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. 2017 Jan-Feb;50(1):13-18.
doi: 10.1590/0100-3984.2015.0131.

Using computed tomography enterography to evaluate patients with Crohn's disease: what impact does examiner experience have on the reproducibility of the method?

Stênio Burlin  1 , Larissa Rossini Favaro  2 , Elisa Almeida Sathler Bretas  3 , Lincoln Seiji Taniguchi  2 , Ana Paula Loch  4 , Marjorie Costa Argollo  5 , Orlando Ambrogini Junior  6 , Giuseppe D'Ippolito  7
Affiliations

Using computed tomography enterography to evaluate patients with Crohn's disease: what impact does examiner experience have on the reproducibility of the method?

Stênio Burlin et al. Radiol Bras. 2017 Jan-Feb.

Abstract
in English, Portuguese

Objective: To assess the impact that examiner experience has on the reproducibility and accuracy of computed tomography (CT) enterography in the detection of radiological signs in patients with Crohn's disease.

Materials and methods: This was a retrospective, cross-sectional observational study involving the analysis of CT enterography scans of 20 patients with Crohn's disease. The exams were analyzed independently by two radiologists in their last year of residence (duo I) and by two abdominal imaging specialists (duo II). The interobserver agreement of each pair of examiners in identifying the main radiological signs was calculated with the kappa test. The accuracy of the examiners with less experience was quantified by using the consensus among three experienced examiners as a reference.

Results: Duo I and duo II obtained a similar interobserver agreement, with a moderate to good correlation, for mural hyperenhancement, parietal thickening, mural stratification, fat densification, and comb sign (kappa: 0.45-0.64). The less experienced examiners showed an accuracy > 80% for all signs, except for lymph nodes and fistula, for which it ranged from 60% to 75%.

Conclusion: Less experienced examiners have a tendency to present a level of interobserver agreement similar to that of experienced examiners in evaluating Crohn's disease through CT enterography, as well as showing satisfactory accuracy in identifying most radiological signs of the disease.

Objetivo: Avaliar o impacto da experiência do examinador na reprodutibilidade e na acurácia de detecção de sinais radiológicos em exames de enterografia por tomografia computadorizada (entero-TC) de pacientes portadores da doença de Crohn.

Materiais e métodos: Análise retrospectiva de exames de entero-TC de 20 pacientes com doença de Crohn. Os exames foram analisados, independentemente, por dois radiologistas do último ano de residência (dupla I) e dois especialistas em imagem abdominal (dupla II). A concordância interobservador de cada dupla de examinadores para a identificação dos principais sinais tomográficos foi calculada pelo teste kappa. A acurácia da dupla I foi medida usando-se como referência um consenso entre três examinadores experientes.

Resultados: Ambas as duplas obtiveram concordância interobservador semelhante e com correlação moderada a boa para os sinais de estratificação mural, espessamento da parede, realce mucoso, densificação da gordura e sinal do pente (kappa: 0,45-0,64). Os examinadores menos experientes apresentaram acurácia superior a 80% para os sinais, exceto para linfonodos e fístula (entre 60% e 75%).

Conclusão: Examinadores menos experientes têm tendência a apresentar grau de concordância entre si semelhante à de examinadores experientes na avaliação dos principais sinais tomográficos da doença de Crohn, com acurácia considerada satisfatória, para a maioria dos sinais.

Keywords: Crohn disease; Reproducibility of results; Tomography, X-ray computed.

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Figures

Figure 1
Figure 1
A: Note the thickened small loop with mucous enhancement (arrow) and the comb sign (arrowhead), corresponding to engorgement of the mesenteric arcade. B: The arrow indicates the area of ileal stenosis, with upstream dilation of the loops (asterisk). C: Note the fistula (arrow), characterized by a starred image corresponding to its pathway, creating a communication through the bowel loops in the right iliac fossa. D: In the region indicated by the arrows, note the mural stratification in the ileal loop, together with mucous enhancement, allowing us to distinguish among the various parietal layers.
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