Development and Validation of a Simplified Magnetic Resonance Index of Activity for Crohn’s Disease

Ordás, Íngrid; Rimola, Jordi; Alfaro, Ignacio; Rodríguez, Sónia; Castro‐Poceiro, Jesús; Ramírez‐Morros, Anna; Gállego, Marta; Giner, Á; Barastegui, Rebeca; Fernández-Clotet, A; Masamunt, Maria Carme; Ricart, Elena; Panés, Julián

doi:10.1053/j.gastro.2019.03.051

Cited by 137 publications

(159 citation statements)

References 35 publications

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“…In that regard, using the simplified MaRIA score recently described may facilitate implementation of the index-based assessment in clinical practice. 10,35 Lastly, we did not include in the analysis segments with active disease of proximal We focused on the response to TNF inhibitors because they are the first-line drug therapy in CD patients started on biologics in most centres. Whether the predictors of response apply only to TNF inhibitors or also to therapies with other mechanism of action needs to be elucidated in future studies.…”

Section: Discussionmentioning

confidence: 99%

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Pre‐treatment magnetic resonance enterography findings predict the response to TNF‐alpha inhibitors in Crohn's disease

Rimola

Fernández-Clotet

Capozzi

et al. 2020

Aliment Pharmacol Ther

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Background: Identifying predictors of therapeutic response is the cornerstone of personalised medicine. Aim: To identify predictors of long-term healing of severe inflammatory lesions based on magnetic resonance enterography (MRE) findings in patients with Crohn's disease (CD) treated with tumour necrosis factor alpha (TNF-α) inhibitors. Methods: This prospective longitudinal single-centre study included patients with clinically active CD requiring treatment with TNF-α inhibitors with at least one intestinal segment with a severe inflammatory lesion detected by MRE (segmental MaRIA ≥11). MRE data were obtained at baseline, and at weeks 14 and 46. The primary endpoint was healing of severe inflammatory lesions (MaRIA <11) in each segment. The secondary endpoint was healing of all severe inflammatory lesions on a per-patient analysis. Results: We included 58 patients with 86 intestinal segments with severe inflammatory lesions. At week 46, healing of severe lesions was found in 51/86 (59.3%) segments, and complete healing of inflammatory lesions in all segments was found in 28/58 (48.6%) patients. Multivariable analysis found baseline-negative predictors of long-term healing of severe inflammation were ileal (as opposed to colonic) loca

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Section: Discussionmentioning

confidence: 99%

“…26 We determined the MaRIA 2 and simplified MaRIA (sMARIA) scores for each segment using the previously described formulas. 10 Two expert radiologists with experience in MRE (JR and NC) independently read the images in chronological order. Both recorded qualitative variables, reaching a consensus about discrepancies.…”

Section: Mre Data Collectionmentioning

confidence: 99%

Pre‐treatment magnetic resonance enterography findings predict the response to TNF‐alpha inhibitors in Crohn's disease

Rimola

Fernández-Clotet

Capozzi

et al. 2020

Aliment Pharmacol Ther

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“…MRE scans were read by a single radiologist, albeit blinded to the patients' clinical and treatment features. Furthermore, interobserver agreement between experienced MRI radiologists is excellent . The decision for stricture surgery in this cohort may have been influenced by the radiological findings, although the decision to operate was always made in the clinical context, with radiological findings being just one of the considerations.…”

Section: Discussionmentioning

confidence: 87%

Magnetic resonance enterography for predicting the clinical course of Crohn's disease strictures

Schulberg

Wright

Holt

et al. 2019

J of Gastro and Hepatol

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Background and Aims Strictures are the most common Crohn's disease complication, but their natural history is unknown. This study aimed to characterize inflammation, predict prognosis, and understand the impact of drug therapy using magnetic resonance enterography (MRE). Methods Patients with a stricture diagnosed on MRE over a 5‐year period were reviewed for MRE disease extent and inflammation, clinical course, C‐reactive protein, response to anti‐TNF therapy, endoscopic dilatation, hospitalization, and surgery. Results 136 patients had 235 strictures (77, one and 59, ≥ 2 strictures). Treatment: 46% of patients underwent surgery after a median 6 months; median follow‐up for those not requiring surgery was 41 months. Predictors of surgery: Hospitalization because of obstruction predicted subsequent surgery (OR 2.50; 95% CI 1.06–5.90) while anti‐TNF therapy commenced at stricture diagnosis was associated with a reduced risk (OR 0.23; 95% CI 0.05–0.99). MRE characteristics associated with surgery were proximal bowel dilatation ≥ 30‐mm diameter (OR 2.98; 95% CI 1.36–6.55), stricture bowel wall thickness ≥ 10‐mm (OR 2.42; 95% CI 1.11–5.27), and stricture length > 5‐cm (OR 2.56; 95% CI 1.21–5.43). 81% of patients with these three adverse MRE features required surgery versus 17% if none were present (P < 0.001). Accuracy for these three MRE variables predicting surgery was high (AUC 0.76). Conclusion Magnetic resonance enterography findings in Crohn's disease strictures are highly predictive of the disease course and the need for future surgery. MRE may also identify who would benefit from treatment intensification. Anti‐TNF therapy is associated with reduced risk of surgery and appears to alter the natural history of this complication.

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“…Several disease activity scores have been proposed [73][74][75][76][77][78], including the Magnetic Resonance Index of Activity (MaRIA) [73], London [74], and Clermont [75] systems. The MaRIA, which scores wall thickness, relative contrast enhancement, mural edema, and ulcers in various segments of the gastrointestinal tract, is the most widely used [73].…”

Section: Magnetic Resonance Enterographymentioning

confidence: 99%

“…The Lémann index has been proposed for intestinal damage assessment [79]. Scoring systems are often complicated and mainly used for clinical trials; however, several simple MRE scoring systems have been proposed for use in clinical practice [77,78]. MRE could detect SB involvement and predict prognoses in patients with negative inflammation on ileocolonoscopy [80].…”

Section: Magnetic Resonance Enterographymentioning

confidence: 99%

Objective evaluation for treat to target in Crohn’s disease

et al. 2020

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Background Crohn's disease (CD) is a chronic and destructive bowel disease; continued disease activity can lead to penetrating complications. With the recent advent of effective medications, the importance of using a treat-totarget approach to guide therapy is becoming important. Methods In this review, we reviewed the previous evidence for evaluating CD lesions. Results We describe ileocolonoscopy's role in assessing disease activity, as well as recent progress in modalities, such as balloon-assisted endoscopy, capsule endoscopy, magnetic resonance enterography, computed tomography enterography, and ultrasonography. Advances in modalities have changed CD assessment, with small-bowel involvement becoming more important. Conclusions Proper optimization is necessary in clinical practice.

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Development and Validation of a Simplified Magnetic Resonance Index of Activity for Crohn’s Disease

Abstract: Development and Validation of a Simplified Magnetic Resonance Index of Activity for Crohn's disease MARIAs segment = thickening (>3mm) + edema + fat stranding + ulcers MARIAs ≥ 1 (a) activity (b) severity

Cited by 137 publications

References 35 publications

Pre‐treatment magnetic resonance enterography findings predict the response to TNF‐alpha inhibitors in Crohn's disease

Pre‐treatment magnetic resonance enterography findings predict the response to TNF‐alpha inhibitors in Crohn's disease

Magnetic resonance enterography for predicting the clinical course of Crohn's disease strictures

Objective evaluation for treat to target in Crohn’s disease

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