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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



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.


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.


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

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Fig. 1
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Fig. 3



Computed tomography


Chronic pancreatitis


Intraclass correlation coefficient


Limits of agreement


Digital Imaging and Communications in Medicine


Largest parenchymal diameter of the pancreatic head


Largest parenchymal diameter of the pancreatic body


Largest main pancreatic duct diameter in the pancreatic head


Largest main pancreatic duct diameter in the pancreatic body


Magnetic resonance imaging


Scandinavian Baltic Pancreatic Club


Limits of agreement with the mean


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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.

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Correspondence to Jens B. Frøkjær.

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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).

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