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Inter- and intra-observer variability of computed tomography-based parenchymal- and ductal diameters in chronic pancreatitis: a multi-observer international study

  • Pancreas
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Abstract

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.

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Abbreviations

CT:

Computed tomography

CP:

Chronic pancreatitis

ICC:

Intraclass correlation coefficient

LoA:

Limits of agreement

DICOM:

Digital Imaging and Communications in Medicine

PDhead:

Largest parenchymal diameter of the pancreatic head

PDbody:

Largest parenchymal diameter of the pancreatic body

MPDhead:

Largest main pancreatic duct diameter in the pancreatic head

MPDbody:

Largest main pancreatic duct diameter in the pancreatic body

MRI:

Magnetic resonance imaging

SBPC:

Scandinavian Baltic Pancreatic Club

LOAM:

Limits of agreement with the mean

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Funding

This work did not receive any grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Radiology, Akershus University Hospital, 1478, Nordbyhagen, Norway

    Jens Borgbjerg & Anne Bethke

  2. Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, PO. Box 365, 9000, Aalborg, Denmark

    Emily Steinkohl, Maria V. Lisitskaya, Gintare Naujokaite & Jens B. Frøkjær

  3. Department of Gastroenterology and Hepatology, Centre for Pancreatic Diseases, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark

    Emily Steinkohl, Søren S. Olesen, Maria V. Lisitskaya & Asbjørn M. Drewes

  4. Department of Clinical Medicine, Aalborg University, Søndre Skovvej 11, 9000, Aalborg, Denmark

    Emily Steinkohl, Søren S. Olesen, Asbjørn M. Drewes & Jens B. Frøkjær

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

    Fatih Akisik & Jordan K. Swensson

  6. Department of Radiology, Lithuanian University of Health Sciences, Eivenių g. 2, 50161, Kaunas, Lithuania

    Edita Bieliuniene

  7. Department of Medicine, University of Bergen, Jonas Lies vei 65, 5021, Bergen, Norway

    Trond Engjom

  8. Department of Clinical Medicine, University of Bergen, Jonas Lies vei 87, 5021, Bergen, Norway

    Trond Engjom & Ingfrid S. Haldorsen

  9. Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Ulriksdal 8, 5009, Bergen, Norway

    Ingfrid S. Haldorsen

  10. Division of Radiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, O-huset 42, 14186, Stockholm, Sweden

    Nikolaos Kartalis

  11. Department of Radiology Huddinge, Karolinska University Hospital, O-huset 42, 14186, Stockholm, Sweden

    Nikolaos Kartalis

  12. Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark

    Srdan Novovic

  13. Centre of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Pilsoņu iela 13, Zemgales priekšpilsēta, Riga, 1002, Latvia

    Imanta Ozola-Zālīte

  14. Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Anna E. Phillips

  15. Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark

    Heidi S. Christensen

  16. Department of Haematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark

    Heidi S. Christensen

Authors
  1. Jens Borgbjerg
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  2. Emily Steinkohl
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  3. Søren S. Olesen
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  4. Fatih Akisik
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  5. Anne Bethke
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  6. Edita Bieliuniene
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  7. Heidi S. Christensen
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  8. Trond Engjom
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  9. Ingfrid S. Haldorsen
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  10. Nikolaos Kartalis
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  11. Maria V. Lisitskaya
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  12. Gintare Naujokaite
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  14. Imanta Ozola-Zālīte
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  15. Anna E. Phillips
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  16. Jordan K. Swensson
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  17. Asbjørn M. Drewes
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  18. Jens B. Frøkjær
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Contributions

All authors attest that they meet the current International Committee of Medical Journal Editors (ICMJE) criteria for Authorship and have made contributions to the paper as follows JB, ES, SSO, HSC, JBF: Conception and design of the study. JB, ES, SSO, FA, AB, EB, TE, ISH, NK, MVL, GN, SN, IO-Z, AEP, JKS, AMD, JBF: Acquisition of data. JB, ES, SSO, FA, AB, EB, HSC, TE, ISH, NK, MVL, GN, SN, IO-Z, AEP, JKS, AMD, JBF: Analysis and interpretation of data. JB, HSC, JBF: Drafting the article. JB, ES, SSO, FA, AB, EB, HSC, TE, ISH, NK, MVL, GN, SN, IO-Z, AEP, JKS, AMD, JBF: Revising the article. JB, ES, SSO, FA, AB, EB, HSC, TE, ISH, NK, MVL, GN, SN, IO-Z, AEP, JKS, AMD, JBF: Final approval.

Corresponding author

Correspondence to Jens B. Frøkjær.

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The authors declare that the work described has been carried out in accordance with the Declaration of Helsinki of the World Medical Association revised in 2013 for experiments involving humans. Informed consent and patient details The authors declare that this report does not contain any personal information that could lead to the identification of the patients.

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Borgbjerg, J., Steinkohl, E., Olesen, S.S. et al. Inter- and intra-observer variability of computed tomography-based parenchymal- and ductal diameters in chronic pancreatitis: a multi-observer international study. Abdom Radiol 48, 306–317 (2023). https://doi.org/10.1007/s00261-022-03667-2

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