title: Inter- and intraobserver agreement in computed tomography enterography in inflammatory bowel disease.
abstract: OBJECTIVE
  To evaluate intra- and interobserver agreement in imaging features in inflammatory bowel disease and comparison with fecal calprotectin (FC) levels.
  
  
  METHODS
  Our institutional computed tomography enterography (CTE) database was retrospectively queried to identify patients who underwent CTE from January 2014 to June 2015. Patient inclusion criteria were confirmed inflammatory bowel disease (IBD) and FC collected < 4 mo after CTE without any change in clinical treatment or surgical treatment during this interval. The exclusion criterion was poor image quality. Two blinded abdominal radiologists, with 12 and 3 years of experience analyzed the CTE regarding localization (small bowel, colonic, both, or no disease detected); type of IBD (inflammatory, stenosing, fistulizing, > 1 pattern, or normal); and signs of active disease (present or absent). In 42 of 44 patients evaluated, routine CTE reports were made by one of the readers who re-evaluated the CTEs ≥ 6 mo later, to determine the intraobserver agreement. FC was considered a sign of disease activity when it was higher than 250 μg/g.
  
  
  RESULTS
  Forty-four patients with IBD (38 with Crohn's disease and 6 with ulcerative colitis) were included. There was a moderate interobserver agreement regarding localization of IBD (κ = 0.540), type of disease (κ = 0.410) and the presence of active signs in CTE (κ = 0.419). There was almost perfect intraobserver agreement regarding localization, type and signs of active disease in IBD. The κ values were 0.902, 0.937 and 0.830, respectively. After a consensus between both radiologists regarding inflammatory activity in CTE, we found that 24 (85.7%) of 28 patients who were classified with active disease had elevated FC, and six (37.5%) of 16 patients without inflammatory activity in CTE had elevated FC (P= 0.003). The correlation between elevated FC and the presence of active disease in CTE was significant (κ = 0.495,P= 0.001).
  
  
  CONCLUSIONS
  We found almost perfect intraobserver and moderate interobserver agreement in the signs of active disease in CTE with concurrence of high FC levels.
authors.affiliation: Natally Horvat, Camila Carlos Tavares, Hilton Muniz Leao-Filho, Angela Hissae Motoyama Caiado, Serli Kiyomi Nakao Ueda, Manoel Souza Rocha, Radiology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP 05403-010, Brazil.
authors.forename: Natally
authors.initials: N
authors.lastname: Horvat
authors.affiliation: Natally Horvat, Camila Carlos Tavares, Hilton Muniz Leao-Filho, Angela Hissae Motoyama Caiado, Serli Kiyomi Nakao Ueda, Manoel Souza Rocha, Radiology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP 05403-010, Brazil.
authors.forename: Camila Carlos
authors.initials: CC
authors.lastname: Tavares
authors.affiliation: Natally Horvat, Camila Carlos Tavares, Hilton Muniz Leao-Filho, Angela Hissae Motoyama Caiado, Serli Kiyomi Nakao Ueda, Manoel Souza Rocha, Radiology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP 05403-010, Brazil.
authors.forename: Adriana Ribas
authors.initials: AR
authors.lastname: Andrade
authors.affiliation: Natally Horvat, Camila Carlos Tavares, Hilton Muniz Leao-Filho, Angela Hissae Motoyama Caiado, Serli Kiyomi Nakao Ueda, Manoel Souza Rocha, Radiology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP 05403-010, Brazil.
authors.forename: Julia Campos Simões
authors.initials: JC
authors.lastname: Cabral
authors.affiliation: Natally Horvat, Camila Carlos Tavares, Hilton Muniz Leao-Filho, Angela Hissae Motoyama Caiado, Serli Kiyomi Nakao Ueda, Manoel Souza Rocha, Radiology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP 05403-010, Brazil.
authors.forename: Hilton Muniz
authors.initials: HM
authors.lastname: Leao-Filho
authors.affiliation: Natally Horvat, Camila Carlos Tavares, Hilton Muniz Leao-Filho, Angela Hissae Motoyama Caiado, Serli Kiyomi Nakao Ueda, Manoel Souza Rocha, Radiology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP 05403-010, Brazil.
authors.forename: Angela Hissae Motoyama
authors.initials: AH
authors.lastname: Caiado
authors.affiliation: Natally Horvat, Camila Carlos Tavares, Hilton Muniz Leao-Filho, Angela Hissae Motoyama Caiado, Serli Kiyomi Nakao Ueda, Manoel Souza Rocha, Radiology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP 05403-010, Brazil.
authors.forename: Serli Kiyomi Nakao
authors.initials: SK
authors.lastname: Ueda
authors.affiliation: Natally Horvat, Camila Carlos Tavares, Hilton Muniz Leao-Filho, Angela Hissae Motoyama Caiado, Serli Kiyomi Nakao Ueda, Manoel Souza Rocha, Radiology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP 05403-010, Brazil.
authors.forename: André Zonetti Arruda
authors.initials: AZ
authors.lastname: Leite
authors.affiliation: Natally Horvat, Camila Carlos Tavares, Hilton Muniz Leao-Filho, Angela Hissae Motoyama Caiado, Serli Kiyomi Nakao Ueda, Manoel Souza Rocha, Radiology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP 05403-010, Brazil.
authors.forename: Aytan Miranda
authors.initials: AM
authors.lastname: Sipahi
authors.affiliation: Natally Horvat, Camila Carlos Tavares, Hilton Muniz Leao-Filho, Angela Hissae Motoyama Caiado, Serli Kiyomi Nakao Ueda, Manoel Souza Rocha, Radiology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP 05403-010, Brazil.
authors.forename: Manoel Souza
authors.initials: MS
authors.lastname: Rocha
mesh_terms: D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000000981:diagnostic imaging*; D003106:Colon / Q000000981:diagnostic imaging*; D003424:Crohn Disease / Q000000981:diagnostic imaging*; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000000981:diagnostic imaging; D007421:Intestine, Small / Q000000981:diagnostic imaging*; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D000072177:Radiologists; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D039841:Leukocyte L1 Antigen Complex
keywords: Computed tomography; Crohn’s disease; Fecal calprotectin; Inflammatory bowel disease activity; Ulcerative colitis