TY - JOUR

T1 - Inter- and intra-observer variability of computed tomography-based parenchymal- and ductal diameters in chronic pancreatitis

T2 - a multi-observer international study

AU - Borgbjerg, Jens

AU - Steinkohl, Emily

AU - Olesen, Søren S.

AU - Akisik, Fatih

AU - Bethke, Anne

AU - Bieliuniene, Edita

AU - Christensen, Heidi S.

AU - Engjom, Trond

AU - Haldorsen, Ingfrid S

AU - Kartalis, Nikolaos

AU - Lisitskaya, Maria V.

AU - Naujokaite, Gintare

AU - Novovic, Srdan

AU - Ozola-Zālīte, Imanta

AU - Phillips, Anna E.

AU - Swensson, Jordan K.

AU - Drewes, Asbjørn M.

AU - Frøkjær, Jens B.

N1 - Publisher Copyright: © 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

PY - 2023

Y1 - 2023

N2 - Purpose: The need for incorporation of quantitative imaging biomarkers of pancreatic parenchymal and ductal structures has been highlighted in recent proposals for new scoring systems in chronic pancreatitis (CP). To quantify inter- and intra-observer variability in CT-based measurements of ductal- and gland diameters in CP patients. Materials and Methods: Prospectively acquired pancreatic CT examinations from 50 CP patients were reviewed by 12 radiologists and four pancreatologists from 10 institutions. Assessment entailed measuring maximum diameter in the axial plane of four structures: (1) pancreatic head (PDhead), (2) pancreatic body (PDbody), (3) main pancreatic duct in the pancreatic head (MPDhead), and (4) body (MPDbody). Agreement was assessed by the 95% limits of agreement with the mean (LOAM), representing how much a single measurement for a specific subject may plausibly deviate from the mean of all measurements on the specific subject. Bland–Altman limits of agreement (LoA) were generated for intra-observer pairs. Results: The 16 observers completed 6400 caliper placements comprising a first and second measurement session. The widest inter-observer LOAM was seen with PDhead (± 9.1 mm), followed by PDbody (± 5.1 mm), MPDhead (± 3.2 mm), and MPDbody (± 2.6 mm), whereas the mean intra-observer LoA width was ± 7.3, ± 5.1, ± 3.7, and ± 2.4 mm, respectively. Conclusion: Substantial intra- and inter-observer variability was observed in pancreatic two-point measurements. This was especially pronounced for parenchymal and duct diameters of the pancreatic head. These findings challenge the implementation of two-point measurements as the foundation for quantitative imaging scoring systems in CP. Graphical abstract: [Figure not available: see fulltext.]

AB - Purpose: The need for incorporation of quantitative imaging biomarkers of pancreatic parenchymal and ductal structures has been highlighted in recent proposals for new scoring systems in chronic pancreatitis (CP). To quantify inter- and intra-observer variability in CT-based measurements of ductal- and gland diameters in CP patients. Materials and Methods: Prospectively acquired pancreatic CT examinations from 50 CP patients were reviewed by 12 radiologists and four pancreatologists from 10 institutions. Assessment entailed measuring maximum diameter in the axial plane of four structures: (1) pancreatic head (PDhead), (2) pancreatic body (PDbody), (3) main pancreatic duct in the pancreatic head (MPDhead), and (4) body (MPDbody). Agreement was assessed by the 95% limits of agreement with the mean (LOAM), representing how much a single measurement for a specific subject may plausibly deviate from the mean of all measurements on the specific subject. Bland–Altman limits of agreement (LoA) were generated for intra-observer pairs. Results: The 16 observers completed 6400 caliper placements comprising a first and second measurement session. The widest inter-observer LOAM was seen with PDhead (± 9.1 mm), followed by PDbody (± 5.1 mm), MPDhead (± 3.2 mm), and MPDbody (± 2.6 mm), whereas the mean intra-observer LoA width was ± 7.3, ± 5.1, ± 3.7, and ± 2.4 mm, respectively. Conclusion: Substantial intra- and inter-observer variability was observed in pancreatic two-point measurements. This was especially pronounced for parenchymal and duct diameters of the pancreatic head. These findings challenge the implementation of two-point measurements as the foundation for quantitative imaging scoring systems in CP. Graphical abstract: [Figure not available: see fulltext.]

KW - Chronic pancreatitis

KW - Computed tomography

KW - Observer agreement

U2 - 10.1007/s00261-022-03667-2

DO - 10.1007/s00261-022-03667-2

M3 - Journal article

C2 - 36138242

AN - SCOPUS:85138534446

VL - 48

SP - 306

EP - 317

JO - Abdominal Radiology

JF - Abdominal Radiology

SN - 2366-004X

ER -