Nunzia Capozzi1,2, Ingrid Ordás3,4,5,6, Agnès Fernandez-Clotet3, Jesús Castro-Poceiro3, Sonia Rodríguez1, Ignacio Alfaro3,7, Víctor Sapena4, Maria Carme Masamunt3, Elena Ricart3,4,5,6, Julian Panés3,4,5,6, Jordi Rimola1,5. 1. Radiology Department IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain. 2. Radiology Department, Policlinico Universitario Sant'Orsola-Malpighi, Bologna, Italy. 3. Gastroenterology Department. IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain. 4. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. 5. Centro de Investigación Biomédica en Red Enfermedades Hepaticas y Digestivas [CIBERehd], Spain. 6. University of Barcelona, Barcelona, Spain. 7. Gastroenterology Department, Hospital Regional de Concepción, Concepción, Chile.
Abstract
BACKGROUND: Gadolinium-enhanced sequences are not included in the simplified Magnetic Resonance Index of Activity [sMARIA], but in the derivation of this index readers had access to these sequences. The current study aimed to validate the sMARIA without gadolinium-enhanced sequences for assessing disease activity, severity, and response to treatment in patients with Crohn's disease. METHODS: We prospectively included patients with active Crohn's disease and at least one segment with severe inflammation [ulcers] at ileocolonoscopy, who required treatment with biologic drugs. Patients were evaluated by both magnetic resonance enterography [MRE] and ileocolonoscopy at baseline and 46 weeks after initiation of medical treatment. We compared the quantification of disease activity and response to treatment with sMARIA versus with ileocolonoscopy Crohn's Disease Index of Severity [CDEIS], considered the gold standard. RESULTS: Data from both MRE and ileocolonoscopy 46 weeks after treatment initiation were available for 39 of the 50 patients. As in the derivation study, the optimal cutoffs were sMARIA ≥1 for predicting active disease (area under the curve [AUC] 0.92) and sMARIA ≥2 for predicting the presence of ulcers at ileocolonoscopy [AUC 0.93]. In evaluating the response to treatment, the sMARIA detected endoscopic ulcer healing at the segment level [sMARIA <2] with 89.5% sensitivity and 87.5% specificity. The sMARIA decreased significantly [p <0.001] in segments achieving endoscopic ulcer healing, but did not change [p = 0.222] in segments with persistent ulceration. CONCLUSIONS: The sMARIA is accurate and reliable in quantifying disease activity and response to treatment in luminal Crohn's disease, without the need for gadolinium-enhanced sequences.
BACKGROUND:Gadolinium-enhanced sequences are not included in the simplified Magnetic Resonance Index of Activity [sMARIA], but in the derivation of this index readers had access to these sequences. The current study aimed to validate the sMARIA without gadolinium-enhanced sequences for assessing disease activity, severity, and response to treatment in patients with Crohn's disease. METHODS: We prospectively included patients with active Crohn's disease and at least one segment with severe inflammation [ulcers] at ileocolonoscopy, who required treatment with biologic drugs. Patients were evaluated by both magnetic resonance enterography [MRE] and ileocolonoscopy at baseline and 46 weeks after initiation of medical treatment. We compared the quantification of disease activity and response to treatment with sMARIA versus with ileocolonoscopy Crohn's Disease Index of Severity [CDEIS], considered the gold standard. RESULTS: Data from both MRE and ileocolonoscopy 46 weeks after treatment initiation were available for 39 of the 50 patients. As in the derivation study, the optimal cutoffs were sMARIA ≥1 for predicting active disease (area under the curve [AUC] 0.92) and sMARIA ≥2 for predicting the presence of ulcers at ileocolonoscopy [AUC 0.93]. In evaluating the response to treatment, the sMARIA detected endoscopic ulcer healing at the segment level [sMARIA <2] with 89.5% sensitivity and 87.5% specificity. The sMARIA decreased significantly [p <0.001] in segments achieving endoscopic ulcer healing, but did not change [p = 0.222] in segments with persistent ulceration. CONCLUSIONS: The sMARIA is accurate and reliable in quantifying disease activity and response to treatment in luminal Crohn's disease, without the need for gadolinium-enhanced sequences.
Authors: Joana Roseira; Ana Rita Ventosa; Helena Tavares de Sousa; Jorge Brito Journal: United European Gastroenterol J Date: 2020-07-14 Impact factor: 4.623
Authors: Shankar Kumar; Andrew Plumb; Sue Mallett; Gauraang Bhatnagar; Stuart Bloom; Caroline S Clarke; John Hamlin; Ailsa L Hart; Ilan Jacobs; Simon Travis; Roser Vega; Steve Halligan; Stuart Andrew Taylor Journal: BMJ Open Date: 2022-10-03 Impact factor: 3.006