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.

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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.