A Magnetic Resonance Imaging Index to Predict Crohn’s Disease Postoperative Recurrence: The MONITOR Index

Schaefer, Marion; Laurent, V.; Grandmougin, Aurélie; Vuitton, Lucine; Bourreille, Arnaud; Luc, Amandine; Clerc‐Urmès, Isabelle; Orry, Xavier; Frampas, É.; Billy, M. de; Pouillon, Lieven; Berre, Catherine Le; Meyer, Jérémy; Baumann, Cédric; Peyrin–Biroulet, Laurent

doi:10.1016/j.cgh.2021.06.035

Cited by 20 publications

(8 citation statements)

References 37 publications

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“… 70 An MRI index developed using seven items (bowel wall thickness, contrast enhancement, T2WI hyperintensity, DWI hyperintensity, mural oedema, ulcers, and the length of diseased segment) was significantly associated with Rutgeerts score and was reported as an easy‐to‐apply tool that can be used in clinical practice to predict the postoperative recurrence with a AUC of 0.85 in an independent test cohort. 71 Additionally, Maconi et al. demonstrated a significant correlation between the length of bowel wall thickening and surgical recurrence in a prospective study based on ultrasonography image features (28.4 ± 10.7 vs. 21.0 ± 11.2 cm, p = 0.04).…”

Section: The Role Of Cross‐sectional Imaging In the Post‐operative Se...mentioning

confidence: 95%

“…MRI has been reported to be valuable for predicting the risk of clinical recurrence in patients with postoperative CD 70 . An MRI index developed using seven items (bowel wall thickness, contrast enhancement, T2WI hyperintensity, DWI hyperintensity, mural oedema, ulcers, and the length of diseased segment) was significantly associated with Rutgeerts score and was reported as an easy‐to‐apply tool that can be used in clinical practice to predict the postoperative recurrence with a AUC of 0.85 in an independent test cohort 71 . Additionally, Maconi et al.…”

Section: The Role Of Cross‐sectional Imaging In the Post‐operative Se...mentioning

confidence: 99%

“…70 An MRI index developed using seven items (bowel wall thickness, contrast enhancement, T2WI hyperintensity, DWI hyperintensity, mural oedema, ulcers, and the length of diseased segment) was significantly associated with Rutgeerts score and was reported as an easy-toapply tool that can be used in clinical practice to predict the postoperative recurrence with a AUC of 0.85 in an independent test cohort. 71 Prior CD studies based on functional MRI have demonstrated abnormal neural activity and functional connectivity, regional homogeneity, and amplitude of low-frequency fluctuations in various regions primarily associated with emotion, pain, and cognitiverelated functions, which would provide information to further understand the neural mechanisms of CD. 73 Moreover, multimodal MRI that combines functional and structural MRI can provide additional information.…”

Section: The Role Of Cross-sectional Imaging In the Post-operative Se...mentioning

confidence: 99%

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Inflammatory bowel disease cross‐sectional imaging: What's new?

et al. 2022

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Cross‐sectional imaging—ultrasonography, computed tomography enterography, and magnetic resonance enterography—is a routine and indispensable tool for patients with Crohn's disease (CD) that helps to detect or monitor disease characteristics before, during, and after CD treatment. New emerging radiological technologies may have further clinical applications in the management of CD. In this review article, we focus on the latest developments in cross‐sectional imaging in CD research, including its role in intra‐ and extra‐luminal lesion detection, intestinal inflammation and fibrosis grading, therapeutic response assessment and outcome prediction, postoperative recurrence detection and prediction, and the gut‐brain axis.

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Section: The Role Of Cross‐sectional Imaging In the Post‐operative Se...mentioning

confidence: 95%

Section: The Role Of Cross‐sectional Imaging In the Post‐operative Se...mentioning

confidence: 99%

“…70 An MRI index developed using seven items (bowel wall thickness, contrast enhancement, T2WI hyperintensity, DWI hyperintensity, mural oedema, ulcers, and the length of diseased segment) was significantly associated with Rutgeerts score and was reported as an easy-toapply tool that can be used in clinical practice to predict the postoperative recurrence with a AUC of 0.85 in an independent test cohort. 71 Prior CD studies based on functional MRI have demonstrated abnormal neural activity and functional connectivity, regional homogeneity, and amplitude of low-frequency fluctuations in various regions primarily associated with emotion, pain, and cognitiverelated functions, which would provide information to further understand the neural mechanisms of CD. 73 Moreover, multimodal MRI that combines functional and structural MRI can provide additional information.…”

Section: The Role Of Cross-sectional Imaging In the Post-operative Se...mentioning

confidence: 99%

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Inflammatory bowel disease cross‐sectional imaging: What's new?

et al. 2022

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“…A Magnetic Resonance Imaging Index to Predict Crohn’s Disease Postoperative Recurrence (MONITOR) Index has been developed and internally validated [ 73 ]. Within this study, DWI signal increase, increased BWT, length of the disease segment of >20 mm, the presence of contrast enhancement, T2 signal increase, oedema, and ulcers at the anastomotic site and terminal ileum were each independently associated with endoscopic disease recurrence (Rutgeerts > i2), with the presence of ulcers on MRE demonstrating the strongest association for recurrence.…”

Section: The Utility Of Mre For Detection Of Post-operative Recurrenc...mentioning

confidence: 99%

“…The index demonstrated an AUC of 0.85 (0.73–0.97) for differentiating active and inactive disease compared to the reference standard of active endoscopic CD (Rutgeerts > i2). Furthermore, in the validation cohort, a MONITOR index of ≥1 gave a sensitivity and specificity of 87% and 75%, respectively [ 73 ]. Given the small validation cohort ( n = 17), external validation of the MONITOR index is awaited prior to widespread clinical application.…”

Section: The Utility Of Mre For Detection Of Post-operative Recurrenc...mentioning

confidence: 99%

Replacing Endoscopy with Magnetic Resonance Enterography for Mucosal Activity Assessment in Terminal Ileal Crohn’s Disease: Are We There Yet?

et al. 2023

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Crohn’s disease (CD) is a chronic immune mediated disorder that most commonly affects the small bowel and/or the large bowel. Treatment targets in CD include mucosal healing assessed via ileocolonoscopy and transmural healing assessed through cross-sectional imaging modalities such as magnetic resonance enterography (MRE). More recently, histological healing in CD has emerged as a treatment target, though it is made cumbersome given its reliance on frequent endoscopic examinations. With expert guidelines now recommending regular objective assessments as part of a treat-to-target approach, accurate non-invasive assessment will become increasingly critical. MRE has an established role in the assessment of small bowel CD, with growing data supportive of its ability in detecting disease activity at mucosal and histological levels. This could therefore potentially reduce the need for serial endoscopic assessment. Thus, this review will assess the capacity of individual MRE parameters and MRE indices for detecting mucosal and histological small bowel CD activity. Furthermore, challenging scenarios, such as CD activity detection in post-operative clinical scenarios and abnormal findings in the context of a normal ileocolonoscopy, will be explored.

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MR enterography radiologic ulcers in newly diagnosed ileal Crohn disease in children: frequency, inter-radiologist agreement, and clinical correlation

Palmer,

Towbin,

Anton

et al. 2024

Pediatr Radiol

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Background Radiologic ulcers are increasingly recognized as an imaging finding of bowel wall active inflammation in Crohn disease (CD). Objective To determine the frequency of ulcers at MR enterography (MRE) in children with newly diagnosed ileal CD, assess agreement between radiologists, and evaluate if their presence correlates with other imaging and clinical features of intestinal active inflammation. Materials and methods This retrospective study included 108 consecutive pediatric patients (ages 6–18 years) with newly diagnosed ileal CD that underwent clinical MRE prior to treatment initiation between January 2021 and December 2022. MRE examinations were independently reviewed by three pediatric radiologists who indicated the presence vs. absence of ulcers, ulcer severity (categorical depth), and ulcer extent (categorical number of ulcers). Maximum bowel wall thickness and length of disease were measured and averaged across readers. Patient demographics and clinical inflammatory markers were documented from electronic health records. Inter-radiologist agreement was assessed using Fleiss’ kappa (k) statistics. Student’s t-test was used to compare continuous variables. Results Mean patient age was 13.9 years (67 [62%] boys). Radiologic ulcers were recorded in 64/108 (59.3%) cases by reader 1, 70/108 (64.8%) cases by reader 2, and 49/108 (45.4%) cases by reader 3 (k = 0.36). Based on majority consensus, radiologic ulcers were present in 60/108 (55.6%) participants. Inter-radiologist agreement for ulcer severity was k = 0.23, while ulcer extent was k = 0.66. There were significant differences in C-reactive protein, erythrocyte sedimentation rate, fecal calprotectin, albumin, maximum bowel wall thickness, and length of disease between patients without and with radiologic ulcers (P < 0.05). The sensitivity and specificity of MRE for detecting endoscopic ulcers were 66.7% (95% CI, 52.1–79.2%) and 69.2% (95% CI, 48.2–85.7%), respectively. Conclusion Radiologic ulcers are visible in children with newly diagnosed ileal CD, although inter-radiologist agreement is only fair. The presence of ulcers is associated with clinical laboratory inflammatory markers as well as other MRE findings of disease activity and is an additional imaging finding that can be used to evaluate intestinal inflammation.

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A Magnetic Resonance Imaging Index to Predict Crohn’s Disease Postoperative Recurrence: The MONITOR Index

Cited by 20 publications

References 37 publications

Inflammatory bowel disease cross‐sectional imaging: What's new?

Inflammatory bowel disease cross‐sectional imaging: What's new?

Replacing Endoscopy with Magnetic Resonance Enterography for Mucosal Activity Assessment in Terminal Ileal Crohn’s Disease: Are We There Yet?

MR enterography radiologic ulcers in newly diagnosed ileal Crohn disease in children: frequency, inter-radiologist agreement, and clinical correlation

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