Skip to main content
SpringerLink
Log in

Inter-observer variability of radiologists for Cambridge classification of chronic pancreatitis using CT and MRCP: results from a large multi-center study

  • Pancreas
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

Determine inter-observer variability among radiologists in assigning Cambridge Classification (CC) of chronic pancreatitis (CP) based on magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP) and contrast-enhanced CT (CECT).

Methods

Among 422 eligible subjects enrolled into the PROCEED study between 6/2017 and 8/2018, 39 were selected randomly for this study (chronic abdominal pain (n = 8; CC of 0), suspected CP (n = 22; CC of 0, 1 or 2) or definite CP (n = 9; CC of 3 or 4). Each imaging was scored by the local radiologist (LRs) and three of five central radiologists (CRs) at other consortium sites. The CRs were blinded to clinical data and site information of the participants. We compared the CC score assigned by the LR with the consensus CC score assigned by the CRs. The weighted kappa statistic (K) was used to estimate the inter-observer agreement.

Results

For the majority of subjects (34/39), the group assignment by LR agreed with the consensus composite CT/MRCP score by the CRs (concordance ranging from 75 to 89% depending on cohort group). There was moderate agreement (63% and 67% agreed, respectively) between CRs and LRs in both the CT score (weighted Kappa [95% CI] = 0.56 [0.34, 0.78]; p-value = 0.57) and the MR score (weighted Kappa [95% CI] = 0.68 [0.49, 0.86]; p-value = 0.72). The composite CT/MR score showed moderate agreement (weighted Kappa [95% CI] = 0.62 [0.43, 0.81]; p-value = 0.80).

Conclusion

There is a high degree of concordance among radiologists for assignment of CC using MRI and CT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Conwell DL, Lee LS, Yadav D, Longnecker DS, Miller FH, Mortele KJ, Levy MJ, Kwon R, Lieb JG, Stevens T (2014) American Pancreatic Association practice guidelines in chronic pancreatitis: evidence-based report on diagnostic guidelines. Pancreas 43 (8):1143–1162

  2. Braganza JM, Lee SH, McCloy RF, McMahon MJ (2011) Chronic pancreatitis. The Lancet 377 (9772):1184–1197

  3. Majumder S, Chari ST (2016) Chronic pancreatitis. The Lancet 387 (10031):1957–1966

  4. Klöppel G, Detlefsen S, Feyerabend B (2004) Fibrosis of the pancreas: the initial tissue damage and the resulting pattern. Virchows Archiv 445 (1):1–8

  5. Sainani NI, Kadiyala V, Mortele K, Lee L, Suleiman S, Rosenblum J, Wang W, Banks PA, Conwell DL (2015) Evaluation of Qualitative Magnetic Resonance Imaging Features for Diagnosis of Chronic Pancreatitis. Pancreas 44 (8):1280–1289

  6. Choueiri NE, Balci NC, Alkaade S, Burton FR (2010) Advanced imaging of chronic pancreatitis. Current gastroenterology reports 12 (2):114–120

  7. Whitcomb DC, Shimosegawa T, Chari ST, Forsmark CE, Frulloni L, Garg P, Hegyi P, Hirooka Y, Irisawa A, Ishikawa T (2018) International consensus statements on early chronic Pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with The International Association of Pancreatology, American Pancreatic Association, Japan Pancreas Society, PancreasFest Working Group and European Pancreatic Club. Pancreatology

  8. Schneider A, Löhr JM, Singer MV (2007) The M-ANNHEIM classification of chronic pancreatitis: introduction of a unifying classification system based on a review of previous classifications of the disease. Journal of gastroenterology 42 (2):101–119

  9. Catalano MF, Sahai A, Levy M, Romagnuolo J, Wiersema M, Brugge W, Freeman M, Yamao K, Canto M, Hernandez LV (2009) EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointestinal endoscopy 69 (7):1251–1261

  10. Shimosegawa T, Kataoka K, Kamisawa T, Miyakawa H, Ohara H, Ito T, Naruse S, Sata N, Suda K, Hirota M (2010) The revised Japanese clinical diagnostic criteria for chronic pancreatitis. Journal of gastroenterology 45 (6):584–591

  11. Ammann RW (1997) A clinically based classification system for alcoholic chronic pancreatitis: summary of an international workshop on chronic pancreatitis. Pancreas 14 (3):215–221

  12. Whitcomb DC, Frulloni L, Garg P, Greer JB, Schneider A, Yadav D, Shimosegawa T (2016) Chronic pancreatitis: an international draft consensus proposal for a new mechanistic definition. Pancreatology 16 (2):218–224

  13. Yadav D, Park WG, Fogel EL, Li L, Chari ST, Feng Z, Fisher WE, Forsmark CE, Jeon CY, Habtezion A (2018) PROspective Evaluation of Chronic Pancreatitis for EpidEmiologic and Translational StuDies: Rationale and Study Design for PROCEED From the Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer. Pancreas 47 (10):1229–1238

  14. Sarner M, Cotton P (1984) Classification of pancreatitis. Gut 25 (7):756–759

  15. Tirkes T, Shah ZK, Takahashi N, Grajo JR, Chang ST, Venkatesh SK, Conwell DL, Fogel EL, Park W, Topazian M, Yadav D, Dasyam AK, For the Consortium for the Study of Chronic Pancreatitis D, Cancer P (2019) Reporting Standards for Chronic Pancreatitis by Using CT, MRI, and MR Cholangiopancreatography: The Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer. Radiology 290 (1):207–215. doi:10.1148/radiol.2018181353

  16. Tirkes T, Yadav D, Conwell DL, Territo PR, Zhao X, Venkatesh SK, Kolipaka A, Li L, Pisegna JR, Pandol SJ, Park WG, Topazian M, Serrano J, Fogel EL, Consortium for the Study of Chronic Pancreatitis D, Pancreatic C (2019) Magnetic resonance imaging as a non-invasive method for the assessment of pancreatic fibrosis (MINIMAP): a comprehensive study design from the consortium for the study of chronic pancreatitis, diabetes, and pancreatic cancer. Abdom Radiol (NY) 44 (8):2809–2821. doi:10.1007/s00261–019–02049–5

  17. Dasyam AK, Vipperla K, Slivka A, Gong T, Papachristou GI, Whitcomb DC, Yadav D (2019) Computed tomography based scoring system in a prospectively ascertained cohort of patients with chronic pancreatitis. Pancreatology 19 (8):1027–1033

  18. Dasyam AK, Shah ZK, Tirkes T, Dasyam N, Borhani AA (2019) Cross-sectional imaging-based severity scoring of chronic pancreatitis: why it is necessary and how it can be done. Abdominal Radiology:1–11

  19. Frøkjær JB, Akisik F, Farooq A, Akpinar B, Dasyam A, Drewes AM, Haldorsen IS, Morana G, Neoptolemos JP, Olesen SS (2018) Guidelines for the Diagnostic Cross Sectional Imaging and Severity Scoring of Chronic Pancreatitis. Pancreatology 18 (7):764–773

  20. Razek AAKA, Elfar E, Abubacker S (2019) Interobserver agreement of computed tomography reporting standards for chronic pancreatitis. Abdominal Radiology:1–7

Download references

Funding

Research reported in this publication was supported by National Cancer Institute and National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award numbers R01DK116963 (MINIMAP), U01DK108323 (IU), U01DK108306 (UPMC), U01DK108327 (OSU), U01DK108314 (CSMC), DKP3041301 (UCLA), U01DK108300 (Stanford) and U01DK108288 (Mayo). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N. University Blvd. Suite 0663, Indianapolis, IN, 46202, USA

    Temel Tirkes

  2. Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH, USA

    Zarine K. Shah

  3. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Naoki Takahashi

  4. University of Florida College of Medicine, Gainesville, FL, USA

    Joseph R. Grajo

  5. Department of Radiology and Division of Body MRI, Stanford University School of Medicine, Stanford, CA, USA

    Stephanie T. Chang

  6. Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Ashley M. Wachsman

  7. Department of Radiology, South San Francisco Medical Center, The Permanente Medical Group, South San Francisco, CA, USA

    Kareem Mawad

  8. Department of Radiology, Baylor College of Medicine, Houston, TX, USA

    Carlos A. Farinas

  9. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Liang Li & Savitri N. Appana

  10. Division of Gastroenterology, Department of Medicine, Ohio State University Wexner Medical Center, Hepatology & Nutrition, Columbus, OH, USA

    Darwin L. Conwell

  11. Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Dhiraj Yadav

  12. Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Anil K. Dasyam

Authors
  1. Temel Tirkes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zarine K. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Naoki Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joseph R. Grajo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stephanie T. Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ashley M. Wachsman
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kareem Mawad
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Carlos A. Farinas
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Liang Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Savitri N. Appana
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Darwin L. Conwell
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Dhiraj Yadav
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Anil K. Dasyam
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

the Consortium for the Study of Chronic Pancreatitis, Diabetes, Pancreatic Cancer

Corresponding author

Correspondence to Temel Tirkes.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tirkes, T., Shah, Z.K., Takahashi, N. et al. Inter-observer variability of radiologists for Cambridge classification of chronic pancreatitis using CT and MRCP: results from a large multi-center study. Abdom Radiol 45, 1481–1487 (2020). https://doi.org/10.1007/s00261-020-02521-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-020-02521-7

Keywords

Search

Navigation