MR enteroclysis in the diagnosis of small-bowel neoplasms.
OBJECTIVE
To evaluate the diagnostic accuracy and interobserver variance of magnetic resonance (MR) enteroclysis in the diagnosis of small-bowel neoplasms, with small-bowel endoscopy, surgery, histopathologic analysis, and follow-up serving as standards of reference, and to identify MR enteroclysis characteristics capable of enabling discrimination between benign and malignant small-bowel neoplasms.


METHODS
This study was performed in accordance with the guidelines of the institutional review board, and the requirement for informed consent was waived. MR enteroclysis studies of 91 patients (43 women, 48 men; age range, 18-83 years) were retrospectively evaluated by two radiologists blinded to clinical details. Only studies explicitly performed to investigate or exclude the presence of small-bowel neoplasms were included. Radiologic findings were compared with findings of double-balloon endoscopy (n = 45), surgery (n = 18), esophagogastroduodenoscopy (n = 3), ileocolonoscopy (n = 2), autopsy (n = 2), and clinical follow-up for more than 18 months (n = 21). Efficacy parameters were calculated with 95% confidence intervals. Tumor characteristics were compared with the Student t test and the Fisher exact test.


RESULTS
Readers 1 and 2 interpreted 31 and 33 studies, respectively, as depicting a small-bowel neoplasm and 19 and 17 studies, respectively, as depicting small-bowel malignancy. In 32 patients, the presence of small-bowel neoplasm was confirmed. In 19 of these patients, the neoplasm was malignant. Sensitivity and specificity in the diagnosis of small-bowel neoplasms was 0.91 and 0.95, respectively, for reader 1 and 0.94 and 0.97, respectively, for reader 2; the kappa value was 0.95. Factors associated with malignancy were the presence of longer solitary nonpedunculated lesions, mesenteric fat infiltration, and enlarged mesenteric lymph nodes.


CONCLUSIONS
Eighty-six of 91 studies were correctly interpreted, resulting in an overall diagnostic accuracy of 0.95 for MR enteroclysis in the detection of small-bowel neoplasms.


BACKGROUND
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.09090828/-/DC1.
Van Weyenberg
Stijn J B
SJ
Departments of Gastroenterology and Hepatology, Radiology, and Surgery, VU University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, the Netherlands.
Meijerink
Martijn R
MR
Jacobs
Maarten A J M
MA
Van der Peet
Donald L
DL
Van Kuijk
Cornelis
C
Mulder
Chris J J
CJ
Van Waesberghe
Jan Hein T M
JH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007414:Intestinal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D007421:Intestine, Small; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012015:Reference Standards; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D003287:Contrast Media