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Poster presentations: Clinical: Therapy and Observation 2020

P578 Inter-observer agreement of an expert panel for gastrointestinal ultrasound in ulcerative colitis

F. de Voogd1, R. Wilkens2, K. Gecse1, M. Allocca3, K. Novak4, C. Lu4, G. D’Haens1, C. Maaser5, International Bowel UltraSound (IBUS) - Group

1Amsterdam University Medical Centers, Departmenn of Gastroenterology and Hepatology, Amsterdam, The Netherlands, 2Hvidovre Hospital, Gastrounit- Division of Medicine, Copenhagen, Denmark, 3Humanitas University, Gastroenterology, Milan, Italy, 4University of Calgary, Medicine- Division of Gastroenterology, Calgary, Canada, 5University Teaching Hospital Lueneburg, Gastroenterology, Lueneburg, Germany

Background

Gastrointestinal ultrasound (GIUS) is increasingly performed in inflammatory bowel disease to assess disease activity and treatment response. It is promising as an effective point-of-care imaging tool since it correlates well with endoscopy and other cross-sectional imaging modalities. Previous studies showed moderate to substantial interobserver agreement in Crohn’s disease. However, in ulcerative colitis (UC) inter-observer agreement for GIUS has not yet been evaluated. Therefore, we conducted a study to assess inter-observer agreement in UC.

Methods

Thirty patients with UC (five with clinically quiescent and 25 with active disease) were included in this study. Cine-loops were recorded for the sigmoid colon (SC) in a longitudinal and cross-sectional axis in B-mode and in colour Doppler mode. Cine-loops were scored by five independent raters blinded for clinical disease activity. The cine-loops were scored for bowel wall thickness (BWT), Doppler activity (0=no activity, 1=small spots limited to the bowel wall, 2=long stretches within the bowel wall, 3=long stretches within and outside of the bowel wall), inflammatory fat, bowel wall stratification, loss of haustration and lymph nodes (present or absent). The intraclass correlation coefficient was used for the assessment of bowel wall thickness. Fleiss’ kappa was used for all nominal variables and weighted Cohen’s kappa was used for all ordinal variables.

Results

Inter-observer agreement was good for bowel wall thickness (ICC: 0.7, 95% CI: 0.51–0.83, p < 0.0001) [1] and moderate for Doppler signal (k=0.57, 95% CI: 0.37–0.77, p < 0.0001) [2]. When Doppler signal was interpreted as absent (0) or present (1–3) the observed agreement was almost perfect (k=0.81, 95% CI: 0.69–0.92). For inflammatory fat the observed agreement was moderate (k=0.42, 95% CI: 0.29–0.58, p < 0.0001). Inter-observer agreement was fair for the presence of lymph nodes (k=0.35, 95% CI:0.20–0.49, p < 0.0001) and loss of stratification (k=0.22 95% CI: 0.09–0.35, p < 0.001). Agreement was slight for loss of haustrations (k=0.15, 95% CI: 0.00–0.29, p = 0.046).

Conclusion

GIUS is a reliable imaging modality with good to moderate interobserver agreement for BWT, vascularisation and fatty wrapping in UC. These ultrasonographic parameters are important features to distinguish active from quiescent disease.

References:

Cicchetti DV. Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess. 1994;6:284–290.

Cohen, Jacob. ‘A coefficient of agreement for nominal scales.’ Educational and psychological measurement 20.1 (1960): 37–46.