者间的变异性。磁共振小肠造影评分的重复性较差（林氏系数0.6）。超声评分的一致性较高（林氏系数0.95）。磁共振小肠造影与临床共识评分之间存在显著正相关（斯皮尔曼相关系数=0.598，P=0.0053），超声与临床共识评分之间也存在显著正相关（斯皮尔曼相关系数=0.657，P=0.0016）。
超声在检测具有临床意义的肠道疾病方面与磁共振小肠造影一样有效。在使用评分系统时，磁共振小肠造影有可能高估疾病的存在。本研究证明了在儿科炎症性肠病成像研究中使用临床共识参考标准的可行性。
