title: Prospective cohort study of ultrasound-ultrasound and ultrasound-MR enterography agreement in the evaluation of pediatric small bowel Crohn disease.
abstract: BACKGROUND
  There is a paucity of published literature describing ultrasound (US)-US and US-MR enterography (MRE) inter-radiologist agreement in pediatric small bowel Crohn disease.
  
  
  OBJECTIVE
  To prospectively assess US-US and US-MRE inter-radiologist agreement in pediatric small bowel Crohn disease.
  
  
  METHODS
  Institutional Review Board approval and informed consent/assent were obtained for this HIPAA-compliant prospective cohort study of children with newly diagnosed distal small bowel Crohn disease (July 2012 to December 2014). Enrolled subjects (n = 29) underwent two small bowel US examinations performed by blinded independent radiologists both before and at multiple time points after initiation of medical therapy (231 unique US examinations, in total); 134 US examinations were associated with concurrent MRE. The MRE examination was interpreted by a third blinded radiologist. The following was documented on each examination: involved length of ileum (cm); maximum bowel wall thickness (mm); amount of bowel wall and mesenteric Doppler signal, and presence of stricture, penetrating disease and/or abscess. Inter-radiologist agreement was assessed with single-measure, three-way, mixed-model intra-class correlation coefficients (ICC) and prevalence-adjusted, bias-adjusted kappa statistics (κ). Numbers in brackets are 95% confidence intervals.
  
  
  RESULTS
  Ultrasound-US agreement was moderate for involved length (ICC: 0.41 [0.35-0.49]); substantial for maximum bowel wall thickness (ICC: 0.67 [0.64-0.70]); moderate for bowel wall Doppler signal (ICC: 0.53 [0.48-0.59]); slight for mesenteric Doppler signal (ICC: 0.25 [0.18-0.42]), and moderate to almost perfect for stricture (κ: 0.54), penetrating disease (κ: 0.80), and abscess (κ: 0.96). US-MRE agreement was moderate for involved length (ICC: 0.42 [0.37-0.49]); substantial for maximum bowel wall thickness (ICC: 0.66 [0.65-0.69]), and substantial to almost perfect for stricture (κ: 0.61), penetrating disease (κ: 0.72) and abscess (κ: 0.88).
  
  
  CONCLUSIONS
  Ultrasound-US agreement was similar to US-MRE agreement for assessing pediatric small bowel Crohn disease. Discrepancies in US-US and US-MRE reporting question the utility of US as an accurate, reproducible radiologic biomarker for assessing response to medical therapy and disease-related complications.
authors.affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229-3039, USA. jonathan.dillman@cchmc.org.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Dillman
authors.affiliation: Department of Radiology, Section of Pediatric Radiology, University of Michigan Health System, C.S. Mott Children's Hospital, Ann Arbor, MI, USA.
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Smith
authors.affiliation: Department of Radiology, Section of Pediatric Radiology, University of Michigan Health System, C.S. Mott Children's Hospital, Ann Arbor, MI, USA.
authors.forename: Ramon
authors.initials: R
authors.lastname: Sanchez
authors.affiliation: Department of Radiology, Section of Pediatric Radiology, University of Michigan Health System, C.S. Mott Children's Hospital, Ann Arbor, MI, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: DiPietro
authors.affiliation: Department of Radiology, Section of Pediatric Radiology, University of Michigan Health System, C.S. Mott Children's Hospital, Ann Arbor, MI, USA.
authors.forename: Soudabeh Fazeli
authors.initials: SF
authors.lastname: Dehkordy
authors.affiliation: Department of Pediatrics, Division of Pediatric Gastroenterology, University of Michigan Health System, C.S. Mott Children's Hospital, Ann Arbor, MI, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Adler
authors.affiliation: Department of Pediatrics, Division of Pediatric Gastroenterology, University of Michigan Health System, C.S. Mott Children's Hospital, Ann Arbor, MI, USA.
authors.forename: Vera
authors.initials: V
authors.lastname: DeMatos-Maillard
authors.affiliation: Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Shokoufeh
authors.initials: S
authors.lastname: Khalatbari
authors.affiliation: Department of Radiology, Division of Abdominal Imaging, University of Michigan Health System, University of Michigan Hospital, Ann Arbor, MI, USA.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Davenport
mesh_terms: D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D003424:Crohn Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D007421:Intestine, Small / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D064847:Multimodal Imaging / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*
keywords: Adolescents; Children; Crohn disease; Inter-observer agreement; MR enterography; Ultrasound