The Simplified MR Index of Activity Score in Pediatric Small-Bowel Crohn Disease: An Interreader Agreement and Responsiveness Study

Dillman, Jonathan R.; Ata, Nadeen Abu; Towbin, Alexander J.; Anton, Christopher; Smith, Ethan A.; Zhang, Bin; Imbus, Rebecca; Tkach, Jean A.; Denson, Lee A.

doi:10.2214/ajr.22.28123

Cited by 5 publications

(3 citation statements)

References 16 publications

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“…Interestingly, we did not nd that classi cation of response using sMaRIA corresponded well to classi cation clinically and the differences in motility index between sMaRIA responders and nonresponders did not reach signi cance. Although sMaRIA is a validated technique, it has been developed for mainly the TI and colon and only tested in a single paediatric small bowel study [7] so may be less well suited to PIBD. The de nition of response using sMaRIA decreasing by ≥ 2 points is based on ulcer healing in adult studies [4], and anecdotally, paediatric disease (particularly in younger children) tends to be in ammatory initially, with a lower prevalence of penetrating disease.…”

Section: Discussionmentioning

confidence: 99%

“…The TI was scored in all cases by both radiologists regardless of whether it visually appeared diseased or normal: it was scored on the MRE slice that captured the worst disease, or if normal, the slice that captured the longest segment of TI. The sMaRIA score was chosen as it has demonstrated reasonable inter reader agreement and has been shown to decrease over time in paediatric Crohn's disease in response to therapy [7]. Each TI segment was classi ed radiologically as "inactive" if there was no active disease at either timepoint (sMaRIA of 0 at both timepoints), "response" (decrease of ≥ 2 points in sMaRIA), or "non-response" (increase, no change, or decrease of 1 point in sMaRIA) [4].…”

Section: Mre Analysismentioning

confidence: 99%

“…It is therefore important to nd reliable, quantitative MRI techniques to measure disease activity and response. MRE disease activity scores, such as the Magnetic Resonance Index of Activity (MaRIA) [3], simpli ed MaRIA (sMaRIA) [4] and Crohn's Disease MRI Index (CDMI) [5], enable a semi-objective and reproducible assessment of disease activity in response to treatment [6,7] and correlate to clinical markers in paediatric Crohn's disease [8]. Although sensitivity and speci city of sMaRIA for evaluating treatment response has been reported as 89% and 87% in adults, respectively [4], scores can be time-consuming to calculate and rely on the measurement of subjective indices which introduce variability [9,10,11].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Quantified small bowel motility assessment on MR enterography in paediatric inflammatory bowel disease – does it reflect clinical response?

Meshaka,

Fitzke,

Barber

et al. 2024

Preprint

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Background Quantified small bowel motility assessment using cine magnetic resonance enterography (MRE) has shown promise as a biomarker in adult inflammatory bowel disease. Whether quantified motility corresponds to treatment response in paediatric inflammatory bowel disease (PIBD) is unknown. Our objective to test whether changes in motility reflect response. Materials and Methods Local ethics approval was granted for this single institution, retrospective study. All children < 18 years with confirmed PIBD, who had > 1 MRE between Jan 2011-Jan 2022 were included. sMaRIA and motility index (quantified motility) at all terminal ileum (TI) and diseased non-TI segments were independently assessed by two radiologists each with ≥ 9 years’ experience. Change in (Δ) motility index was compared to clinical (gastroenterologist physician’s global assessment) and consensus radiological reference standard (response = decrease in sMaRIA ≥ 2) in responders versus non-responders using Mann-Whitney test. Sensitivity and specificity of Δmotility index ≥ 0 was compared to decrease in sMaRIA ≥ 2 for identifying clinical response. Results Of 64 children aged 5–16; 21 out of 64 (33%) were responders, 37 out of 64 (58%) were non-responders and 6 out of 64 (9%) had inactive disease according to clinical reference standard. Δmotility index by both radiologists was higher in responders (+ 16, + 39) than non-responders (-43, -44), p = 0.04, p = 0.009 each radiologist, respectively. Motility index was more sensitive (57% versus 24%), but less specific (67% versus 93%) than sMaRIA in identifying clinical response. Conclusion Motility index on cine MRE corresponds to clinical response, and is more sensitive at detecting response compared to sMaRIA in PIBD.

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Section: Discussionmentioning

confidence: 99%

Section: Mre Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Quantified small bowel motility assessment on MR enterography in paediatric inflammatory bowel disease – does it reflect clinical response?

Meshaka,

Fitzke,

Barber

et al. 2024

Preprint

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Quantitative MRI in children with Crohn’s disease – where do we stand?

Debnath,

Dillman

2024

Pediatr Radiol

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Crohn’s disease (CD) is a chronic inflammatory condition that affects the gastrointestinal tract, particularly the ileum and colon. This disease is characterized by recurrent bouts of intestinal inflammation with subsequent bowel wall damage, including scarring (i.e., fibrosis) and abnormal smooth muscle proliferation. MR enterography, an MRI examination tailored to assess the small bowel, is a first-line diagnostic tool for diagnosing CD in children, characterization and monitoring of disease severity and extent, and assessment of disease-related complications. To date, such MRI evaluations have been mostly qualitative, which can adversely impact diagnostic performance and inter-radiologist agreement. Quantitative MRI methods have been shown to aid in the evaluation of a variety of medical conditions and have been increasingly investigated in children and adults with CD. In CD, such objective techniques have been used to assist with diagnosis, assess treatment response, and characterize bowel wall histologic abnormalities. In the current work, we will review quantitative MRI methods for detecting and measuring intestinal active inflammation (MRI-based scoring systems, T1 relaxation mapping, diffusion-weighted imaging, intra-voxel incoherent motion, mesenteric phase contrast), bowel wall damage (magnetization transfer), and motility (quantitative cine imaging) in small bowel CD, with an emphasis on the pediatric population. Graphical Abstract

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Prospective characterization of intestinal MRI intravoxel incoherent motion in pediatric and young adult patients with newly diagnosed small bowel Crohn’s disease

Alves,

Mahalingam,

Tkach

et al. 2024

Abdom Radiol

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The Simplified MR Index of Activity Score in Pediatric Small-Bowel Crohn Disease: An Interreader Agreement and Responsiveness Study

Cited by 5 publications

References 16 publications

Quantified small bowel motility assessment on MR enterography in paediatric inflammatory bowel disease – does it reflect clinical response?

Quantified small bowel motility assessment on MR enterography in paediatric inflammatory bowel disease – does it reflect clinical response?

Quantitative MRI in children with Crohn’s disease – where do we stand?

Prospective characterization of intestinal MRI intravoxel incoherent motion in pediatric and young adult patients with newly diagnosed small bowel Crohn’s disease

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