Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn's disease

Abstract

Objective: Assessment of disease extension and activity is crucial to guide treatment in Crohn's disease. The objective of the current cross-sectional study was to determine the accuracy of MR for this assessment. Design: 50 patients with clinically active (n = 35) or inactive (n = 15) Crohn's disease underwent ileocolonoscopy (reference standard) and MR. T2-weighted and precontrast and postcontrast-enhanced T1-weighted sequences were acquired. Endoscopic activity was evaluated by CDEIS (Crohn's Disease Endoscopic Index of Severity); in addition endoscopic lesions were classified as absent, mild (inflammation without ulcers) or severe (presence of ulceration). Results: The comparison of intestinal segments with absent, mild and severe inflammation demonstrated a progressive and significant (p,0.001) increase in the following MR parameters: wall thickness, postcontrast wall signal intensity, relative contrast enhancement, presence of oedema, ulcers, pseudopolyps and lymph node enlargement. Independent predictors for CDEIS in a segment were wall thickness (p = 0.007), relative contrast enhancement (p = 0.01), presence of oedema (p = 0.02) and presence of ulcers at MR (p = 0.003). There was a significant correlation (r = 0.82, p,0.001) between the CDEIS of the segment and the MR index calculated according to the logistic regression analysis coefficients. The MR index had a high accuracy for the detection of disease activity (area under the receiver operating characteristic (ROC) curve 0.891, sensitivity 0.81, specificity 0.89) and for the detection of ulcerative lesions (area under the ROC curve 0.978, sensitivity 0.95, specificity 0.91) in the colon and terminal ileum.

Using of magnetic resonance enterography in the management of Crohn's disease of the small intestine: First year of experience

“…Recently, a radiological index of disease activity, the Magnetic Resonance Index of Activity (MRIA), has been described based on the quantitative changes observed on MRE. This correlates with the severity of the endoscopic lesions and with the presence of oedema, ulcers, size of lymph nodes and the presence of pseudopolyps (14,15). In our series, we evaluate CD activity based on wall thickening, the presence of ulcers, increase in vascularisation, mesenteric inflammation and the presence of reactive lymphadenopathies (16).…”

Role of 18F-fluorodeoxyglucose Positron Emission Tomography in the Monitoring of Inflammatory Activity in Crohnʼs Disease

“…9/13 patients who completed PET scanning both at baseline and a median [range] of 12 [11][12][13][14][15][16][17][18] weeks after initiation of anti-TNF treatment had favourable clinical responses 27 (median [range] responder ΔHBI = 5 [3][4][5][6][7][8][9]; non-responder ΔHBI = 1[-1-2]), (Table 1). …”

“…Table 6 4 Test-retest repeatability 5 patients (1 female) with active CD were recruited for this arm of the study, and 4 completed the two scans within a median [range] period of 7 [4][5][6][7][8][9][10][11][12] days. The repeatability of the PET measures were estimated in segments with a signal focus > LivSUVMEAN (Table 7).…”

“…Biomarkers currently in use in clinical practice (e.g., C-reactive protein [CRP] and faecal calprotectin) lack sensitivity and specificity 5,4 . Recently, imaging biomarkers, such as the Magnetic Resonance Index of Activity (MaRIA) have been validated against colonoscopy as a measure of mucosal and transmural disease load in cross sectional studies [6][7][8] . However a significant unmet need remains for non-invasive longitudinal biomarkers reflecting disease activity.…”

A hybrid optimization strategy for registering images with large local deformations and intensity variations

“…However, there are still many registration problems that remain challenging. We encountered such a challenge upon registering three-dimensional pre-to post-contrast abdominal images acquired by magnetic resonance imaging (MRI) for quantifying Crohn's disease activity [1]. This registration is far from trivial as peristalsis of the bowel (or organ motion) may cause large local deformations, which makes that the registration algorithm gets trapped in a local minimum as discussed in [2].…”