The new simplified MARIA score applies beyond clinical trials: A suitable clinical practice tool for Crohn’s disease that parallels a simple endoscopic index and fecal calprotectin

Abstract

Background A simplified magnetic resonance enterography (MRe) index (sMARIA) for Crohn’s disease (CD) was recently developed and validated. Objective Our aims were (a) to assess sMARIA’s accuracy in a sample other than the validation cohort; (b) to evaluate its correlation with a simpler endoscopy index (SES-CD) and fecal calprotectin (FC); and (c) to assess the need of an expert radiologist to reliably use sMARIA. Methods Patients with CD who underwent MRe, ileocolonoscopy and FC within 2–4 weeks had their MRe retrospectively reviewed by two blinded raters. Disease activity was evaluated through sMARIA, SES-CD and FC. sMARIA’s accuracy, indices correlation, and interrater reliability were assessed. Results In total, 84 patients were included, comprising 420 intestinal segments evaluations. sMARIA ≥1 accurately identified segments with active disease (90% sensitivity, 98% specificity; area under the curve 0.94, 95% confidence interval (CI) 0.91–0.97; p < 0.01). sMARIA correlated with endoscopy, both for ileal and colonic segments (R = 0.94 and R = 0.82; p < 0.01). Per patient, there was a strong correlation between sMARIA, endoscopy (R = 0.95; p < 0.01) and FC (R = 0.91; p < 0.01). Interrater agreement was excellent (intraclass correlation coefficient 0.95; 95% CI 0.94–0.96; p < 0.01). Conclusion sMARIA accurately measured CD activity using SES-CD as standard of reference, and exhibited high correlation with a simple endoscopic index and a biomarker. The interrater reliability between a radiology resident and an expert was excellent.

Development of a multimodal machine-learning fusion model to non-invasively assess ileal Crohn’s disease endoscopic activity

“…23 Yet, the reference standard for evaluating MRE indices for CD severity assessment remains endoscopic scores such as the SES-CD. 24 However, current MRE indices achieved only a moderate correlation with the reference endoscopic scores. In this study, we hypothesized that the moderate correlation to the TI SES-CD achieved by MRE indices may be attributed, at least in part, to the utilization of classical linear regression models to characterize the correlation between the MRE-based variables and EH which limited their ability to determine the potentially complex, non-linear correlation.…”

Diagnostic Performance of Magnetic Resonance Enterography Disease Activity Indices Compared with a Histological Reference Standard for Adult Terminal Ileal Crohn’s Disease: Experience from the METRIC Trial

“… 14 Roseira and colleagues evaluated the sMARIA index in a series of 84 patients. 25 For identifying active disease, they reported that the per-segment diagnostic accuracy of sMARIA had a sensitivity and specificity of 90% and 98%, respectively. Similarly, Tao et al found the sMARIA score provided a sensitivity of 81.4% and 88.9%, and a specificity of 90.8% and 95.1%, for identifying active and severe CD, respectively, with a Simple Endoscopic Score for Crohn’s Disease [SES-CD] reference standard.…”

Recent advances in clinical practice: advances in cross-sectional imaging in inflammatory bowel disease

“…The sMaRIA has also been validated against endoscopic standards of reference (Crohn's disease endoscopic index of activity [CDEIS] and the simple endoscopic score for Crohn's disease (SES-CD)). [47][48][49] The London and 'extended' scores were derived and validated using a histological standard of reference 50 and were subsequently validated against the CDEIS. 51 The components of the sMaRIA and extended London score are very similar; however, whereas the sMaRIA and London scores can be applied regardless of whether contrast material administration, the extended London score cannot.…”

“…These drawbacks led to the development of the simplified MaRIA (sMaRIA), which requires much less time to calculate, and normal segments do not account in the global score. The sMaRIA has also been validated against endoscopic standards of reference (Crohn's disease endoscopic index of activity [CDEIS] and the simple endoscopic score for Crohn's disease (SES-CD)) 47–49…”