Abstract
Purpose
Given that ileal pouch-anal anastomosis (IPAA) surgery is a technically challenging and high-morbidity procedure, there are numerous pertinent imaging findings that need to be clearly and efficiently communicated to the IBD surgeons for essential patient management and surgical planning. Structured reporting has been increasingly used over the past decade throughout various radiology subspecialties to improve reporting clarity and completeness. We compare structured versus non-structured reporting of pelvic MRI for ileal pouch to evaluate for clarity and effectiveness.
Methods
164 consecutive pelvic MRI’s for ileal pouch evaluation, excluding subsequent exams for the same patient, acquired between 1/1/2019 and 7/31/2021 at one institution were included, before and after implementation (11/15/2020) of a structured reporting template, which was created with institutional IBD surgeons. Reports were assessed for the presence of 18 key features required for complete ileal pouch assessment: anastomosis (IPAA, tip of J, pouch body), cuff (length, cuffitis), pouch body (size, pouchitis, stricture), pouch inlet/pre-pouch ileum (stricture, inflammation, sharp angulation), pouch outlet (stricture), peripouch mesentery (position, mesentery twist), pelvic abscess, peri-anal fistula, pelvic lymph nodes, and skeletal abnormalities. Subgroup analysis was performed based on reader experience and divided into three categories: experienced (n = 2), other intra-institutional (n = 20), or affiliate site (n = 6).
Results
57 (35%) structured and 107 (65%) non-structured pelvic MRI reports were reviewed. Structured reports contained 16.6 [SD:4.0] key features whereas non-structured reports contained 6.3 [SD:2.5] key features (p < .001). The largest improvement following template implementation was for reporting sharp angulation of the pouch inlet (91.2% vs. 0.9%, p < .001), tip of J suture line and pouch body anastomosis (both improved to 91.2% from 3.7%). Structured versus non-structured reports contained mean 17.7 versus 9.1 key features for experienced readers, 17.0 versus 5.9 for other intra-institutional readers, and 8.7 versus 5.3 for affiliate site readers.
Conclusion
Structured reporting of pelvic MRI guides a systematic search pattern and comprehensive evaluation of ileal pouches, and therefore facilitates surgical planning and clinical management. This standardized reporting template can serve as baseline at other institutions for adaptation based on specific radiology and surgery preferences, fostering a collaborative environment between radiology and surgery, and ultimately improving patient care.
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References
Kayal M, Plietz M, Rizvi A, et al. Inflammatory Pouch Conditions Are Common After Ileal Pouch Anal Anastomosis in Ulcerative Colitis Patients. Inflammatory bowel diseases 2020; 26:1079-1086
Hahnloser D, Pemberton JH, Wolff BG, Larson DR, Crownhart BS, Dozois RR. Results at up to 20 years after ileal pouch-anal anastomosis for chronic ulcerative colitis. The British journal of surgery 2007; 94:333-340
Scoglio D, Ahmed Ali U, Fichera A. Surgical treatment of ulcerative colitis: ileorectal vs ileal pouch-anal anastomosis. World journal of gastroenterology 2014; 20:13211-13218
Aydinli HH, Peirce C, Aytac E, Remzi F. The usefulness of the H-pouch configuration in salvage surgery for failed ileal pouches. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland 2017; 19:e312-e315
Sheedy SP, Bartlett DJ, Lightner AL, et al. Judging the J pouch: a pictorial review. Abdominal radiology (New York) 2019; 44:845-866
Remzi FH, Aytac E, Ashburn J, et al. Transabdominal Redo Ileal Pouch Surgery for Failed Restorative Proctocolectomy: Lessons Learned Over 500 Patients. Annals of surgery 2015; 262:675-682
Nobel JM, van Geel K, Robben SGF. Structured reporting in radiology: a systematic review to explore its potential. European radiology 2022; 32:2837-2854
Ganeshan D, Duong PT, Probyn L, et al. Structured Reporting in Radiology. Academic radiology 2018; 25:66-73
Kahn CE, Jr., Langlotz CP, Burnside ES, et al. Toward best practices in radiology reporting. Radiology 2009; 252:852-856
Marcovici PA, Taylor GA. Journal Club: Structured radiology reports are more complete and more effective than unstructured reports. AJR American journal of roentgenology 2014; 203:1265-1271
Tuncyurek O, Garces-Descovich A, Jaramillo-Cardoso A, et al. Structured versus narrative reporting of pelvic MRI in perianal fistulizing disease: impact on clarity, completeness, and surgical planning. Abdominal radiology (New York) 2019; 44:811-820
Franconeri A, Fang J, Carney B, et al. Structured vs narrative reporting of pelvic MRI for fibroids: clarity and impact on treatment planning. European radiology 2018; 28:3009-3017
Gassenmaier S, Armbruster M, Haasters F, et al. Structured reporting of MRI of the shoulder - improvement of report quality? European radiology 2017; 27:4110-4119
Armbruster M, Gassenmaier S, Haack M, et al. Structured reporting in petrous bone MRI examinations: impact on report completeness and quality. International journal of computer assisted radiology and surgery 2018; 13:1971-1980
Herts BR, Gandhi NS, Schneider E, et al. How We Do It: Creating Consistent Structure and Content in Abdominal Radiology Report Templates. AJR American journal of roentgenology 2019; 212:490-496
Schwartz LH, Panicek DM, Berk AR, Li Y, Hricak H. Improving communication of diagnostic radiology findings through structured reporting. Radiology 2011; 260:174-181
Sistrom CL, Honeyman-Buck J. Free text versus structured format: information transfer efficiency of radiology reports. AJR American journal of roentgenology 2005; 185:804-812
Hong Y, Zhang J, Heilbrun ME, Kahn CE, Jr. Analysis of RadLex coverage and term co-occurrence in radiology reporting templates. Journal of digital imaging 2012; 25:56-62
Huang C, Remzi FH, Dane B, et al. Reporting Templates for MRI and Water-Soluble Contrast Enema in Patients With Ileal Pouch-Anal Anastomosis: Experience From a Large Referral Center. AJR American journal of roentgenology 2021; 217:347-358
Kruskal JB, Reedy A, Pascal L, Rosen MP, Boiselle PM. Quality initiatives: lean approach to improving performance and efficiency in a radiology department. Radiographics : a review publication of the Radiological Society of North America, Inc 2012; 32:573–587
Levin DC. Checklists: from the cockpit to the radiology department. Journal of the American College of Radiology : JACR 2012; 9:388-390
Kushner DC, Lucey LL. Diagnostic radiology reporting and communication: the ACR guideline. Journal of the American College of Radiology : JACR 2005; 2:15-21
Weiss DL, Langlotz CP. Structured reporting: patient care enhancement or productivity nightmare? Radiology 2008; 249:739-747
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Author AM is a consultant for Bracco Inc. None of the other authors have any disclosures to report.
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Ginocchio, L.A., Dane, B., Smereka, P.N. et al. Structured versus non-structured reporting of pelvic MRI for ileal pouch evaluation: clarity and effectiveness. Abdom Radiol 48, 2978–2985 (2023). https://doi.org/10.1007/s00261-023-03858-5
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DOI: https://doi.org/10.1007/s00261-023-03858-5