Abstract
PurposeTo prospectively evaluate interobserver agreement for small bowel ultrasound (SBUS) in newly diagnosed and relapsing Crohn’s disease.MethodsA subset of patients recruited to a prospective trial comparing the diagnostic accuracy of MR enterography and SBUS underwent a second SBUS performed by one of a pool of six practitioners, who recorded the presence, activity and location of small bowel and colonic disease. Detailed segmental mural and extra-mural observations were also scored. Interobserver variability was expressed as percentage agreement with a construct reference standard, split by patient cohort, grouping disease as present or absent. Prevalence adjusted bias adjusted kappa (PABAK), and simple percentage agreement between practitioners, irrespective of the reference standard, were calculated.ResultsThirty-eight patients (11 new diagnosis, 27 relapse) were recruited from two sites. Overall percentage agreement for small bowel disease presence against the consensus reference was 82% (52–95% (95%CI)), kappa coefficient (κ) 0.64, (substantial agreement) for new diagnosis and 81%, κ 0.63 (substantial agreement) for the relapsing cohort. Agreement for colonic disease presence was 64%, κ 0.27 (fair agreement) in new diagnosis and 78%,κ 0.56 (moderate agreement) in the relapsing cohort. Simple agreement between practitioners was 84% and 87% for small bowel and colonic disease presence respectively. Practitioners agreed on small bowel disease activity in 24/27 (89%) where both identified disease. Kappa agreement for detailed mural observations ranged from κ 0.00 to 1.00.ConclusionThere is substantial practitioner agreement for small bowel disease presence in newly diagnosed and relapsing CD patients, supporting wider dissemination of enteric US.
Highlights
Meta-analyses suggest that small bowel ultrasound (SBUS) achieves a high sensitivity for the presence and extent of small bowel Crohn’s disease (CD), recently confirmed in a prospective multicentre trial setting by the METRIC trial [1,2,3,4]
The study population consisted of thirty-eight patients (11 new-diagnosis and 26 relapse), representing 23% of the 163 patients recruited to the sites as part of the main METRIC trial
We report substantial sonographic agreement for the presence of small bowel CD, both in newly diagnosed patients and those suspected of luminal relapse
Summary
Meta-analyses suggest that small bowel ultrasound (SBUS) achieves a high sensitivity for the presence and extent of small bowel Crohn’s disease (CD), recently confirmed in a prospective multicentre trial setting by the METRIC trial [1,2,3,4]. SBUS has several advantages over Magnetic resonance enterography (MRE). It does not require oral or intravenous contrast and is preferred by patients [5]. It is widely available and can be employed at both bedside and out-patient clinic [6]. SBUS uptake has been hampered by perceptions of high levels of operator dependence i.e. inter-observer variability. While sonographic features of advanced CD, such as mural thickening and increased colour doppler flow, are usually appreciated readily [7,8,9,10], subtle disease can be difficult
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