Magnetic resonance enterography, small bowel ultrasound and colonoscopy to diagnose and stage Crohn’s disease: patient acceptability and perceived burden

Miles, Anne; Bhatnagar, Gauraang; Halligan, Steve; Gupta, Arun; Tolan, Damian; Zealley, Ian; Taylor, Stuart A.

doi:10.1007/s00330-018-5661-2

Cited by 53 publications

(52 citation statements)

References 26 publications

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“…The risk of low-dose radiation exposure is a concern for our growing population of young patients with IBD [24]. Miles et al [25], on behalf of the METRIC study, reports that younger patients and those with more emotional distress reported significantly increased burden and longer recovery times for MRE compared with US. This limits the available imaging modalities for patients younger than 9 years of age to CT or small bowel follow-through, which are not desirable due to the exposure to ionizing radiation [26].…”

Section: Resultsmentioning

confidence: 99%

Underutilization of Bowel Ultrasound in North America in Children with Inflammatory Bowel Disease

Gamboa

Molle-Rios

Anupindi

2019

Dig Dis

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Background: Inflammatory bowel disease (IBD) is a chronic relapsing disease that requires evaluation using multiple objective tools. In Europe, bowel ultrasound (US) is a widely accepted modality used for the management of patients with IBD; however, its use in North America has only recently emerged as a potential technique. Objectives: Our goal was to identify current practice patterns of pediatric gastroenterologists and radiologists using bowel US in patients with IBD and highlight perceived limitations to the widespread adoption of this modality in North America. Methods: A 14-question survey was e-mailed to the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition internet bulletin board composed of 3,058 subscribers from 51 countries; the Society of Pediatric Radiology listserv composed of 1,917 subscribers worldwide; and the Society of Chairs of Radiology at Children's Hospitals listserv. Descriptive summary statistics was used. Results: In North America, about one-quarter of gastroenterology and radiology participants reported using bowel US for IBD; over 3-fourths expressed an interest in using US more often. Bowel US was performed more frequently for Crohn's disease. Both groups agreed the main limitation to using bowel US was concern for inter-observer variability and operator-dependent factors; radiologists reported that other modalities are more effective to assess IBD, whereas gastroenterologists reported unfamiliarity with bowel US indications and techniques. Conclusions: Our data show there is significant interest among both radiologists and gastroenterologists in using bowel US. However, lack of education, insufficient training, and perceived high inter-observer variability among US technologists are limitations preventing the widespread adoption of US for IBD in North America.

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Section: Resultsmentioning

confidence: 99%

Underutilization of Bowel Ultrasound in North America in Children with Inflammatory Bowel Disease

Gamboa

Molle-Rios

Anupindi

2019

Dig Dis

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“…The questionnaire combines a series of individual items into three main domains: satisfaction, worry and discomfort. The MRE questionnaire included 31 items (7, 6 and 18 in satisfaction, worry and discomfort domains, respectively) and the US questionnaire included 28 items (7, 6 and 15 in satisfaction, worry and discomfort domains, respectively), 60 additionally including an item relating to the abdominal pressure of the probe.…”

Section: Scan Burden For Magnetic Resonance Imaging and Ultrasonographymentioning

confidence: 99%

“…Scores for each item were reverse scored, totalled and averaged so that higher scores equated to higher burden. 60…”

Section: Scan Burden For Magnetic Resonance Imaging and Ultrasonographymentioning

confidence: 99%

Magnetic resonance enterography compared with ultrasonography in newly diagnosed and relapsing Crohn’s disease patients: the METRIC diagnostic accuracy study

Taylor

Mallett

Bhatnagar

et al. 2019

Health Technol Assess

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Background Magnetic resonance enterography and enteric ultrasonography are used to image Crohn’s disease patients. Their diagnostic accuracy for presence, extent and activity of enteric Crohn’s disease was compared. Objective To compare diagnostic accuracy, observer variability, acceptability, diagnostic impact and cost-effectiveness of magnetic resonance enterography and ultrasonography in newly diagnosed or relapsing Crohn’s disease. Design Prospective multicentre cohort study. Setting Eight NHS hospitals. Participants Consecutive participants aged ≥ 16 years, newly diagnosed with Crohn’s disease or with established Crohn’s disease and suspected relapse. Interventions Magnetic resonance enterography and ultrasonography. Main outcome measures The primary outcome was per-participant sensitivity difference between magnetic resonance enterography and ultrasonography for small bowel Crohn’s disease extent. Secondary outcomes included sensitivity and specificity for small bowel Crohn’s disease and colonic Crohn’s disease extent, and sensitivity and specificity for small bowel Crohn’s disease and colonic Crohn’s disease presence; identification of active disease; interobserver variation; participant acceptability; diagnostic impact; and cost-effectiveness. Results Out of the 518 participants assessed, 335 entered the trial, with 51 excluded, giving a final cohort of 284 (133 and 151 in new diagnosis and suspected relapse cohorts, respectively). Across the whole cohort, for small bowel Crohn’s disease extent, magnetic resonance enterography sensitivity [80%, 95% confidence interval (CI) 72% to 86%] was significantly greater than ultrasonography sensitivity (70%, 95% CI 62% to 78%), with a 10% difference (95% CI 1% to 18%; p = 0.027). For small bowel Crohn’s disease extent, magnetic resonance enterography specificity (95%, 95% CI 85% to 98%) was significantly greater than ultrasonography specificity (81%, 95% CI 64% to 91%), with a 14% difference (95% CI 1% to 27%). For small bowel Crohn’s disease presence, magnetic resonance enterography sensitivity (97%, 95% CI 91% to 99%) was significantly greater than ultrasonography sensitivity (92%, 95% CI 84% to 96%), with a 5% difference (95% CI 1% to 9%). For small bowel Crohn’s disease presence, magnetic resonance enterography specificity was 96% (95% CI 86% to 99%) and ultrasonography specificity was 84% (95% CI 65% to 94%), with a 12% difference (95% CI 0% to 25%). Test sensitivities for small bowel Crohn’s disease presence and extent were similar in the two cohorts. For colonic Crohn’s disease presence in newly diagnosed participants, ultrasonography sensitivity (67%, 95% CI 49% to 81%) was significantly greater than magnetic resonance enterography sensitivity (47%, 95% CI 31% to 64%), with a 20% difference (95% CI 1% to 39%). For active small bowel Crohn’s disease, magnetic resonance enterography sensitivity (96%, 95% CI 92% to 99%) was significantly greater than ultrasonography sensitivity (90%, 95% CI 82% to 95%), with a 6% difference (95% CI 2% to 11%). There was some disagreement between readers for both tests. A total of 88% of participants rated magnetic resonance enterography as very or fairly acceptable, which is significantly lower than the percentage (99%) of participants who did so for ultrasonography. Therapeutic decisions based on magnetic resonance enterography alone and ultrasonography alone agreed with the final decision in 122 out of 158 (77%) cases and 124 out of 158 (78%) cases, respectively. There were no differences in costs or quality-adjusted life-years between tests. Limitations Magnetic resonance enterography and ultrasonography scans were interpreted by practitioners blinded to clinical data (but not participant cohort), which does not reflect use in clinical practice. Conclusions Magnetic resonance enterography has higher accuracy for detecting the presence, extent and activity of small bowel Crohn’s disease than ultrasonography does. Both tests have variable interobserver agreement and are broadly acceptable to participants, although ultrasonography produces less participant burden. Diagnostic impact and cost-effectiveness are similar. Recommendations for future work include investigation of the comparative utility of magnetic resonance enterography and ultrasonography for treatment response assessment and investigation of non-specific abdominal symptoms to confirm or refute Crohn’s disease. Trial registration Current Controlled Trials ISRCTN03982913. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 42. See the NIHR Journals Library website for further project information.

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“…This goal is then evaluated frequently to monitor progress and the treatment plan adjusted if the target is not achieved. Cross-sectional imaging may have a crucial role in this monitoring strategy as it is non-invasive with a lower complication rate then invasive colonoscopy, providing greater patient comfort and safety [41]. To achieve this, we must embed cross-sectional imaging into large clinical trials, so we can truly establish its added value, not only in monitoring disease response (for example as an endpoint in clinical trials of novel therapies), but also predicting longer term outcomes.…”

Section: Next Steps (Near Future)mentioning

confidence: 99%

Differences in the imaging of Crohn’s disease patients between North America and Europe: are we ready to bridge the divide?

2018

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The emphasis of treatment in Crohn's disease has evolved from a reactive model to "treat-to-target" approaches. Cross-sectional imaging has rapidly evolved in parallel, with a growing evidence base supporting its abilities for diagnosis, monitoring and prognostication. Whilst there are differences in emphasis between Europe and North America, particularly around the type of imaging modalities and patterns of multidisciplinary care, there is increasing convergence. This perspective piece provides an overview of the evolving role of cross-sectional imaging in Crohn's disease, discusses practice differences between North America and Europe and provides suggestions on areas for future collaboration and research priorities.

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Magnetic resonance enterography, small bowel ultrasound and colonoscopy to diagnose and stage Crohn’s disease: patient acceptability and perceived burden

Cited by 53 publications

References 26 publications

Underutilization of Bowel Ultrasound in North America in Children with Inflammatory Bowel Disease

Underutilization of Bowel Ultrasound in North America in Children with Inflammatory Bowel Disease

Magnetic resonance enterography compared with ultrasonography in newly diagnosed and relapsing Crohn’s disease patients: the METRIC diagnostic accuracy study

Differences in the imaging of Crohn’s disease patients between North America and Europe: are we ready to bridge the divide?

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