Increasing efficiency of MRE for diagnosis of Crohn’s disease activity through proper sequence selection: a practical approach for clinical trials

Rimola, Jordi; Alvarez-Cofiño, Almudena; Pérez-Jeldres, Tamara; Rodríguez, Sónia; Alfaro, Ignacio; Ordás, Íngrid; Ricart, Elena; Panés, Julián

doi:10.1007/s00261-017-1203-7

Cited by 22 publications

(6 citation statements)

References 18 publications

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“…Previous studies indicated that mural T2 hyperintensity and bowel wall thickness were independent predictors of CD activity assessed by hispathological evaluation [11825]. Higher mural T2 signal, probably reflecting mural edema, was found to be associated with higher degrees of inflammation [182526]. Similarly, this study found a significant association with T2 signal hyperintensity and disease activity, particularly when this parameter is combined with DWI score.…”

Section: Discussionsupporting

confidence: 72%

Can MR Enterography and Diffusion-Weighted Imaging Predict Disease Activity Assessed by Simple Endoscopic Score for Crohn’s Disease?

Soydan

Demır

Özer

et al. 2019

Journal of the Belgian Society of Radiology

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Purpose:Monitoring Crohn’s disease (CD) activity has a crucial importance, especially for evaluating treatment efficacy. Magnetic resonance enterography (MRE) and diffusion-weighted imaging (DWI) or their combination may represent potential non-invasive tools for this purpose. This study aimed to examine DWI and MRE for their potential to differentiate between different grades of ileocolonic CD activity.Materials and Methods:This retrospective study included 54 adult patients with a diagnosis of CD who underwent ileocolonoscopy and MRE including the DWI sequence. The severity of CD inflammation was categorized by Simple Endoscopic Score for Crohn’s Disease (SES-CD) as inactive, mild, moderate and severe. In addition, following conventional MRE and DWI parameters were examined: bowel wall thickness, mural T2 hyperintensity, contrast enhancement, DWI signal intensity, and apparent diffusion coefficient (ADC) values.Results:In patients with moderate to severe disease based on SES-CD, T2 hyperintensity score [1.68 ± 0.77 (1–3) vs. 2.19 ± 0.69 (1–3); p = 0.013] and mean DWI score [2.42 ± 0.58 (1–3) vs. 2.04 ± 0.69 (1–3); p = 0.037 ] were higher and mean ADC values [1.5 ± 0.4 (0.9–2.5) vs. 1.2 ± 0.3 (0.6–1.8)] were lower compared to patients with inactive to mild CD. ADC had a moderate diagnostic accuracy in predicting moderate to severe disease (AUC = 0.729, 95% CI = 0.591–0.841, p = 0.001), with a cut-off value of ≤1.47 × 10–3 mm2/sec yielded 88.5% (23/26) sensitivity, 57.1% (16/28) specificity.Conclusion:DWI, ADC and T2 signal appear to differentiate moderate to severe CD from inactive to mildly active CD, based on SES-CD evaluation and may be useful in monitoring disease activity, particularly when evaluating treatment response.

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Section: Discussionsupporting

confidence: 72%

Can MR Enterography and Diffusion-Weighted Imaging Predict Disease Activity Assessed by Simple Endoscopic Score for Crohn’s Disease?

Soydan

Demır

Özer

et al. 2019

Journal of the Belgian Society of Radiology

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“…The main characteristics of each of the studies [32,[52][53][54][55][56][57][58][59][60] evaluating the ability of the MaRIA score to diagnose active bowel disease in CD are summarized in Table III. Recently, Erden et al [60] have evaluated the MaRIA score in patients with entero-enteric fistulas and found no significant difference between patients with fistulas from those without fistulas. A potential limitation of the MaRIA is that it does not take into account the overall length of inflamed segments, even in the small bowel where extensive disease can occur.…”

Section: Magnetic Resonance Index Of Activity (Maria)mentioning

confidence: 99%

“…The estimation of activity using the MaRIA score also correlated with endoscopy findings. More recently, in 2017, the same group [54] compared the accuracy of MRE and MaRIA score versus ileocolonoscopy performed within 1 month. For detecting active disease, a combination of T2-weighted and DWI sequences resulted in the highest specificity and most accurate sequence combination, and had similar sensitivity to those of the MaRIA but a lower specificity and accuracy than the MaRIA score.…”

Section: ) Mre As An Alternative Technique To Endoscopymentioning

confidence: 99%

Assessment of Crohn’s Disease Activity: Magnetic Resonance Enterography in Comparison with Clinical and Endoscopic Evaluations

Minordi

Larosa

Papa

et al. 2019

JGLD

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Crohn’s disease (CD) is a chronic inflammatory transmural disease of the gastrointestinal tract. The small bowel is the most frequently involved site. Assessment of the bowel is essential in guiding therapeutic decisions, medical or surgical therapy. Personalized medicine is a new concept that has the potential to improve therapeutic efficacy, reduce the risk of drug adverse events, and decrease costs if the therapy is the most suitable treatment for selected patients. Many techniques have been verified and standardised for small bowel CD. Among radiological techniques, CT enterography (CTE) and MRI-enterography (MRE) are the most widely accepted techniques, although MRI is generally preferable as it avoids radiation. In this review, we will present the current role and new innovative technological perspectives of MR enterography in comparison with clinical and endoscopic evaluations for the assessment of CD activity in adult patients. In particular, many studies have been performed to validate MRE signs such as biomarkers of active Crohn’s disease (such as mural thickening, mural T2 hyperintense signal, target sign, comb sign, ulceration and extramural mesenteric signs) and to select the most appropriate index for identifying active disease or severe inflammation (such as MaRIA score, Clermont index, and others). We conclude that MRE is a minimally invasive tool for the evaluation of disease activity and shows a very good correlation with the presence and severity of endoscopic lesions, so to allow a personalized medicine in patients with CD.

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“…Although endoscopy is the current gold standard for activity assessment, standardised imaging criteria also depict and quantify inflammatory burden (32)(33)(34). The magnetic resonance of activity (MaRIA) score is perhaps best known, and was derived by correlating various MR features with the Crohn's Disease Endoscopic Index of severity (CDEIS) score (35).…”

Section: Activity Assessmentmentioning

confidence: 99%

Diagnostic pathways in Crohn's disease

et al. 2019

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Increasing efficiency of MRE for diagnosis of Crohn’s disease activity through proper sequence selection: a practical approach for clinical trials

Abstract: 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.

Cited by 22 publications

References 18 publications

Can MR Enterography and Diffusion-Weighted Imaging Predict Disease Activity Assessed by Simple Endoscopic Score for Crohn’s Disease?

Can MR Enterography and Diffusion-Weighted Imaging Predict Disease Activity Assessed by Simple Endoscopic Score for Crohn’s Disease?

Assessment of Crohn’s Disease Activity: Magnetic Resonance Enterography in Comparison with Clinical and Endoscopic Evaluations

Diagnostic pathways in Crohn's disease

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