Intra- and interobserver variability in the diagnosis of GERD by real-time MRI
Intra- and interobserver variability in the diagnosis of GERD by real-time MRI
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DOI：
10.1016/j.ejrad.2018.04.029
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发表时间：
2018-07-01
影响因子：
3.3
通讯作者：
Biggemann, Lorenz
中科院分区：
文献类型：
--
作者：
Hosseini, Ali Seif Amir;Beham, Alexander;Biggemann, Lorenz
本研究的目的是评估通过 40 毫秒时间分辨率（每秒 25 帧）的实时 MRI 确定的吞咽事件功能和解剖参数的再现性。连续 23 名胃食管反流病 (GERD) 患者在 3.0 T 下接受了胃食管交界处的实时 MRI。实时 MRI 基于高度欠采样径向快速低角度拍摄 (FLASH) 采集，并通过正则非线性反转 (NLINV) 进行迭代图像重建。 MRI 电影可视化了菠萝汁丸的食道运输、其通过胃食管连接处的通道以及瓦氏动作期间的功能反应。希氏角、括约肌位置、括约肌长度和括约肌通过时间由两名放射科医生评估。评估观察者间和观察者内的组内相关系数 (ICC)，并构建 Bland-Altman 图来评估观察者的一致性。观察者间在括约肌通过时间 (ICC = 0.92)、His 角 (ICC = 0.93)、Valsalva 动作期间的 His 角 (ICC = 0.91) 和括约肌到膈肌距离 (ICC = 0.98) 方面的一致性非常好。括约肌长度和食管直径显示出良好的观察者间一致性（ICC = 0.62 和 ICC = 0.70）。观察者内的括约肌长度一致性良好（ICC = 0.80），括约肌通过时间、Valsalva 动作期间的 His 角和 His 角、括约肌到膈肌距离和食管直径的一致性也很好（ICC = 0.91；ICC = 0.97；ICC = 0.97；ICC = 0.998；ICC = 0.93）。胃食管连接部的所有功能参数均具有良好至极好的重现性。对布兰德奥特曼图的视觉评估没有揭示任何系统性的观察者间偏差。总之，实时 MRI 吞咽事件的可视化在胃食管反流病的临床应用中具有很高的潜力。
The purpose of this study was to assess the reproducibility of functional and anatomical parameters of swallowing events as determined by real-time MRI at 40 ms temporal resolution (25 frames per second). Twenty-three consecutive patients with gastroesophageal reflux disease (GERD) underwent real-time MRI of the gastroesophageal junction at 3.0 T. Real-time MRI was based on highly undersampled radial fast low angle shot (FLASH) acquisitions with iterative image reconstruction by regularized nonlinear inversion (NLINV). MRI movies visualized the esophageal transport of a pineapple juice bolus, its passage through the gastroesophageal junction and functional responses during a Valsalva maneuver. His-angle, sphincter position, sphincter length and sphincter transit time were assessed by two radiologists. Interobserver and intraobserver intraclass correlation coefficients (ICC) were evaluated and Bland-Altman plots were constructed to assess the observer agreement. Interobserver agreement was excellent for sphincter transit time (ICC = 0.92), His-angle (ICC = 0.93), His-angle during Valsalva maneuver (ICC = 0.91) and sphincter-to-diaphragm distance (ICC = 0.98). Sphincter length and oesophageal diameter showed good interobserver agreement (ICC = 0.62 and ICC = 0.70). Intraobserver agreement was good for sphincter length (ICC = 0.80) and excellent for sphincter transit time, His-angle and His-angle during Valsalva maneuver, sphincter-to-diaphragm distance, and esophageal diameter (ICC = 0.91; ICC = 0.97; ICC = 0.97; ICC = 0.998; ICC = 0.93). All functional parameters of the gastroesophageal junction had good to excellent reproducibility. Visual assessment of Bland Altman plots did not reveal any systematic interobserver bias. In conclusion, the visualization of swallowing events by realtime MRI has a high potential for clinical application in gastroesophageal reflux disease.