Debnath Pradipta, Ata Nadeen K Abu, Cao Joseph Y, Lala Shailee V, Malik Archana, Riedesel Erica L, Schooler Gary R, Shet Narendra S, Spence Leslie H, Stanescu A Luana, Zhang Bin, Tkach Jean A, Khendek Leticia, Miethke Alexander G, Trout Andrew T, Dillman Jonathan R
Cincinnati Children's Hospital Medical Center, Cincinnati, USA.
AdventHealth Orlando, Orlando, USA.
Pediatr Radiol. 2025 Mar;55(3):479-487. doi: 10.1007/s00247-025-06173-x. Epub 2025 Feb 4.
Magnetic resonance cholangiopancreatography (MRCP) is used to diagnose and monitor primary sclerosing cholangitis (PSC).
To assess inter-reader agreement for the diagnosis of PSC/autoimmune sclerosing cholangitis (ASC) and for individual MRCP features of cholangiopathy in a pediatric sample.
This was a retrospective, IRB-approved study that included MRCP examinations from patients <21 years old with known or suspected cholangiopathy. Multiple biliary and hepatic imaging features were assessed independently by nine pediatric radiologists using 2D and 3D MRCP images. Kappa (κ) statistics and intra-class correlation coefficients (ICC) with 95% confidence intervals (CI) were used to measure inter-reader agreement.
Seventy-five patients were included (median age=16.8 [IQR 13.8-18.7] years; 48 boys); 22.7% (17/75) had PSC, 22.7% (17/75) had ASC, and 54.7% (41/75) had other diagnoses. Among observers, agreement was only slight for presence of cholangiopathy (κ=0.15 [95% CI 0.07 to 0.23]) and presence of PSC/ASC (κ=0.13 [0.06 to 0.21]). Agreement was poor for categorical intrahepatic stricture number (κ=-0.002 [(-0.16 to 0.15]) and stricture extent (κ=-0.06 [-0.09 to-0.02]). Agreement was slight for presence of intrahepatic stricturing disease (κ=0.08 [0.04 to 0.12]). Most other findings had fair agreement between readers (including intrahepatic focal dilations, intrahepatic and extrahepatic diverticula, diffuse extrahepatic dilation without stricture, bile duct mural thickening, and biliary obstruction [κ=0.22 to 0.34]). There was moderate agreement for categorical extrahepatic stricture length (κ=0.46 [-0.11 to 1]) and presence of extrahepatic biliary dilation (κ=0.53 [0.40 to 0.65]). There was excellent agreement for extrahepatic bile duct maximum diameter (ICC=0.89 [0.85 to 0.92]).
Inter-reader agreement for interpreting MRCP in children and young adults is slight to fair for the diagnosis of PSC/ASC and for most findings of cholangiopathy.
磁共振胰胆管造影（MRCP）用于诊断和监测原发性硬化性胆管炎（PSC）。
评估儿科样本中PSC/自身免疫性硬化性胆管炎（ASC）诊断及胆管病个体MRCP特征的阅片者间一致性。
这是一项经机构审查委员会批准的回顾性研究，纳入了年龄小于21岁、患有已知或疑似胆管病的患者的MRCP检查。9名儿科放射科医生使用二维和三维MRCP图像独立评估多个胆管和肝脏成像特征。采用Kappa（κ）统计量和95%置信区间（CI）的组内相关系数（ICC）来衡量阅片者间一致性。
共纳入75例患者（中位年龄=16.8[四分位间距13.8 - 18.7]岁；48名男孩）；22.7%（17/75）患有PSC，22.7%（17/75）患有ASC，54.7%（41/75）有其他诊断。在观察者中，胆管病存在情况（κ=0.15[95%CI 0.07至0.23]）和PSC/ASC存在情况（κ=0.13[0.06至0.21]）的一致性仅为轻度。肝内狭窄数量分类（κ=-0.002[(-0.16至0.15])和狭窄范围（κ=-0.06[-0.09至 - 0.02]）的一致性较差。肝内狭窄性疾病存在情况的一致性为轻度（κ=0.08[0.04至0.12]）。大多数其他发现阅片者间一致性尚可（包括肝内局灶性扩张、肝内和肝外憩室、无狭窄的弥漫性肝外扩张、胆管壁增厚和胆管梗阻[κ=0.22至0.34]）。肝外狭窄长度分类（κ=0.46[-0.11至1]）和肝外胆管扩张存在情况（κ=0.53[0.40至0.65]）的一致性为中度。肝外胆管最大直径的一致性极佳（ICC=0.89[0.85至0.92]）。
在儿童和青年中解读MRCP时，对于PSC/ASC的诊断以及胆管病的大多数发现，阅片者间一致性为轻度至尚可。
