Tsai Richard, Mintz Aaron, Lin Michael, Mhlanga Joyce, Chiplunker Adeeti, Salter Amber, Ciorba Matthew, Deepak Parakkal, Fowler Kathryn
1 Mallinckrodt Institute of Radiology, Washington University in St. Louis , St. Louis, MO , United States.
2 Division of Gastroenterology. Washington University in St. Louis. , St. Louis, MO , United States.
Br J Radiol. 2019 Jul;92(1099):20180930. doi: 10.1259/bjr.20180930. Epub 2019 May 29.
The aim of this study is to determine the interrater agreement in a clinical practice environment for the most commonly used magnetic resonance enterography (MRE) features of Crohn's disease (CD).
CD patients with MRE's before and after treatment were retrospectively identified using search queries over a 7-year period (May 2017-September 2017). MRE features of CD comprising components of multiple CD scoring indices were scored by radiologists in the same segment of bowel. Agreement for nominal categorical and continuous variables was assessed using a κ and interclass correlation coefficients, respectively.
80 scans comprised the study population. Moderate interrater agreement was seen in both the pre- and post-treatment MRE's for presence of diffusion restriction (к = 0.43, 0.48; pre- and post-treatment), stricturing disease (к = 0.51, 0.52), overall degree of severity (к = 0.49, 0.59). Substantial agreement was seen in pre- and post-treatment scans for length of involvement (interclass correlation coefficient = 0.67, 0.61). The presence of mucosal ulceration had no agreement (к = -0.07, -0.042).
Many MRE features of active CD comprising the major CD scoring indices are reproducible when interpreted by non-CD focused abdominal radiologists. However, the presence of mucosal ulcerations had no agreement and may need more investigation before including this feature as a driver in therapeutic decision making.
Demonstrates the unreliability of mucosal ulceration by non-CD focused abdominal radiologists, targeting a potential area for future education. The majority of MRE findings incorporated in to many CD scoring indices have fair to moderate inter-rater agreement even when read by non-MRE expert radiologists. Substantial agreement was seen in the length of involved bowel, but this feature is only incorporated in to one of the CD scoring indices. Presence of mucosal ulcerations had no interrater agreement in our study-a feature which is heavily weighted by several CD scoring indices. Research should be focused bridging those features which have poor interrater agreement.
本研究旨在确定在临床实践环境中，针对克罗恩病（CD）最常用的磁共振肠造影（MRE）特征，不同评估者之间的一致性。
通过检索查询，回顾性识别2017年5月至2017年9月这7年期间接受治疗前后进行MRE检查的CD患者。由放射科医生对包含多个CD评分指数组成部分的CD的MRE特征在同一肠段进行评分。分别使用κ系数和组内相关系数评估名义分类变量和连续变量的一致性。
80次扫描构成研究人群。在治疗前和治疗后的MRE中，对于扩散受限的存在（κ = 0.43，0.48；治疗前和治疗后）、狭窄性疾病（κ = 0.51，0.52）、总体严重程度（κ = 0.49，0.59），不同评估者之间存在中等程度的一致性。在治疗前和治疗后的扫描中，对于受累长度存在高度一致性（组内相关系数 = 0.67，0.61）。黏膜溃疡的存在不存在一致性（κ = -0.07，-0.042）。
由非专注于CD的腹部放射科医生解读时，构成主要CD评分指数的许多活动性CD的MRE特征是可重复的。然而，黏膜溃疡的存在不存在一致性，在将该特征作为治疗决策的驱动因素之前，可能需要更多的研究。
证明了非专注于CD的腹部放射科医生对黏膜溃疡的评估不可靠，这是未来教育的一个潜在领域。即使由非MRE专家放射科医生阅读，纳入许多CD评分指数的大多数MRE结果在不同评估者之间也有一般到中等程度的一致性。在受累肠段的长度方面存在高度一致性，但该特征仅纳入了一个CD评分指数。在我们的研究中，黏膜溃疡的存在不存在不同评估者之间的一致性——这一特征在几个CD评分指数中权重很大。研究应集中于弥合那些不同评估者之间一致性较差的特征。
