danilo moulin sales correlação interobservador ... - (DDI) - UNIFESP

Abstract
Objective: To describe the biliary changes by means of magnetic resonance (MR)
cholangiography in a group of patients with schistosomiasis mansoni. To evaluate
interobserver agreement in detecting biliary ducts changes in these patients. Materials
and methods: A prospective and transversal study was carried out from February 2005
to February 2007 in our University Hospital. Twenty four patients with hepatosplenic
schistosomiasis and six healthy patients without known liver disease, considered as a
control group, were submitted to MR cholangiography exam. The following patterns of
biliary duct changes were established: distortion, thinning, stenosis, dilation and
irregularity. The assessment of interobserver agreement in characterizing biliary
changes was calculated using the McNemar test and the weight kappa test. It was also
calculated the relationship between the occurrence of changes in the biliary ducts and
the serum level of gamaglutamiltransferase, using the Fisher’s exact test. Results: The
interobserver agreement in detecting distortion and thinning of the biliary tree was
almost perfect (k = 0,867; confidence interval [CI] 95% [0,512 – 1,0] e k = 0,865; CI 95%
[0,51 – 1,0], respectively). There was a substantial agreement in viewing stenosis (k =
0,78; CI 95% [0,424 – 1,0]), moderate agreement for dilation (k = 0,595; CI 95% [0,247
– 0,942]) and mild agreement for thinning (k = 0,229; CI 95% [0,095 – 0,552]). A
substantial agreement was also found when we considered any change in the biliary
tree (k = 0,722; CI 95% [0,364 – 1,0]) Conclusions: The changes found in the biliary
tree were, from the most to the lesser frequent: thinning, distortion, stenosis, dilation
and irregularity. The interobserver agreement was almost perfect in viewing distortion
and thinning of the biliary ducts and it was substantial in detecting stenosis.