Inter-rater and intra-rater reliability of multi-slice CT and three-dimensional reconstructed imaging analysis of mesenteric vascular anatomy for planning and performing complete mesocolic excision

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease Pub Date : 2025-03-13 DOI:10.1111/codi.70025

Jordan Fletcher, Phillip Lung, Ellen Van Eetvelde, Claus Anders Bertelsen, Adam Stearns, Kristian Storli, Danilo Miskovic

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Abstract

Aim

Complete mesocolic excision (CME) for colon cancer has been associated with improved oncological outcomes but requires a detailed understanding of complex mesenteric vasculature. Three-dimensional (3D) reconstructed models derived from patient imaging could enhance preoperative anatomical comprehension, enabling safer, precision CME.

Methods

In this two-phase, blinded, crossover study, four expert CME surgeons evaluated mesenteric vascular anatomy on CT scans and 3D models. In phase 1, surgeons assessed 66 cases, while 20 were re-evaluated in phase 2. The primary outcome measure was inter-rater reliability by Fleiss's kappa. Secondary outcomes were intra-rater reliability by Cohen's kappa and anatomical accuracy rates measured as a percentage of correct responses on a standardised questionnaire.

Results

In phase 1, inter-rater agreement was higher for 3D models (average kappa 0.6, moderate agreement) than for CT scans (average kappa 0.1, poor agreement). Ileocolic vein drainage and ileocolic artery trajectory showed the highest kappa values with 3D imaging (0.85 and 0.93, respectively). Accuracy was also superior with 3D across all surgeons (mean 89.7% correct) versus CT (mean 79.1% correct, P < 0.001). In phase 2, intra-rater reliability remained higher for 3D (average Cohen's kappa 0.61) than CT scans (Cohen's kappa 0.27).

Conclusion

3D mesenteric models significantly improve inter- and intra-rater reliability among CME experts over traditional CT scans while markedly enhancing anatomical comprehension accuracy about critical right-sided colonic vasculature. 3D planning could facilitate CME by enabling superior preoperative visualisation of these vessels.

Abstract Image

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多层螺旋CT及肠系膜血管解剖三维重建成像分析对计划和实施完整肠系膜切除的可靠性

目的：结肠癌全肠系膜切除（CME）可改善肿瘤预后，但需要详细了解复杂的肠系膜血管系统。基于患者影像的三维（3D）重建模型可以增强术前解剖学理解，实现更安全、精确的CME。方法在这项两期、盲法、交叉研究中，四名CME专家外科医生通过CT扫描和3D模型评估肠系膜血管解剖。在第一阶段，外科医生对66例进行了评估，而在第二阶段对20例进行了重新评估。主要结果测量是通过Fleiss's kappa进行的量表间信度。次要结果是由Cohen's kappa测量的评分者内部可靠性和以标准化问卷上正确回答的百分比测量的解剖准确率。结果在第一阶段，3D模型的评分一致性（平均kappa 0.6，一致性中等）高于CT扫描（平均kappa 0.1，一致性较差）。回肠静脉引流和回肠动脉轨迹三维成像kappa值最高，分别为0.85和0.93。在所有外科医生中，3D的准确率（平均89.7%）也优于CT（平均79.1%,P < 0.001）。在第二阶段，3D扫描（Cohen’s kappa平均值为0.61）比CT扫描（Cohen’s kappa平均值为0.27）的内部可靠性更高。结论与传统CT扫描相比，三维肠系膜模型显著提高了CME专家之间和内部的可靠性，同时显著提高了对右侧关键结肠血管的解剖理解准确性。三维规划可以通过更好的术前血管可视化来促进CME。

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.