Volume assessment MRI technique for monitoring perianal Crohn’s fistulas
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Published version
Author(s)
Type
Journal Article
Abstract
Background
Perianal Crohn’s fistula and their response to anti-TNF therapies are best assessed with MRI, but radiologist reporting is subjective and variable. This study investigates whether segmentation software could provide precise and reproducible objective measurements of fistula volume.
Methods
Retrospective analysis of patients with perianal Crohn’s fistula at our institution between 2007 and 2013. Pre- and post biologic MRI scans were used with varying time intervals. Two radiologists recorded fistula volumes, mean signal intensity and time taken to measure fistula volumes using validated open-source segmentation software. Three radiologists assessed fistula response to treatment (improved, worse or unchanged) by comparing MRI scans.
Results
Eighteen cases were reviewed for this pilot study. Inter-observer variability was very good for volume and mean signal intensity; ICC 0.95 (95%CI 0.91-0.98) and 0.95 (95%CI 0.90-0.97) respectively. Intra-observer variability was very good for volume and mean signal intensity; ICC 0.99 (95%CI 0.97-0.99) and 0.98 (95%CI 0.95-0.99) respectively. Average time taken to measure fistula volume was 202s and 250s for readers 1 and 2.
Agreement between 3 specialist radiologists was good (kappa 0.69 [95%CI 0.49-0.90]) for the subjective assessment of fistula response. Significant association was found between objective percentage volume change and subjective consensus agreement of response (p=0.001). Median volume change for improved, stable or worsening fistula response was -67% (IQR:-78,-47), 0% (IQR:-16,+17), and +487% (IQR:+217,+559) respectively.
Conclusion
Quantification of fistula volumes and signal intensities is feasible and reliable, providing an objective measure of perianal Crohn’s fistula and response to treatment.
Perianal Crohn’s fistula and their response to anti-TNF therapies are best assessed with MRI, but radiologist reporting is subjective and variable. This study investigates whether segmentation software could provide precise and reproducible objective measurements of fistula volume.
Methods
Retrospective analysis of patients with perianal Crohn’s fistula at our institution between 2007 and 2013. Pre- and post biologic MRI scans were used with varying time intervals. Two radiologists recorded fistula volumes, mean signal intensity and time taken to measure fistula volumes using validated open-source segmentation software. Three radiologists assessed fistula response to treatment (improved, worse or unchanged) by comparing MRI scans.
Results
Eighteen cases were reviewed for this pilot study. Inter-observer variability was very good for volume and mean signal intensity; ICC 0.95 (95%CI 0.91-0.98) and 0.95 (95%CI 0.90-0.97) respectively. Intra-observer variability was very good for volume and mean signal intensity; ICC 0.99 (95%CI 0.97-0.99) and 0.98 (95%CI 0.95-0.99) respectively. Average time taken to measure fistula volume was 202s and 250s for readers 1 and 2.
Agreement between 3 specialist radiologists was good (kappa 0.69 [95%CI 0.49-0.90]) for the subjective assessment of fistula response. Significant association was found between objective percentage volume change and subjective consensus agreement of response (p=0.001). Median volume change for improved, stable or worsening fistula response was -67% (IQR:-78,-47), 0% (IQR:-16,+17), and +487% (IQR:+217,+559) respectively.
Conclusion
Quantification of fistula volumes and signal intensities is feasible and reliable, providing an objective measure of perianal Crohn’s fistula and response to treatment.
Date Issued
2018-08-30
Date Acceptance
2018-06-25
Citation
Therapeutic Advances in Gastroenterology, 2018, 11, pp.1-8
ISSN
1756-2848
Publisher
SAGE Publications (UK and US)
Start Page
1
End Page
8
Journal / Book Title
Therapeutic Advances in Gastroenterology
Volume
11
Copyright Statement
© The Author(s) 2018. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
Publication Status
Published
Date Publish Online
2018-08-30