Gastroesophageal reflux scintigraphy: interpretation methods and inter-reader agreement
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Gastroesophageal reflux scintigraphy: interpretation methods and inter-reader agreement Murat Tuncel, Pınar Özgen Kıratlı, Tamer Aksoy, Murat Fani Bozkurt Ankara, Turkey
Methods: Scintigraphic images of 49 children with suspected gastroesophageal reflux were interpreted by three different methods: visual interpretation, time activity curves, and condensed images. The readings were performed by three specialists and a resident. The discordant results were resolved by a consensus reading done together by all interpreters based on the three different methods. The gastroesophageal refluxes were grouped according to their number, location and intensity. Results: Gastroesophageal reflux scintigraphy revealed 22 patients with negative results and 27 with positive results. The sensitivity, positive predictive value and specificity for each of the three specialists vs. the resident were 96%, 96% and 81% vs. 96%; 93%, 90% and 96% vs. 81%; and 90%, 86%, and 95% vs. 73%, respectively. The mean inter-observer reproducibility (κ value) was 0.910 for visual interpretation, 0.652 for time activity curves and 0.789 for condensed images. Twentyseven percent of the results were discordant and most of these refluxes were of low grade (92%), low intensity (77%) and localization in the distal esophagus (54%). Conclusion: Gastroesophageal scintigraphy is a useful tool for detecting patients with suspected reflux,
Author Affiliations: Department of Nuclear Medicine, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey (Tuncel M, Kıratlı PÖ, Aksoy T, Bozkurt MF) Corresponding Author: Murat Tuncel, MD, Department of Nuclear Medicine, Hacettepe University Faculty of Medicine, Sihhiye, Ankara 06110, Turkey (Tel: +90 536 213 03 41; Fax: +90 312 309 35 08; Email: [email protected]) doi: 10.1007/s12519-011-0322-4
©Children's Hospital, Zhejiang University School of Medicine, China and Springer-Verlag Berlin Heidelberg 2011. All rights reserved.
World J Pediatr, Vol 7 No 3 . August 15, 2011 . www.wjpch.com
and visual interpretation is better than the other two methods in terms of accuracy and inter-observer reproducibility. World J Pediatr 2011;7(3):245-249 Key words: gastroesophageal reflux; inter-observer variability; scintigraphy; time activity curve
Introduction
G
astroesophageal reflux (GER) is a common, self-limited process in infants and children that usually resolves at 12 to 18 months of age. Clinical management of GER includes conservative treatment, thickened feedings, positional therapy and parental reassurance.[1] On the other hand, GER disease (GERD) is a less common, more serious pathological process that is manifested by poor weight gain, signs of esophagitis and persistent respiratory symptoms that usually warrant medical management and diagnostic evaluation.[2] Diagnostic studies are indicated only in cases of doubtful diagnosis or manifestations outside the digestive system. Esophageal 24-hour pH probe monitoring, radionuclide scintigraphy, multichannel intraluminal impedance and ultrasonography have gained
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