Utility of 3-dimensional image reconstruction in the diagnosis of small-bowel masses in capsule endoscopy (with video)

Gastrointest Endosc. 2014 Oct;80(4):642-651. doi: 10.1016/j.gie.2014.04.057. Epub 2014 Jul 3.

Abstract

Background: In small-bowel capsule endoscopy (SBCE), differentiating masses (ie, lesions of higher probability for neoplasia) requiring more aggressive intervention from bulges (essentially, false-positive findings) is a challenging task; recently, software that enables 3-dimensional (3D) reconstruction has become available.

Objective: To evaluate whether "coupling" 3D reconstructed video clips with the standard 2-dimensional (s2D) counterparts helps in distinguishing masses from bulges.

Design: Three expert and 3 novice SBCE readers, blind to others and in a random order, reviewed the s2D video clips and subsequently the s2D clips coupled with their 3D reconstruction (2D+3D).

Setting: Multicenter study in 3 community hospitals in Italy and a university hospital in Scotland.

Patients: Thirty-two deidentified 5-minute video clips, containing mucosal bulging (19) or masses (13).

Intervention: 3D reconstruction of s2D SBCE video clips.

Main outcome measure: Differentiation of masses from bulges with s2D and 2D+3D video clips, estimated by the area under the receiver operating characteristic curve (AUC); interobserver agreement.

Results: AUC for experts and novices for s2D video clips was .74 and .5, respectively (P = .0053). AUC for experts and novices with 2D+3D was .70 (compared with s2D: P = .245) and .57 (compared s2D: P = .049), respectively. AUC for experts and novices with 2D+3D was similar (P = .1846). The interobserver agreement was good for both experts and novices with the s2D (k = .71 and .54, respectively) and the 2D+3D video clips (k = .58 in both groups).

Limitations: Few, short video clips; fixed angle of 3D reconstruction.

Conclusions: The adjunction of a 3D reconstruction to the s2D video reading platform does not improve the performance of expert SBCE readers, although it significantly increases the performance of novices in distinguishing masses from bulging.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Capsule Endoscopy / methods*
  • Cohort Studies
  • Confidence Intervals
  • Diagnosis, Differential
  • Female
  • Humans
  • Image Interpretation, Computer-Assisted*
  • Imaging, Three-Dimensional / statistics & numerical data*
  • Intestinal Diseases / diagnosis
  • Intestinal Diseases / pathology*
  • Intestinal Neoplasms / diagnosis
  • Intestinal Neoplasms / pathology
  • Intestine, Small / pathology*
  • Male
  • Observer Variation
  • ROC Curve
  • Sensitivity and Specificity
  • Video Recording