M A Samaan1,2, C A J Puylaert3, B G Levesque4,5, G Y Zou2,6, L Stitt2, S A Taylor7, L M Shackelton2, M K Vandervoort2, R Khanna2,8, C Santillan9, J Rimola10, P Hindryckx2,11, C Y Nio3, W J Sandborn4,5, G D'Haens12,13, B G Feagan2,6,8, V Jairath2,6,8, J Stoker3. 1. Department of Gastroenterology, Guy's & St Thomas' Hospital, London, UK. 2. Robarts Clinical Trials, Inc, London, Canada. 3. Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands. 4. Department of Gastroenterology, University of California San Diego, La Jolla, CA, USA. 5. Robarts Clinical Trials, Inc, San Diego, CA, USA. 6. Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada. 7. Department of Medical Imaging, University College London, London, UK. 8. Department of Medicine, University of Western Ontario, London, Canada. 9. Department of Radiology, University of California San Diego, La Jolla, CA, USA. 10. Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain. 11. Department of Gastroenterology, University Hospital of Ghent, Ghent, Belgium. 12. Department of Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands. 13. Robarts Clinical Trials, BV, Amsterdam, The Netherlands.
Abstract
BACKGROUND: Magnetic resonance imaging (MRI) is the gold standard for assessment of perianal fistulising Crohn's disease (CD). The Van Assche index is the most commonly used MRI fistula index. AIMS: To assess the reliability of the Van Assche index, and to modify the instrument to improve reliability and create a novel index for fistulising CD. METHODS: A consensus process developed scoring conventions for existing Van Assche index component items and new items. Four experienced radiologists evaluated 50 MRI images in random order on three occasions. Reliability was assessed by estimates of intraclass correlation coefficients (ICCs). Common sources of disagreement were identified and recommendations made to minimise disagreement. A mixed effects model used a 100 mm visual anologue scale (VAS) for global severity as outcome and component items as predictors to create a modified Van Assche index. RESULTS: Intraclass correlation coefficients (95% confidence intervals) for intra-rater reliability of the original and modified Van Assche indices and the VAS were 0.86 (0.81-0.90), 0.90 (0.86-0.93) and 0.86 (0.82-0.89). Corresponding ICCs for inter-rater reliability were 0.66 (0.52-0.76), 0.67 (0.55-0.75) and 0.58 (0.47-0.66). Sources of disagreement included number, location, and extension of fistula tracts, and rectal wall involvement. A modified Van Assche index (range 0-24) was created that included seven component items. CONCLUSIONS: Although "almost perfect" intra-rater reliability was observed for the assessment of MRI images for fistulising CD using the Van Assche index, inter-rater reliability was considerably lower. Our modification of this index should result in a more optimal instrument.
BACKGROUND: Magnetic resonance imaging (MRI) is the gold standard for assessment of perianal fistulising Crohn's disease (CD). The Van Assche index is the most commonly used MRI fistula index. AIMS: To assess the reliability of the Van Assche index, and to modify the instrument to improve reliability and create a novel index for fistulising CD. METHODS: A consensus process developed scoring conventions for existing Van Assche index component items and new items. Four experienced radiologists evaluated 50 MRI images in random order on three occasions. Reliability was assessed by estimates of intraclass correlation coefficients (ICCs). Common sources of disagreement were identified and recommendations made to minimise disagreement. A mixed effects model used a 100 mm visual anologue scale (VAS) for global severity as outcome and component items as predictors to create a modified Van Assche index. RESULTS: Intraclass correlation coefficients (95% confidence intervals) for intra-rater reliability of the original and modified Van Assche indices and the VAS were 0.86 (0.81-0.90), 0.90 (0.86-0.93) and 0.86 (0.82-0.89). Corresponding ICCs for inter-rater reliability were 0.66 (0.52-0.76), 0.67 (0.55-0.75) and 0.58 (0.47-0.66). Sources of disagreement included number, location, and extension of fistula tracts, and rectal wall involvement. A modified Van Assche index (range 0-24) was created that included seven component items. CONCLUSIONS: Although "almost perfect" intra-rater reliability was observed for the assessment of MRI images for fistulising CD using the Van Assche index, inter-rater reliability was considerably lower. Our modification of this index should result in a more optimal instrument.
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