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Obaro AE, Plumb AA, Halligan S, Mallett S, Bassett P, McCoubrie P, Baldwin-Cleland R, Ugarte-Cano C, Lung P, Muckian J, Ilangovan R, Gupta A, Robinson C, Higginson A, Britton I, Greenhalgh R, Patel U, Mainta E, Gangi A, Taylor SA, Burling D. Colorectal Cancer: Performance and Evaluation for CT Colonography Screening- A Multicenter Cluster-randomized Controlled Trial. Radiology 2022; 303:361-370. [PMID: 35166585 DOI: 10.1148/radiol.211456] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Most radiologists reporting CT colonography (CTC) do not undergo compulsory performance accreditation, potentially lowering diagnostic sensitivity. Purpose To determine whether 1-day individualized training in CTC reporting improves diagnostic sensitivity of experienced radiologists for 6-mm or larger lesions, the durability of any improvement, and any associated factors. Materials and Methods This prospective, multicenter cluster-randomized controlled trial was performed in National Health Service hospitals in England and Wales between April 2017 and January 2020. CTC services were cluster randomized into intervention (1-day training plus feedback) or control (no training or feedback) arms. Radiologists in the intervention arm attended a 1-day workshop focusing on CTC reporting pitfalls with individualized feedback. Radiologists in the control group received no training. Sensitivity for 6-mm or larger lesions was tested at baseline and 1, 6, and 12 months thereafter via interpretation of 10 CTC scans at each time point. The primary outcome was the mean difference in per-lesion sensitivity between arms at 1 month, analyzed using multilevel regression after adjustment for baseline sensitivity. Secondary outcomes included per-lesion sensitivity at 6- and 12-month follow-up, sensitivity for flat neoplasia, and effect of prior CTC experience. Results A total of 69 hospitals were randomly assigned to the intervention (31 clusters, 80 radiologists) or control (38 clusters, 59 radiologists) arm. Radiologists were experienced (median, 500-999 CTC scans interpreted) and reported CTC scans routinely (median, 151-200 scans per year). One-month sensitivity improved after intervention (66.4% [659 of 992]) compared with sensitivity in the control group (42.4% [278 of 655]; difference = 20.8%; 95% CI: 14.6, 27.0; P < .001). Improvements were maintained at 6 (66.4% [572 of 861] vs 50.5% [283 of 560]; difference = 13.0%; 95% CI: 7.4, 18.5; P < .001) and 12 (63.7% [310 of 487] vs 44.4% [187 of 421]; difference = 16.7%; 95% CI: 10.3, 23.1; P < .001) months. This beneficial effect applied to flat lesions (difference = 22.7%; 95% CI: 15.5, 29.9; P < .001) and was independent of career experience (≥1500 CTC scans: odds ratio = 1.09; 95% CI: 0.88, 1.36; P = .22). Conclusion For radiologists evaluating CT colonography studies, a 1-day training intervention yielded sustained improvement in detection of clinically relevant colorectal neoplasia, independent of previous career experience. Clinical trial registration no. NCT02892721 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Pickhardt in this issue.
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Affiliation(s)
- Anu E Obaro
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Andrew A Plumb
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Steve Halligan
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Susan Mallett
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Paul Bassett
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Paul McCoubrie
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Rachel Baldwin-Cleland
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Carmen Ugarte-Cano
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Phillip Lung
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Janice Muckian
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Rajapandian Ilangovan
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Arun Gupta
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Charlotte Robinson
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Antony Higginson
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Ingrid Britton
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Rebecca Greenhalgh
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Uday Patel
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Evgenia Mainta
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Anmol Gangi
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - Stuart A Taylor
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
| | - David Burling
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, UK (A.E.O., A.A.P., S.H., S.M., S.A.T.); Departments of Intestinal Imaging (A.E.O., R.B., C.U., P.L., J.M., R.I., A. Gupta, R.G., U.P., E.M., D.B.), St Mark's Academic Institute, St Mark's Hospital, Harrow, UK; Statsconsultancy, Amersham, UK (P.B.); Department of Radiology, Southmead Hospital, Bristol, UK (P.M.); Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK (C.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK (A.H., A. Gangi); and Department of Radiology, University Hospitals of North Midlands, Stoke-on-Trent, UK (I.B.)
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Taylor SA, Mallett S, Bhatnagar G, Morris S, Quinn L, Tomini F, Miles A, Baldwin-Cleland R, Bloom S, Gupta A, Hamlin PJ, Hart AL, Higginson A, Jacobs I, McCartney S, Murray CD, Plumb AA, Pollok RC, Rodriguez-Justo M, Shabir Z, Slater A, Tolan D, Travis S, Windsor A, Wylie P, Zealley I, Halligan S. Magnetic resonance enterography compared with ultrasonography in newly diagnosed and relapsing Crohn's disease patients: the METRIC diagnostic accuracy study. Health Technol Assess 2020; 23:1-162. [PMID: 31432777 DOI: 10.3310/hta23420] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Magnetic resonance enterography and enteric ultrasonography are used to image Crohn's disease patients. Their diagnostic accuracy for presence, extent and activity of enteric Crohn's disease was compared. OBJECTIVE To compare diagnostic accuracy, observer variability, acceptability, diagnostic impact and cost-effectiveness of magnetic resonance enterography and ultrasonography in newly diagnosed or relapsing Crohn's disease. DESIGN Prospective multicentre cohort study. SETTING Eight NHS hospitals. PARTICIPANTS Consecutive participants aged ≥ 16 years, newly diagnosed with Crohn's disease or with established Crohn's disease and suspected relapse. INTERVENTIONS Magnetic resonance enterography and ultrasonography. MAIN OUTCOME MEASURES The primary outcome was per-participant sensitivity difference between magnetic resonance enterography and ultrasonography for small bowel Crohn's disease extent. Secondary outcomes included sensitivity and specificity for small bowel Crohn's disease and colonic Crohn's disease extent, and sensitivity and specificity for small bowel Crohn's disease and colonic Crohn's disease presence; identification of active disease; interobserver variation; participant acceptability; diagnostic impact; and cost-effectiveness. RESULTS Out of the 518 participants assessed, 335 entered the trial, with 51 excluded, giving a final cohort of 284 (133 and 151 in new diagnosis and suspected relapse cohorts, respectively). Across the whole cohort, for small bowel Crohn's disease extent, magnetic resonance enterography sensitivity [80%, 95% confidence interval (CI) 72% to 86%] was significantly greater than ultrasonography sensitivity (70%, 95% CI 62% to 78%), with a 10% difference (95% CI 1% to 18%; p = 0.027). For small bowel Crohn's disease extent, magnetic resonance enterography specificity (95%, 95% CI 85% to 98%) was significantly greater than ultrasonography specificity (81%, 95% CI 64% to 91%), with a 14% difference (95% CI 1% to 27%). For small bowel Crohn's disease presence, magnetic resonance enterography sensitivity (97%, 95% CI 91% to 99%) was significantly greater than ultrasonography sensitivity (92%, 95% CI 84% to 96%), with a 5% difference (95% CI 1% to 9%). For small bowel Crohn's disease presence, magnetic resonance enterography specificity was 96% (95% CI 86% to 99%) and ultrasonography specificity was 84% (95% CI 65% to 94%), with a 12% difference (95% CI 0% to 25%). Test sensitivities for small bowel Crohn's disease presence and extent were similar in the two cohorts. For colonic Crohn's disease presence in newly diagnosed participants, ultrasonography sensitivity (67%, 95% CI 49% to 81%) was significantly greater than magnetic resonance enterography sensitivity (47%, 95% CI 31% to 64%), with a 20% difference (95% CI 1% to 39%). For active small bowel Crohn's disease, magnetic resonance enterography sensitivity (96%, 95% CI 92% to 99%) was significantly greater than ultrasonography sensitivity (90%, 95% CI 82% to 95%), with a 6% difference (95% CI 2% to 11%). There was some disagreement between readers for both tests. A total of 88% of participants rated magnetic resonance enterography as very or fairly acceptable, which is significantly lower than the percentage (99%) of participants who did so for ultrasonography. Therapeutic decisions based on magnetic resonance enterography alone and ultrasonography alone agreed with the final decision in 122 out of 158 (77%) cases and 124 out of 158 (78%) cases, respectively. There were no differences in costs or quality-adjusted life-years between tests. LIMITATIONS Magnetic resonance enterography and ultrasonography scans were interpreted by practitioners blinded to clinical data (but not participant cohort), which does not reflect use in clinical practice. CONCLUSIONS Magnetic resonance enterography has higher accuracy for detecting the presence, extent and activity of small bowel Crohn's disease than ultrasonography does. Both tests have variable interobserver agreement and are broadly acceptable to participants, although ultrasonography produces less participant burden. Diagnostic impact and cost-effectiveness are similar. Recommendations for future work include investigation of the comparative utility of magnetic resonance enterography and ultrasonography for treatment response assessment and investigation of non-specific abdominal symptoms to confirm or refute Crohn's disease. TRIAL REGISTRATION Current Controlled Trials ISRCTN03982913. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 42. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Sue Mallett
- Institute of Applied Health Research, National Institute for Health Research Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Stephen Morris
- Applied Health Research, University College London, London, UK
| | - Laura Quinn
- Institute of Applied Health Research, National Institute for Health Research Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Florian Tomini
- Applied Health Research, University College London, London, UK
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Rachel Baldwin-Cleland
- Intestinal Imaging Centre, St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Stuart Bloom
- Department of Gastroenterology, University College Hospital, London, UK
| | - Arun Gupta
- Intestinal Imaging Centre, St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Peter John Hamlin
- Department of Gastroenterology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ailsa L Hart
- Inflammatory Bowel Disease Unit, St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Antony Higginson
- Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Ilan Jacobs
- Independent patient representative, c/o Centre for Medical Imaging, University College London, London, UK
| | - Sara McCartney
- Department of Gastroenterology, University College Hospital, London, UK
| | - Charles D Murray
- Department of Gastroenterology and Endoscopy, Royal Free London NHS Foundation Trust, London, UK
| | - Andrew Ao Plumb
- Centre for Medical Imaging, University College London, London, UK
| | - Richard C Pollok
- Department of Gastroenterology, St George's Hospital, London, UK
| | | | - Zainib Shabir
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Andrew Slater
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Damian Tolan
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Simon Travis
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Peter Wylie
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Ian Zealley
- Department of Radiology, Ninewells Hospital, Dundee, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
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