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. 2025 May 27;16(1):111.
doi: 10.1186/s13244-025-01978-8.

Inter- and intra-observer variability of software quantified bowel motility measurements of small bowel Crohn's disease: findings from the MOTILITY trial

Maira Hameed  1   2 , Andrew A Plumb  1   2 , Kashfia Chowdhury  3 , Norin Ahmed  3 , Safi Rahman  4 , Gauraang Bhatnagar  2   5 , Elen Thomson  6 , Maryam Mohsin  6 , Jude Holmes  2 , Steve Halligan  1   2 , Stuart A Taylor  7   8 ; MOTILITY trial investigators
Collaborators, Affiliations

Inter- and intra-observer variability of software quantified bowel motility measurements of small bowel Crohn's disease: findings from the MOTILITY trial

Maira Hameed et al. Insights Imaging. .

Abstract

Objectives: Motility magnetic resonance imaging (mMRI) is a potential marker of disease activity of small bowel Crohn's disease (SBCD), but there is limited data on its reproducibility. We assessed inter- and intra-observer agreement of small bowel motility as part of a prospective multicentre trial investigating whether mMRI can predict longer-term response to biologic therapy in active, non-stricturing SB-CD (MOTILITY Trial).

Methods: 297 segmental small bowel motility scores from 104 SBCD patients (mean age 38.9 years, 43 female) recruited to the MOTILITY trial were measured independently by two radiologists experienced in mMRI, using GIQuant software. Twenty-six datasets were re-read by both radiologists to test intra-observer variability after a washout period of at least 6 weeks. Five gastrointestinal radiologists inexperienced in mMRI derived 66 segmental motility scores from the same 30 randomly selected patients. Agreement was quantified using the intra-class correlation coefficient (ICC).

Results: There was moderate agreement for mMRI-derived segmental small bowel motility measurements for both mMRI-experienced and inexperienced radiologists (ICC 0.59 (95% CI: 0.51, 0.66) and 0.70 (95% CI: 0.61, 0.78), respectively). Agreement remained moderate to good, combining the experienced trial MRI reader measurements with those of the five inexperienced radiologists (ICC 0.69 (95% CI: 0.61, 0.78). Intra-observer agreement for the two mMRI experienced radiologists was (0.71 (95% CI: 0.44, 0.86) and 0.70 (95% CI: 0.44, 0.86)).

Conclusions: There is moderate to good interobserver agreement for mMRI measurements of segmental small bowel motility for both experienced and inexperienced radiologists.

Critical relevance statement: Study findings support the continuing clinical translation of motility MRI as a reproducible biomarker of disease activity and treatment response in Crohn's disease.

Key points: Motility MRI is a novel biomarker of small bowel Crohn's disease activity. Currently, limited data on intra- and inter-observer variability exists. Motility MRI shows moderate to good inter- and intra-observer agreement. Intraclass correlation was 0.59-0.71 for experienced and inexperienced radiologists. Motility MRI is reproducible, supporting its utility as a biomarker of disease activity.

Keywords: Biomarkers; Crohn disease; Gastrointestinal motility; Magnetic resonance imaging; Observer variation.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The prospective trial was ethically approved (NHS West Midlands Research Ethics Committee: 17/WM/0106) and registered (ISRCTN14481560). The current study is a prespecified sub-study. Consent for publication: All study participants included provided informed, written consent as per the study protocol. Competing interests: S.T. is a consultant to AstraZeneca, has research grant support from Takeda, and is a shareholder in Motilent. G.B. is an employee of and shareholder in Motilent, is a consultant for Alimentiv, and owns the patent for P295276.US.02: system to characterise topology and morphology of fistulae from medical imaging data. The remaining authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Technique for region of interest (ROI) placement for segmental small bowel motility MRI quantification. a, c Coronal T2-weighted images showing ROI placement by readers in the terminal ileum in 2 different cases. This ROI placement was selected to be as large as possible but also reproducible between studies at different time points within one patient. These ROIs were transferred to a calculated motility map (b, d) derived from the reference coronal T2-weighted images. This enables an average motility score to be derived (standard deviation of the Jacobean measured in artificial units)
Fig. 2
Fig. 2
CONSORT diagram of the flow of study participants. mMRI (motility MRI). *Excluded as the reader could not reliably place a region of interest in the study/studies. mMRI inexperienced radiologists were presented 90 scans from 30 patients at 3 time points
Fig. 3
Fig. 3
Bland–Altman plot showing interobserver agreement in segmental small bowel mMRI measurements between the two mMRI-experienced radiologists. The red lines represent ± 95% (± 1.96 SD) limits of agreement. SD, standard deviation
Fig. 4
Fig. 4
Scatter plot demonstrating mMRI measurement agreement between the two experienced radiologists
Fig. 5
Fig. 5
Bland–Altman plot of intra-observer agreement at two time points for mMRI measurements in the experienced radiologists, n = 25 for radiologist 1, n = 26 for radiologist 2. The red lines represent ± 95% (± 1.96 SD) limits of agreement. SD, standard deviation
Fig. 6
Fig. 6
Scatter plots of segmental mMRI measurement intra-observer agreement in the two experienced radiologists between repeat scan reads (reads 1 and 2)
See this image and copyright information in PMC

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