Jordi Rimola1, Almudena Alvarez-Cofiño2, Tamara Pérez-Jeldres3, Sonia Rodríguez4, Ignacio Alfaro5, Ingrid Ordás5, Elena Ricart5,6, Julián Panés5,6. 1. Department of Radiology, Centre de Diagnòstic per la Imatge (CDI), Hospital Clínic Barcelona, University of Barcelona, C/Villarroel 170 Escala 3 Planta 1, Barcelona, 08036, Catalonia, Spain. jrimola@clinic.cat. 2. Department of Radiology, Fundación Hospital de Jove, Gijón, Spain. 3. Gastroenterology Department, Hospital San Borja Arriaran, Santiago, Chile. 4. Department of Radiology, Centre de Diagnòstic per la Imatge (CDI), Hospital Clínic Barcelona, University of Barcelona, C/Villarroel 170 Escala 3 Planta 1, Barcelona, 08036, Catalonia, Spain. 5. Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain. 6. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
Abstract
PURPOSE: To derive the best magnetic resonance enterography (MRE) approach for detecting activity and severe lesions in Crohn's disease (CD) to use for selecting patients and measuring response to treatment in clinical trials. METHODS: We compared the accuracies of MRE (T2-weighted sequences, DWI (b = 800 s/mm2) sequences, combined T2-weighted and DWI sequences, combined T2-weighted or DWI sequences, and MaRIA score based on T2-weighted and contrast-enhanced T1-weighted sequences) versus ileocolonoscopy (SES-CD) performed within 1 month. Bowel segments were classified as inactive (SES-CD < 2), active (SES-CD ≥ 2), or active with severe lesions (ulcers seen at endoscopy). McNemar's test was used to compare the accuracies of the different approaches against endoscopy. RESULTS: 224 segments in 43 patients were analyzed. For detecting active disease, the combination of findings from T2 and DWI sequences results in the highest specific and accurate sequence combination. Combined T2-weighted and DWI sequences had similar sensitivity to those of MaRIA (P = 0.25) but lower specificity (P = 0.007) and accuracy (P = 0.0013) than MaRIA score. For detecting severe lesions, T2-weighted sequences alone had greater accuracy [similar to MaRIA score (P > 0.999)] than other noncontrast approaches. CONCLUSIONS: T2-weighted sequences should be used as a first screening step, and followed by contrast-enhanced T1-weighted sequences only when abnormal findings are identified; adding DWI does not improve the accuracy of MRE.
PURPOSE: To derive the best magnetic resonance enterography (MRE) approach for detecting activity and severe lesions in Crohn's disease (CD) to use for selecting patients and measuring response to treatment in clinical trials. METHODS: We compared the accuracies of MRE (T2-weighted sequences, DWI (b = 800 s/mm2) sequences, combined T2-weighted and DWI sequences, combined T2-weighted or DWI sequences, and MaRIA score based on T2-weighted and contrast-enhanced T1-weighted sequences) versus ileocolonoscopy (SES-CD) performed within 1 month. Bowel segments were classified as inactive (SES-CD < 2), active (SES-CD ≥ 2), or active with severe lesions (ulcers seen at endoscopy). McNemar's test was used to compare the accuracies of the different approaches against endoscopy. RESULTS: 224 segments in 43 patients were analyzed. For detecting active disease, the combination of findings from T2 and DWI sequences results in the highest specific and accurate sequence combination. Combined T2-weighted and DWI sequences had similar sensitivity to those of MaRIA (P = 0.25) but lower specificity (P = 0.007) and accuracy (P = 0.0013) than MaRIA score. For detecting severe lesions, T2-weighted sequences alone had greater accuracy [similar to MaRIA score (P > 0.999)] than other noncontrast approaches. CONCLUSIONS: T2-weighted sequences should be used as a first screening step, and followed by contrast-enhanced T1-weighted sequences only when abnormal findings are identified; adding DWI does not improve the accuracy of MRE.
Entities:
Keywords:
Activity; Crohn’s disease; MR enterography; MaRIA
Authors: Giuseppe Cicero; Stefania Mondello; Julian L Wichmann; Moritz H Albrecht; Thomas J Vogl; Marco Cavallaro; Luciano Frosina; Tommaso D'Angelo; Silvio Mazziotti Journal: J Clin Imaging Sci Date: 2020-05-02