European Radiology

, Volume 19, Issue 8, pp 1960–1967

MRI of small bowel Crohn’s disease: determining the reproducibility of bowel wall gadolinium enhancement measurements

  • A. Sharman
  • I. A. Zealley
  • R. Greenhalgh
  • P. Bassett
  • S. A. Taylor


This study aims to determine inter- and intra-observer variation in MRI measurements of relative bowel wall signal intensity (SI) in Crohn’s disease. Twenty-one small bowel MRI examinations (11 male, mean age 40), including T1-weighted acquisitions acquired 30 to 120s post-gadolinium, were analysed. Maximal bowel wall SI (most avid, conspicuous contrast enhancement) in designated diseased segments was measured by two radiologists and two trainees using self-positioned “free” regions of interest (ROIs) followed by “fixed” ROIs chosen by one radiologist, and this procedure was repeated 1 month later. Relative enhancement (post-contrast SI minus pre-contrast SI/pre-contrast SI) was calculated. Data were analysed using Bland–Altman limits of agreement and intra-class correlation. Inter-observer agreement for relative enhancement was poor (spanning over 120%) using a free ROI—95% limits of agreement −0.69, 0.70 and −0.47, 0.74 for radiologists and trainees, respectively, only marginally improved by use of a fixed ROI −0.60, 0.67 and −0.59, 0.49. Intra-class correlation ranged from 0.46 to 0.72. Intra-observer agreement was slightly better and optimised using a fixed ROI—95% limits of agreement −0.52, 0.50 and −0.34, 0.28 for radiologists and trainees, respectively. Intra-class correlation ranged from 0.49 to 0.86. Relative bowel wall signal intensity measurements demonstrate wide limits of observer agreement, unrelated to reader experience but improved using fixed ROIs.


Magnetic resonance imaging Crohn disease Observer variation 


  1. 1.
    Masselli G, Brizi GM, Parrella A, Minordi LM, Vecchioli A, Marano P (2004) Crohn disease: magnetic resonance enteroclysis. Abdom Imaging 29:326–324PubMedCrossRefGoogle Scholar
  2. 2.
    Gourtsoyiannis N, Papanikolaou N, Grammatikakis J, Maris T, Prassopoulos P (2000) MR imaging of the small bowel with a true-FISP sequence after enteroclysis with water solution. Invest Radiol 35:707–711PubMedCrossRefGoogle Scholar
  3. 3.
    Schunk K, Kern A, Oberholzer K et al (2000) Hydro-MRI in Crohn’s disease: appraisal of disease activity. Invest Radiol 35:431–437PubMedCrossRefGoogle Scholar
  4. 4.
    Horsthuis K, Lavini Mphil C, Stoker J (2005) MRI in Crohn’s disease. J Magn Reson Imaging 22:1–12PubMedCrossRefGoogle Scholar
  5. 5.
    van Oostayen JA, Wasser MNJM, van Hogezand RA, Griffioen G et al (1997) Doppler sonography evaluation of superior mesenteric artery flow to assess Crohn’s disease activity: correlation with clinical evaluation, Crohn’s disease activity index, and alpha(1)-antitrypsin clearance in feces. AJR Am J Roentgenol 168:429–33PubMedGoogle Scholar
  6. 6.
    Sempere GA, Martinez Sanjuan V, Medina Chulia E et al (2005) MRI evaluation of inflammatory activity in Crohn’s disease. AJR Am J Roentgenol 184:1829–1835PubMedGoogle Scholar
  7. 7.
    Marcos HB, Semelka RC (2002) Evaluation of Crohn’s disease using half-Fourier RARE and gadolinium-enhanced SGE sequences: initial results. Magn Reson Imaging 18:263–268CrossRefGoogle Scholar
  8. 8.
    Florie J, Wasser MN, Arts-Cieslik K, Akkerman EM, Siersema PD, Stoker J (2006) Dynamic contrast-enhanced MRI of the bowel wall for assessment of disease activity in Crohn’s disease. AJR Am J Roentgenol 186:1384–1392PubMedCrossRefGoogle Scholar
  9. 9.
    Laghi A, Borrelli O, Paolantonio P, Dito L et al (2003) Contrast enhanced magnetic resonance imaging of the terminal ileum in children with Crohn’s disease. Gut 52:393–397PubMedCrossRefGoogle Scholar
  10. 10.
    Madsen SM, Thomsen HS, Munkholm P, Dorph S, Schlichting P (1998) Active Crohn’s disease and ulcerative colitis evaluated by low-field magnetic resonance imaging. Scand J Gastroenterol 33:1193–2000PubMedCrossRefGoogle Scholar
  11. 11.
    Koh DM, Miao Y, Chinn RJ et al (2001) MR imaging evaluation of the activity of Crohn’s disease. AJR Am J Roentgenol 177:1325–1332PubMedGoogle Scholar
  12. 12.
    Goh V, Halligan S, Hugill J, Bassett P, Bartram CI (2005) Quantitative assessment of colorectal cancer perfusion using MDCT: inter- and intraobserver agreement. AJR Am J Roentgenol 185:225–231PubMedGoogle Scholar
  13. 13.
    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310PubMedGoogle Scholar
  14. 14.
    Semelka RC, Shoenut JP, Silverman R, Kroeker MA, Yaffe CS, Micflikier AB (1991) Bowel disease: prospective comparison of CT and 1.5-T pre- and postcontrast MR imaging with T1-weighted fat-suppressed and breath-hold FLASH sequences. J Magn Reson Imaging 1:625–32PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2009

Authors and Affiliations

  • A. Sharman
    • 1
  • I. A. Zealley
    • 1
  • R. Greenhalgh
    • 2
  • P. Bassett
    • 3
  • S. A. Taylor
    • 2
  1. 1.Ninewells HospitalDundeeUK
  2. 2.Department of ImagingUniversity College HospitalLondonUK
  3. 3.Stats ConsultancyRuislipUK

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