1
|
Minordi LM, D’Angelo FB, Privitera G, Papa A, Larosa L, Laterza L, Scaldaferri F, Barbaro B, Carbone L, Pugliese D. Crohn's Disease: Radiological Answers to Clinical Questions and Review of the Literature. J Clin Med 2024; 13:4145. [PMID: 39064186 PMCID: PMC11277847 DOI: 10.3390/jcm13144145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Crohn's disease (CD) is a chronic, progressive inflammatory condition, involving primarily the bowel, characterized by a typical remitting-relapsing pattern. Despite endoscopy representing the reference standard for the diagnosis and assessment of disease activity, radiological imaging has a key role, providing information about mural and extra-visceral involvement. Methods: Computed Tomography and Magnetic Resonance Imaging are the most frequently used radiological techniques in clinical practice for both the diagnosis and staging of CD involving the small bowel in non-urgent settings. The contribution of imaging in the management of CD is reported on by answering the following practical questions: (1) What is the best technique for the assessment of small bowel CD? (2) Is imaging a good option to assess colonic disease? (3) Which disease pattern is present: inflammatory, fibrotic or fistulizing? (4) Is it possible to identify the presence of strictures and to discriminate inflammatory from fibrotic ones? (5) How does imaging help in defining disease extension and localization? (6) Can imaging assess disease activity? (7) Is it possible to evaluate post-operative recurrence? Results: Imaging is suitable for assessing disease activity, extension and characterizing disease patterns. CT and MRI can both answer the abovementioned questions, but MRI has a greater sensitivity and specificity for assessing disease activity and does not use ionizing radiation. Conclusions: Radiologists are essential healthcare professionals to be involved in multidisciplinary teams for the management of CD patients to obtain the necessary answers for clinically relevant questions.
Collapse
Affiliation(s)
- Laura Maria Minordi
- UOC di Radiologia Addomino-Pelvica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Largo Francesco Vito, 1, 00168 Roma, Italy; (F.B.D.)
| | - Francesca Bice D’Angelo
- UOC di Radiologia Addomino-Pelvica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Largo Francesco Vito, 1, 00168 Roma, Italy; (F.B.D.)
| | - Giuseppe Privitera
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20122 Milan, Italy;
| | - Alfredo Papa
- Unità Operativa Semplice Dipartimentale Day Hospital (UOSD DH) Medicina Interna e Malattie dell’Apparato Digerente, Fondazione Policlinico Universitario “A. Gemelli” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, 00168 Roma, Italy;
| | - Luigi Larosa
- UOC di Radiologia Addomino-Pelvica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Largo Francesco Vito, 1, 00168 Roma, Italy; (F.B.D.)
| | - Lucrezia Laterza
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario “A. Gemelli” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Catholic University of Rome, 00168 Rome, Italy; (L.L.); (F.S.); (D.P.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, L. Go A. Gemelli 8, 00168 Rome, Italy
| | - Franco Scaldaferri
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario “A. Gemelli” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Catholic University of Rome, 00168 Rome, Italy; (L.L.); (F.S.); (D.P.)
| | - Brunella Barbaro
- UOC di Radiologia Addomino-Pelvica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Largo Francesco Vito, 1, 00168 Roma, Italy; (F.B.D.)
| | - Luigi Carbone
- UOC Pronto Soccorso, Medicina d’Urgenza e Medicina Interna, Ospedale Isola Tiberina Gemelli Isola, 00186 Rome, Italy;
| | - Daniela Pugliese
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario “A. Gemelli” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Catholic University of Rome, 00168 Rome, Italy; (L.L.); (F.S.); (D.P.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, L. Go A. Gemelli 8, 00168 Rome, Italy
- UOS Gastroenterologia, Ospedale Isola Tiberina Gemelli Isola, 00186 Rome, Italy
| |
Collapse
|
2
|
Balestrieri P, Ribolsi M, Cimini P, Alvaro G, Zobel BB, Tullio A, Cicala M. Wall Thickness Ratio-A New Magnetic Resonance Parameter-Is Associated With the Outcome of Biological Therapy in Patients With Ileal and Ileocolonic Crohn's Disease. J Clin Gastroenterol 2024; 58:64-70. [PMID: 36730458 DOI: 10.1097/mcg.0000000000001809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 10/20/2022] [Indexed: 02/04/2023]
Abstract
GOALS The present study was aimed at identifying a new magnetic resonance enterography (MRE) parameter assessing the clinical outcome of biological therapy in patients with active ileal/ileocolonic Crohn's disease (CD). BACKGROUND Transmural healing (TH) has been associated with improved outcomes in CD. However, some patients with clinical remission and inactive disease at endoscopy do not achieve TH. MATERIALS AND METHODS Ileal/ileocolonic CD patients scheduled for biological therapy were prospectively evaluated, at baseline (T0) and after 1 year of treatment (T1), with Harvey Bradshaw Index score, blood tests, ileocolonscopy, and MRE. Clinical activity was assessed after 2 years of treatment (T2). Wall thickness ratio (WTR) was calculated in the same affected ileal segment, as the ratio between the ileum wall thickness value at T1 and the ileum wall thickness value at T0. RESULTS A total of 103 patients were included. Mean WTR at T1 in nonresponders was significantly higher than in responders. At receiver operating characteristic analysis, WTR values were significantly associated to biological therapy responsiveness. A WTR cutoff value of 0.77 mm was identified to discriminate responders from nonresponders (sensitivity: 79%; specificity: 67%). In responders, the proportion of patients with a WTR<0.77 was significantly higher than the proportion of patients achieving TH at T1. Among patients achieving endoscopic remission, 11/29 (37.9%) presented TH, while 20/29 (68.9%) presented WTR<0.77 ( P : 0.035). At multivariate logistic regression analysis, WTR<0.77 was significantly associated to biological therapy response. CONCLUSION WTR index represents an easy-to-calculate MRE parameter and seems to be a promising tool for monitoring therapeutic response in CD patients during biological therapy.
Collapse
Affiliation(s)
| | | | - Paola Cimini
- Diagnostic Imaging, Campus Bio Medico University of Rome, Roma, Italy
| | - Giuseppe Alvaro
- Diagnostic Imaging, Campus Bio Medico University of Rome, Roma, Italy
| | - Bruno B Zobel
- Diagnostic Imaging, Campus Bio Medico University of Rome, Roma, Italy
| | | | | |
Collapse
|
3
|
Shi L, Wang YD, Shen XD, Mao R, Meng JX, Huang SY, Song T, Li ZP, Feng ST, Lin SC, Peng ZP, Li XH. Clinical outcome is distinct between radiological stricture and endoscopic stricture in ileal Crohn's disease. Eur Radiol 2023; 33:7595-7608. [PMID: 37231068 DOI: 10.1007/s00330-023-09743-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 03/13/2023] [Accepted: 03/26/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Differences in clinical adverse outcomes (CAO) based on different intestinal stricturing definitions in Crohn's disease (CD) are poorly documented. This study aims to compare CAO between radiological strictures (RS) and endoscopic strictures (ES) in ileal CD and explore the significance of upstream dilatation in RS. METHODS This retrospective double-center study included 199 patients (derivation cohort, n = 157; validation cohort, n = 42) with bowel strictures who simultaneously underwent endoscopic and radiologic examinations. RS was defined as a luminal narrowing with wall thickening relative to the normal gut on cross-sectional imaging (group 1 (G1)), which further divided into G1a (without upstream dilatation) and G1b (with upstream dilatation). ES was defined as an endoscopic non-passable stricture (group 2 (G2)). Strictures met the definitions of RS (with or without upstream dilatation) and ES were categorized as group 3 (G3). CAO referred to stricture-related surgery or penetrating disease. RESULTS In the derivation cohort, G1b (93.3%) had the highest CAO occurrence rate, followed by G3 (32.6%), G1a (3.2%), and G2 (0%) (p < 0.0001); the same order was found in the validation cohort. The CAO-free survival time was significantly different among the four groups (p < 0.0001). Upstream dilatation (hazard ratio, 1.126) was a risk factor for predicting CAO in RS. Furthermore, when upstream dilatation was added to diagnose RS, 17.6% of high-risk strictures were neglected. CONCLUSIONS CAO differs significantly between RS and ES, and clinicians should pay more attention to strictures in G1b and G3. Upstream dilatation has an important impact on the clinical outcome of RS but may not be an essential factor for RS diagnosis. CLINICAL RELEVANCE STATEMENT This study explored the definition of intestinal stricture with the greatest significance for the clinical diagnosis and prognosis of patients with CD, and consequently provided effective auxiliary information for clinicians to formulate strategies for the treatment of CD intestinal strictures. KEY POINTS • The retrospective double-center study showed that clinical adverse outcome is different between radiological strictures and endoscopic strictures in CD. • Upstream dilatation has an important impact on the clinical outcome of radiological strictures but may not be an essential factor for diagnosis of radiological strictures. • Radiological stricture with upstream dilatation and simultaneous radiological and endoscopic stricture were at increased risk for clinical adverse outcomes; thus, closer monitoring should be considered.
Collapse
Affiliation(s)
- Li Shi
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, 510150, People's Republic of China
| | - Yang-di Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Xiao-di Shen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Ren Mao
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Ji-Xin Meng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Si-Yun Huang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Ting Song
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, 510150, People's Republic of China
| | - Zi-Ping Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Shao-Chun Lin
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China.
| | - Zhen-Peng Peng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China.
| | - Xue-Hua Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China.
| |
Collapse
|
4
|
Ingenerf M, Schmid-Tannwald C. Diffusion-weighted imaging in Crohn's disease. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:27-33. [PMID: 37603068 DOI: 10.1007/s00117-023-01191-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Diffusion-weighted MRI (DWI) is routinely used in abdominal imaging. In addition to neoplastic diseases, inflammatory changes can be delineated and diagnosed based on diffusion restriction in DWI. DWI is also increasingly used in the context of MRI of the small and large intestine. OBJECTIVE This article focuses on the technical aspects of DWI and its role in the diagnosis of Crohn's disease (CD) as well as in the grading of disease severity and in treatment monitoring. MATERIALS AND METHODS Guidelines, basic research papers, and review articles were analyzed. RESULTS Diffusion-weighted MRI is a specialized MRI technique that visualizes the diffusion of water molecules in biological tissues. In the context of MRI of the small and large intestine, DWI facilitates the diagnosis of inflammatory bowel disease and assessment of treatment response. DWI enables detection of not only intra- and transmural changes, but also extramural pathologies and complications. However, DWI also has its limitations and challenges. CONCLUSION This article provides a comprehensive overview of the use of DWI for diagnostic evaluation of bowel wall changes and extramural complications in the setting of CD. It also summarizes the relevant evidence available in the literature.
Collapse
Affiliation(s)
- Maria Ingenerf
- Department of Radiology, University Hospital, LMU Munich, Ziemssenstr. 5, 80336, Munich, Germany
| | | |
Collapse
|
5
|
Wessling J, Kucharzik T, Bettenworth D, Luegering A, Maaser C, Grenacher L, Juchems MS, Ringe KI, Lauenstein T, Schreyer AG. Intestinal MRI in Inflammatory Bowel Disease - Literature and Survey-Based Recommendations regarding Reporting by the German Radiological Society (DRG) and the German Competence Network for Inflammatory Bowel Diseases. ROFO-FORTSCHR RONTG 2023; 195:675-690. [PMID: 37137321 DOI: 10.1055/a-2036-7190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND MR-enterography/enteroclysis (MRE) is increasingly used for primary diagnosis, detection of complications, and monitoring of patients with inflammatory bowel disease (IBD). Standardization of reporting is relevant to ensure quality of the methodology and to improve communication between different faculties. The current manuscript describes the features that are required for optimized reporting of MRE in IBD. METHODS An expert consensus panel of radiologists and gastroenterologists conducted a systematic search of the literature. In a Delphi process, members of the German Radiological Society (DRG) and members of the Competence Network for Inflammatory Bowel Diseases voted on relevant criteria for the reporting of findings in MRE. Based on the voting results, statements were developed by the expert consensus panel. RESULTS Clinically relevant aspects of MRE findings have been defined to optimize reporting and to standardize terminology. Minimal requirements for standardized reporting are suggested. The statements focus on the description of disease activity as well as on complications of IBD. Attributes of intestinal inflammation are described and illustrated by exemplary images. CONCLUSION The current manuscript provides standardized parameters and gives practical recommendations on how to report and how to characterize MRE findings in patients with IBD. KEY POINTS · Systematic overview provides practice-oriented recommendations and names and evaluates the decisive criteria for reporting and interpretation of MRI in inflammatory bowel disease.. · Standardized terminology and reporting criteria for MRI in IBD improves interdisciplinary communication.. · Standardized collection and documentation of MRI findings in IBD helps to further establish the method and to improve care for IBD patients.. CITATION FORMAT · Wessling J, Kucharzik T, Bettenworth D et al. Intestinal MRI in Inflammatory Bowel Disease - Literature and Survey-Based Recommendations regarding Reporting by the German Radiological Society (DRG) and the German Competence Network for Inflammatory Bowel Diseases. Fortschr Röntgenstr 2023; 195: 675 - 690.
Collapse
Affiliation(s)
| | - Torsten Kucharzik
- Department of Gastroenterology, Lüneburg Municipal Hospital Clinic for General Internal Medicine and Gastroenterology, Lüneburg, Germany
| | - Dominik Bettenworth
- Department for CED, praxis for internal medicine and CED, Himmelreichallee 37-41, Muenster, Germany
| | - Andreas Luegering
- center for gastrointestinal diseases, mvz portal 10 Muenster, Germany
| | - Christian Maaser
- Department of Gastroenterology, Lüneburg Municipal Hospital Clinic for General Internal Medicine and Gastroenterology, Lüneburg, Germany
| | - Lars Grenacher
- Imaging and Prevention Center, Conradia Radiology Munich, Germany
| | - Markus S Juchems
- Department of interventional and diagnostic radiology, Schmieder Hospitals - Hospital Konstanz, Germany
| | | | - Thomas Lauenstein
- Department of Radiology, Evangelical Hospital Düsseldorf Medical Clinic, Düsseldorf, Germany
| | - Andreas G Schreyer
- Institute of diagnostic and interventional radiology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg a. d. Havel, Germany
| |
Collapse
|
6
|
Ukashi O, Yablecovitch D, Lahat A, Selinger L, Neuman S, Eliakim R, Ben-Horin S, Kopylov U. Middle small-bowel segment Lewis score may predict long-term outcomes among patients with quiescent Crohn's disease. Therap Adv Gastroenterol 2023; 16:17562848231188587. [PMID: 37533708 PMCID: PMC10392190 DOI: 10.1177/17562848231188587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/02/2023] [Indexed: 08/04/2023] Open
Abstract
Background Video capsule endoscopy (VCE) has been proven to accurately diagnose small-bowel inflammation and predict flares among patients with quiescent Crohn's disease (CD). However, data regarding its predictive role in this population over an extended follow-up are scarce. Objectives To predict clinical exacerbation and to assess the yield of Lewis score in identifying CD patients with future clinical exacerbation during an extended follow-up (>24 months). Design A post hoc analysis study. Methods Adult patients with quiescent small-bowel CD who were followed with VCE, inflammatory biomarkers and magnetic resonance enterography in a prospective study (between 2013 and 2018). We extracted extended clinical data (up to April 2022). The primary composite outcome (i.e. clinical exacerbation) was defined as intestinal surgery, endoscopic dilation, CD-related admission, corticosteroid administration, or biological/immunomodulator treatment change during follow-up. Results Of the 61 patients in the study [median age 29 (24-37) years, male 57.4%, biologic treatment 46.7%], 18 patients met the primary outcome during an extended follow-up [median 58.0 (34.5-93.0) months]. On univariable analysis, complicated [hazard ratio (HR) 7.348, p = 0.002] and stricturing disease phenotype (HR 5.305, p = 0.001) were associated with higher risk for clinical exacerbation during follow-up. A baseline VCE middle small-bowel segment Lewis score (midLS) ⩾ 135 identified patients with future exacerbation [AUC (area under the curve) 0.767, 95% confidence interval (CI) 0.633-0.902, p = 0.001, HR 6.317, 93% negative predictive value], whereas the AUC of the conventional Lewis score was 0.734 (95% CI: 0.589-0.879, p = 0.004). Sensitivity analysis restricted to patients with either complicated (n = 34) or stricturing (n = 26) disease phenotype revealed that midLS still predicted clinical exacerbation during follow-up (AUC 0.747/0.753, respectively), in these patients. Conclusion MidLS predicts treatment failure in quiescent CD patients (median follow-up of 5 years) independently of disease phenotype.
Collapse
Affiliation(s)
| | - Doron Yablecovitch
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Lahat
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Limor Selinger
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sandra Neuman
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rami Eliakim
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shomron Ben-Horin
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | |
Collapse
|
7
|
Maccioni F, Busato L, Valenti A, Cardaccio S, Longhi A, Catalano C. Magnetic Resonance Imaging of the Gastrointestinal Tract: Current Role, Recent Advancements and Future Prospectives. Diagnostics (Basel) 2023; 13:2410. [PMID: 37510154 PMCID: PMC10378103 DOI: 10.3390/diagnostics13142410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
This review focuses on the role of magnetic resonance imaging (MRI) in the evaluation of the gastrointestinal tract (GI MRI), analyzing the major technical advances achieved in this field, such as diffusion-weighted imaging, molecular imaging, motility studies, and artificial intelligence. Today, MRI performed with the more advanced imaging techniques allows accurate assessment of many bowel diseases, particularly inflammatory bowel disease and rectal cancer; in most of these diseases, MRI is invaluable for diagnosis, staging, and disease monitoring under treatment. Several MRI parameters are currently considered activity biomarkers for inflammation and neoplastic disease. Furthermore, in younger patients with acute or chronic GI disease, MRI can be safely used for short-term follow-up studies in many critical clinical situations because it is radiation-free. MRI assessment of functional gastro-esophageal and small bowel disorders is still in its infancy but very promising, while it is well established and widely used for dynamic assessment of anorectal and pelvic floor dysfunction; MRI motility biomarkers have also been described. There are still some limitations to GI MRI related to high cost and limited accessibility. However, technical advances are expected, such as faster sequences, more specific intestinal contrast agents, AI analysis of MRI data, and possibly increased accessibility to GI MRI studies. Clinical interest in the evaluation of bowel disease using MRI is already very high, but is expected to increase significantly in the coming years.
Collapse
Affiliation(s)
- Francesca Maccioni
- Department of Radiological Sciences, Pathology and Oncology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Ludovica Busato
- Department of Radiological Sciences, Pathology and Oncology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Alessandra Valenti
- Department of Radiological Sciences, Pathology and Oncology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Sara Cardaccio
- Department of Radiological Sciences, Pathology and Oncology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Alessandro Longhi
- Department of Radiological Sciences, Pathology and Oncology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Pathology and Oncology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| |
Collapse
|
8
|
Tavares de Sousa H, Magro F. How to Evaluate Fibrosis in IBD? Diagnostics (Basel) 2023; 13:2188. [PMID: 37443582 DOI: 10.3390/diagnostics13132188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
In this review, we will describe the importance of fibrosis in inflammatory bowel disease (IBD) by discussing its distinct impact on Crohn's disease (CD) and ulcerative colitis (UC) through their translation to histopathology. We will address the existing knowledge on the correlation between inflammation and fibrosis and the still not fully explained inflammation-independent fibrogenesis. Finally, we will compile and discuss the recent advances in the noninvasive assessment of intestinal fibrosis, including imaging and biomarkers. Based on the available data, none of the available cross-sectional imaging (CSI) techniques has proved to be capable of measuring CD fibrosis accurately, with MRE showing the most promising performance along with elastography. Very recent research with radiomics showed encouraging results, but further validation with reliable radiomic biomarkers is warranted. Despite the interesting results with micro-RNAs, further advances on the topic of fibrosis biomarkers depend on the development of robust clinical trials based on solid and validated endpoints. We conclude that it seems very likely that radiomics and AI will participate in the future non-invasive fibrosis assessment by CSI techniques in IBD. However, as of today, surgical pathology remains the gold standard for the diagnosis and quantification of intestinal fibrosis in IBD.
Collapse
Affiliation(s)
- Helena Tavares de Sousa
- Gastroenterology Department, Algarve University Hospital Center, 8500-338 Portimão, Portugal
- ABC-Algarve Biomedical Center, University of Algarve, 8005-139 Faro, Portugal
| | - Fernando Magro
- Unit of Pharmacology and Therapeutics, Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Department of Gastroenterology, São João University Hospital Center, 4200-319 Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| |
Collapse
|
9
|
Gladkikh M, Benchimol EI, Mack DR, Mojaverian N, Highmore K, Miller E, Davila J. MR Enterography Scores Correlate with Degree of Mucosal Healing in Pediatric Crohn's Disease: A Pilot Study. J Can Assoc Gastroenterol 2023; 6:125-130. [PMID: 37273972 PMCID: PMC10235592 DOI: 10.1093/jcag/gwad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Objectives MR enterography (MRE) Index of Activity (MaRIA) and Clermont are validated scores that correlate with Crohn's disease (CD) activity; however, the Clermont score has not been validated to correlate with the degree of change in mucosal inflammation post induction treatment in children. This pilot study evaluated if MaRIA and Clermont scores can serve as surrogates to ileocolonoscopy for assessing interval change in mucosal inflammation in pediatric CD post-induction treatment. Methods Children with known or newly diagnosed ileocolonic CD starting or changing therapy underwent ileocolonoscopy, scored with simple endoscopic score for Crohn's disease (SES-CD), and MRE on the same day at two time points (Week 0 and 12). Accuracy of global MaRIA and Clermont indices relative to ileocolonoscopy in detecting degree of post-treatment interval change in mucosal inflammation was assessed through correlational coefficients (r). Inter-reader agreement was calculated for imaging scores through intraclass correlation (ICC). Results Sixteen children (mean age 11.5 ± 2.8) were evaluated. Global MaRIA/Clermont correlated with SES-CD in detecting the degree of change in mucosal inflammation (r = 0.676 and r = 0.677, P < 0.005, respectively). Correlation for pooled timepoint assessments between SES-CD and global MaRIA/Clermont was moderate (r = 0.546, P < 0.001 and r = 0.582, P < 0.001, respectively). Inter-rater reliability for global MaRIA and Clermont was good (ICC = 0.809 and ICC = 0.768, respectively, P < 0.001). Conclusions MRE-based global scores correlate with endoscopic indices and may be used to monitor disease changes in children with CD undergoing induction treatment, which can advise the physician if treatment changes should be made.
Collapse
Affiliation(s)
- Maria Gladkikh
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medical Imaging, McMaster University, Hamilton, Ontario, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - David R Mack
- Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Nassim Mojaverian
- Institute for Clinical Evaluative Sciences, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kerri Highmore
- Department of Medical Imaging, CHEO, Ottawa, Ontario, Canada
- Faculty of Medicine, Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Elka Miller
- Department of Medical Imaging, CHEO, Ottawa, Ontario, Canada
- Faculty of Medicine, Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Jorge Davila
- Correspondence: Jorge Davila, MD, FRCPC, Department of Medical Imaging, CHEO, 401 Smyth Road, Ottawa, Ontario K1H 8L1, Canada, e-mail:
| |
Collapse
|
10
|
Jannatdoust P, Valizadeh P, Razaghi M, Rouzbahani M, Abbasi A, Arian A. Role of abbreviated non-contrast-enhanced MR-enterography in the evaluation of Crohn's disease activity and complications as an alternative for full protocol contrast-enhanced study: A systematic review and meta-analysis. RESEARCH IN DIAGNOSTIC AND INTERVENTIONAL IMAGING 2023; 6:100030. [PMID: 39077544 PMCID: PMC11265495 DOI: 10.1016/j.redii.2023.100030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/24/2023] [Indexed: 07/31/2024]
Abstract
Background Crohn's disease (CD) is a chronic disorder that often starts at a young age and involves periods of remission and relapse. Prompt diagnosis of relapses through screening is crucial due to the potential morbid complications of untreated active inflammation. Magnetic resonance enterography (MRE) is a noninvasive technique to screen for active inflammation. The standard protocol involves intravenous injection of contrast agents with potential side effects. Some abbreviated non-contrast-enhanced MRE protocols are proposed as alternatives for conventional MRE to identify active inflammation. Currently, there is controversy regarding the applicability and accuracy of these protocols. This study aims to describe and compare these protocols and evaluate their accuracy in detecting active inflammation and CD complications. Methods Results from a systematic search of three databases in August 2022 were queried and screened by abstract and full text. Eligible studies were qualitatively and quantitatively analyzed by diagnostic test accuracy meta-analysis. Results 59 studies entered the systematic review, and 37 were eligible for meta-analysis. Diffusion-weighted imaging (DWI) and fast T2-weighted (T2w) sequences were most frequently used in abbreviated protocols and showed non-inferior accuracy compared to the full protocol in detecting active inflammation. ADC and qualitative DWI had pooled sensitivity of 90% (CI: 82-95%) and 89% (CI:82-93%) and pooled specificity of 94% (CI: 88-97%) and 89% (CI: 79-94%), respectively for detecting active inflammation. Moreover, T2w and combined T2w+DWI sequences had pooled sensitivity of 80% (CI: 64-90%) and 76% (CI: 61-86%) and pooled specificity of 90% (CI: 80-95%) and 87% (CI: 74 - 94%), respectively. Unenhanced protocols show relatively poor diagnostic accuracy in detecting penetrating complications of CD. Magnetization transfer imaging (MTI) has demonstrated excellent accuracy in detecting fibrosis. High heterogeneity was observed in all subgroups, and accuracy was reported to be highly operator dependent in most studies. Conclusion An abbreviated protocol consisting of DWI and fast T2w imaging can potentially replace the full protocol MRE. Full protocol MRE will still have its role in identifying penetrating complications. MTI should be indicated in case of suspected fibrostenotic disease.
Collapse
Affiliation(s)
- Payam Jannatdoust
- School of Medicine, Tehran University of Medical Science, Tehran, Iran
- Advanced Diagnostic and Interventional Radiologic Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Parya Valizadeh
- School of Medicine, Tehran University of Medical Science, Tehran, Iran
- Advanced Diagnostic and Interventional Radiologic Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahshad Razaghi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Advanced Diagnostic and Interventional Radiologic Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maedeh Rouzbahani
- Advanced Diagnostic and Interventional Radiologic Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirbahador Abbasi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Advanced Diagnostic and Interventional Radiologic Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arvin Arian
- School of Medicine, Tehran University of Medical Science, Tehran, Iran
- Advanced Diagnostic and Interventional Radiologic Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
11
|
Guo X, Cai L, Cao Y, Liu Z, Zhang J, Liu D, Jiang Z, Chen Y, Fu M, Xia Z, Yi G. New pattern of individualized management of chronic diseases: focusing on inflammatory bowel diseases and looking to the future. Front Med (Lausanne) 2023; 10:1186143. [PMID: 37265491 PMCID: PMC10231387 DOI: 10.3389/fmed.2023.1186143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/17/2023] [Indexed: 06/03/2023] Open
Abstract
Non-infectious chronic diseases, especially inflammatory bowel diseases (IBDs), hypertension, and diabetes mellitus, are characterized by a prolonged and multisystemic course, and their incidence increases annually, usually causing serious economic burden and psychological stress for patients. Therefore, these diseases deserve scientific and consistent disease management. In addition, the lack of a comprehensive "early disease clues tracking-personalized treatment system-follow-up" model in hospitals also exacerbates this dilemma. Based on these facts, we propose an individualized prediction management system for IBDs based on chronic diseases, focusing on the established IBDs-related prediction models and summarizing their advantages and disadvantages. We call on researchers to pay attention to the integration of models with clinical practice and the continuous correction of models to achieve truly individualized medical treatment for chronic diseases, thus providing substantial value for the rapid diagnosis and adequate treatment of chronic diseases such as IBDs, which follow the "relapse-remission" disease model, and realizing long-term drug use and precise disease management for patients. The goal is to achieve a new level of chronic disease management by scientifically improving long-term medication, precise disease management, and individualized medical treatment, effectively prolonging the remission period and reducing morbidity and disability rates.
Collapse
Affiliation(s)
- Xi Guo
- Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- School of Rehabilitation Sciences, Southern Medical University, Guangzhou, Guangdong, China
- The Second Clinical School of Southern Medical University, Guangzhou, Guangdong, China
| | - Liyang Cai
- Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- The Second Clinical School of Southern Medical University, Guangzhou, Guangdong, China
| | - Yuchen Cao
- Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- The Second Clinical School of Southern Medical University, Guangzhou, Guangdong, China
- Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zining Liu
- The First Clinical School of Southern Medical University, Guangzhou, Guangdong, China
| | - Jiexin Zhang
- The Third Clinical School of Southern Medical University, Guangzhou, Guangdong, China
| | - Danni Liu
- Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- The Second Clinical School of Southern Medical University, Guangzhou, Guangdong, China
| | - Zhujun Jiang
- The Second Clinical Medical College, Tianjin Medical University, Tianjin, China
| | - Yanxia Chen
- Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Min Fu
- Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- The Second Clinical School of Southern Medical University, Guangzhou, Guangdong, China
| | - Zhaoxia Xia
- The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Guoguo Yi
- The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| |
Collapse
|
12
|
Bae H, Seo N, Kang EA, Cheon JH, Lim JS, Kim MJ. Validation of the simplified magnetic resonance index of activity by using DWI without gadolinium enhancement to evaluate bowel inflammation in Crohn's disease. Eur Radiol 2023; 33:3266-3275. [PMID: 36899087 DOI: 10.1007/s00330-023-09501-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/04/2023] [Accepted: 02/03/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVES To validate the modified simplified magnetic resonance index of activity (sMARIA) score using DWI on non-contrast magnetic resonance enterography (MRE) to evaluate active inflammation in patients with Crohn's disease (CD), compared to the original sMARIA scoring system, with and without contrast enhancement. METHODS This retrospective study included 275 bowel segments from 55 CD patients who underwent ileocolonoscopy and MRE within a 2-week period. Two blinded radiologists evaluated original sMARIA on both conventional MRE (CE-sMARIA) and non-contrast MRE (T2-sMARIA). Modified sMARIA was then evaluated using non-contrast MRE, replacing ulcerations with DWI grades. Three scoring systems were compared for diagnostic accuracy of active inflammation, correlation with simple endoscopic score (SES)-CD, and interobserver reproducibility. RESULTS The AUC of modified sMARIA for detecting active inflammation (0.863, 95% confidence interval [0.803-0.923]) was significantly higher than T2-sMARIA (0.827 [0.773-0.881], p = 0.017), and comparable to CE-sMARIA (0.908 [0.857-0.959], p = 0.122). CE-sMARIA, T2-sMARIA, and modified sMARIA all showed moderate correlation with SES-CD (r = 0.795, 0.722, and 0.777, respectively). Interobserver reproducibility of diffusion restriction (κ, 0.686 [0.602-0.770]) was significantly better than ulcers on conventional MRE (κ, 0.382 [0.212-0.552]; p = 0.001) and T2-weighted image (κ, 0.312 [0.034-0.590]; p = 0.012). CONCLUSIONS Modified sMARIA using DWI can improve the diagnostic performance of sMARIA on non-contrast MRE, showing comparable performance to sMARIA using contrast-enhanced MRE. KEY POINTS • DWI can improve the diagnostic performance of non-contrast magnetic resonance enterography (MRE) for assessing active inflammation in patients with Crohn's disease. • Modified simplified magnetic resonance index of activity (sMARIA) using DWI grades in place of ulcers showed comparable diagnostic performance to sMARIA using conventional MRE with contrast-enhanced sequences.
Collapse
Affiliation(s)
- Heejin Bae
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, Republic of Korea, 03722
| | - Nieun Seo
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, Republic of Korea, 03722.
| | - Eun Ae Kang
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Hee Cheon
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon Seok Lim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, Republic of Korea, 03722
| | - Myeong-Jin Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, Republic of Korea, 03722
| |
Collapse
|
13
|
Replacing Endoscopy with Magnetic Resonance Enterography for Mucosal Activity Assessment in Terminal Ileal Crohn’s Disease: Are We There Yet? Diagnostics (Basel) 2023; 13:diagnostics13061061. [PMID: 36980368 PMCID: PMC10046927 DOI: 10.3390/diagnostics13061061] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/18/2023] Open
Abstract
Crohn’s disease (CD) is a chronic immune mediated disorder that most commonly affects the small bowel and/or the large bowel. Treatment targets in CD include mucosal healing assessed via ileocolonoscopy and transmural healing assessed through cross-sectional imaging modalities such as magnetic resonance enterography (MRE). More recently, histological healing in CD has emerged as a treatment target, though it is made cumbersome given its reliance on frequent endoscopic examinations. With expert guidelines now recommending regular objective assessments as part of a treat-to-target approach, accurate non-invasive assessment will become increasingly critical. MRE has an established role in the assessment of small bowel CD, with growing data supportive of its ability in detecting disease activity at mucosal and histological levels. This could therefore potentially reduce the need for serial endoscopic assessment. Thus, this review will assess the capacity of individual MRE parameters and MRE indices for detecting mucosal and histological small bowel CD activity. Furthermore, challenging scenarios, such as CD activity detection in post-operative clinical scenarios and abnormal findings in the context of a normal ileocolonoscopy, will be explored.
Collapse
|
14
|
Grassi G, Laino ME, Fantini MC, Argiolas GM, Cherchi MV, Nicola R, Gerosa C, Cerrone G, Mannelli L, Balestrieri A, Suri JS, Carriero A, Saba L. Advanced imaging and Crohn’s disease: An overview of clinical application and the added value of artificial intelligence. Eur J Radiol 2022; 157:110551. [DOI: 10.1016/j.ejrad.2022.110551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 11/03/2022]
|
15
|
Focht G, Cytter-Kuint R, Greer MLC, Pratt LT, Castro DA, Church PC, Walters TD, Hyams J, Navon D, Martin de Carpi J, Ruemmele F, Russell RK, Gavish M, Griffiths AM, Turner D. Development, Validation, and Evaluation of the Pediatric Inflammatory Crohn's Magnetic Resonance Enterography Index From the ImageKids Study. Gastroenterology 2022; 163:1306-1320. [PMID: 35872072 DOI: 10.1053/j.gastro.2022.07.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 06/21/2022] [Accepted: 07/17/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND & AIMS Cross-sectional imaging is important in the assessment of transmural inflammation in Crohn's disease (CD). Small bowel involvement is often more extensive in pediatric CD, requiring a panentering measuring tool. We undertook to develop a magnetic resonance enterography (MRE)-based index that would measure inflammation in all segments of the intestine, without rectal contrast. METHODS Children with CD underwent ileocolonoscopy and MRE and half were prospectively followed for 18 months when MRE was repeated. Item generation and reduction were performed by a Delphi panel of pediatric radiologists, a systematic literature review, a cross-sectional study of 48 MREs, and a steering committee. Formatting and weighting were performed using multivariate modeling adjusted by a steering committee. MREs were read locally and centrally. Reliability, validity, and responsiveness were determined using several clinimetric and psychometric approaches. RESULTS Thirty items were initially generated and reduced to 5 using regression analysis on 159 MREs: wall thickness, wall diffusion weighted imaging, ulcerations, mesenteric edema, and comb sign. In the validation cohort of 81 MREs, the weighted global PICMI correlated well with the radiologist global assessment (r = 0.85; P < .001) and with the simple endoscopic score in a subsample with ileocolonic disease (r = 0.63; P < .001). Interobserver and test-retest reliability were high (interclass correlation coefficients, 0.84; 95% confidence interval [CI], 0.79-0.87; and 0.81, 95% CI, 0.65-0.90, respectively; both P < .001). Excellent responsiveness was found at repeated visits (n = 116 MREs; area under the receiver operating characteristic curve 0.96; 95% CI, 0.93-0.99). Transmural healing was defined as PICMI ≤10 and response as a change of >20 points with excellent discriminative validity (area under the receiver operating characteristic curve = 0.96; 95% CI, 0.93-0.99). CONCLUSIONS The PICMI is a valid, reliable, and responsive index for assessing transmural inflammation in pediatric CD. It scores the entire bowel length and does not require intravenous contrast or rectal enema and, therefore, is suitable for use in children. (ClinicalTrials.gov, Number: NCT01881490.).
Collapse
Affiliation(s)
- Gili Focht
- Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ruth Cytter-Kuint
- Radiology Department, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mary-Louise C Greer
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Li-Tal Pratt
- Pediatric Imaging Unit, Imaging Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Denise A Castro
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Diagnostic Radiology, Kingston Health Science Centre, Queen's University, Kingston, Ontario, Canada
| | - Peter C Church
- Department of Gastroenterology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Thomas D Walters
- Department of Gastroenterology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey Hyams
- Connecticut Children's Medical Center, Hartford, Connecticut
| | - Dan Navon
- Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Frank Ruemmele
- Université Paris Descartes - Sorbonne Paris Cité, Assistance Publique - Hôpitaux de Paris, Hôpital Necker Enfants Malades, Service de Gastroentérologie, Paris, France
| | - Richard K Russell
- Department of Paediatric Gastroenterology, Royal Hospital for Sick Children, National Health Services Lothian, Edinburgh, United Kingdom
| | - Matan Gavish
- School of Computer Science and Engineering, The Hebrew University, Jerusalem, Israel
| | - Anne M Griffiths
- Department of Diagnostic Radiology, Kingston Health Science Centre, Queen's University, Kingston, Ontario, Canada
| | - Dan Turner
- Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel.
| |
Collapse
|
16
|
Marija C, Kresimir D, Ognjen B, Iva P, Nenad K, Matija B. Estimation of colon cancer grade and metastatic lymph node involvement using DWI/ADC sequences. Acta Radiol 2022; 64:1341-1346. [PMID: 36197524 DOI: 10.1177/02841851221130008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The potential benefit of neoadjuvant chemotherapy (NAC) in colon cancer is under evaluation. There is a need to improve preoperative non-invasive diagnostics using techniques that provide more accurate staging information in assessing patient eligibility for NAC. PURPOSE To investigate the link between the tumor grade (pathohistological confirmed) and the N status (corresponding to lymph node involvement) with apparent diffusion coefficient (ADC) values. MATERIAL AND METHODS A total of 17 patients planned for surgical resection had a biopsy confirming colon carcinoma and participated in the study. Abdominal magnetic resonance imaging with diffusion-weighted imaging/ADC sequence was recorded before surgery. The tumor and all visible lymph nodes were manually delineated directly on a grayscale ADC map for every single slice and detected to access the total tumor and summarized lymph node volume. The mean ADC value was further calculated for the mean tumor and mean lymph node values. RESULTS Low-grade tumors had a mean ADC equivalent to 1225 ± 170×10-6 mm2/s, and the coefficient of high-grade tumors was 1444 ± 69×10-6 mm2/s. The group of patients with positive lymph nodes in operative tissue samples (N+) exhibited lower mean ADC values (1023 ± 142×10-6 mm2/s) as opposed to the group without metastatic lymph nodes (N-) with ADC values of 1260 ± 231×10-6 mm2/s. CONCLUSION The mean whole-tumor ADC is associated with the histological tumor grade, and the mean ADC value of whole-volume abdominal lymph nodes could assume real nodal infiltration.
Collapse
Affiliation(s)
- Cavar Marija
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Split, Split, Croatia
| | - Dolic Kresimir
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Split, Split, Croatia
| | - Barcot Ognjen
- Department of Abdominal Surgery, 162037University Hospital Split, Split, Croatia
| | - Peric Iva
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Split, Split, Croatia
| | - Kunac Nenad
- Clinical Department for Pathology, Forensic Medicine and Cytology, University Hospital Split, Split, Croatia
| | - Boric Matija
- Department of Abdominal Surgery, 162037University Hospital Split, Split, Croatia
| |
Collapse
|
17
|
Ungar B, Eliakim R. Does pan-enteric capsule endoscopy obviate magnetic resonance entero-colonography in suspected Crohn's disease? United European Gastroenterol J 2022; 10:917-918. [PMID: 36191127 PMCID: PMC9731651 DOI: 10.1002/ueg2.12315] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Bella Ungar
- Department of GastroenterologySheba Medical CenterTel Hashomer, Affiliated to Sackler Medical SchoolTel Aviv UniversityTel AvivIsrael
| | - Rami Eliakim
- Department of GastroenterologySheba Medical CenterTel Hashomer, Affiliated to Sackler Medical SchoolTel Aviv UniversityTel AvivIsrael
| |
Collapse
|
18
|
Brodersen JB, Knudsen T, Kjeldsen J, Juel MA, Rafaelsen SR, Jensen MD. Diagnostic accuracy of pan-enteric capsule endoscopy and magnetic resonance enterocolonography in suspected Crohn's disease. United European Gastroenterol J 2022; 10:973-982. [PMID: 36069336 PMCID: PMC9731660 DOI: 10.1002/ueg2.12307] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/08/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND AND AIMS Magnetic resonance enterocolonography (MREC) and pan-enteric capsule endoscopy (CE) offers visualization of the entire gastrointestinal tract in a single examination. We examined the diagnostic accuracy of MREC and CE in patients with suspected Crohn's disease (CD). METHOD In a prospective, blinded, multicenter study, we included patients with clinically suspected CD. Patients were examined with MREC, CE, and ileocolonoscopy (IC) within 2 weeks. The primary outcome was per patient sensitivity, specificity, and diagnostic accuracy for ileocolonic CD. IC served as reference standard. RESULTS 153 patients were included in the study and IC, MREC, and CE was performed in 152, 151, 133 patients, respectively. CD was diagnosed with IC in 59 (39%) patients (terminal ileum (TI) 22, colon 20, TI and colon 17). The sensitivity and specificity for diagnosing ileocolonic CD with MREC was 67.9% (CI 53.7-80.1) and 76.3% (CI 65.2-85.3) (TI 76.9% and 85.6%; colon 27% and 93%) compared to 87.5% (CI 73.2-95.8) and 87.8% (CI 78.2-94.3) with CE (TI 96.6% and 87.5%; colon 75.0% and 93.0%). The sensitivity of CE was superior to that of MREC (p = 0.02). The patient experienced discomfort was equal with CE and MREC and significantly less than with IC. CONCLUSION In patients with suspected CD, CE has a high sensitivity for diagnosing CD in the TI and colon, which is superior to that of MREC. The sensitivity of MREC for diagnosing CD in the colon is poor. CE could be a patient-friendly alternative to IC in selected patients with suspected CD. Registered at ClinicalTrials.gov: NCT03134586.
Collapse
Affiliation(s)
- Jacob Broder Brodersen
- Department of Internal MedicineSection of GastroenterologyHospital of South West JutlandEsbjergDenmark,Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Torben Knudsen
- Department of Internal MedicineSection of GastroenterologyHospital of South West JutlandEsbjergDenmark,Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Jens Kjeldsen
- Department of Medical GastroenterologyOdense University HospitalOdenseDenmark,Research Unit of Medical GastroenterologyDepartment of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark,OPEN Odense Patient Data Explorative NetworkOdense University HospitalOdenseDenmark
| | - Mie Agerbæk Juel
- Department of Internal MedicineSection of GastroenterologyLillebaelt HospitalVejleDenmark
| | - Søren Rafael Rafaelsen
- Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark,Department of RadiologyLillebaelt HospitalVejleDenmark
| | - Michael Dam Jensen
- Department of Internal MedicineSection of GastroenterologyLillebaelt HospitalVejleDenmark
| |
Collapse
|
19
|
Avila F, Caron B, Hossu G, Ambarki K, Kannengiesser S, Odille F, Felblinger J, Danese S, Choukour M, Laurent V, Peyrin-Biroulet L. Magnetic Resonance Elastography for Assessing Fibrosis in Patients with Crohn's Disease: A Pilot Study. Dig Dis Sci 2022; 67:4518-4524. [PMID: 34802092 DOI: 10.1007/s10620-021-07311-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/01/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients with Crohn's disease can develop intestinal strictures, containing various degrees of inflammation and fibrosis. Differentiation of the main component of a stricturing lesion is the key for defining the therapeutic management. AIMS We assessed for the first time the accuracy of magnetic resonance elastography in detecting intestinal fibrosis and predicting clinical course in patients with Crohn's disease. METHODS This was a prospective study of adult patients with Crohn's disease and magnetic resonance imaging examination, including magnetic resonance elastography, between April 2019 and February 2020. The association between the bowel stiffness value and the degree of fibrosis was evaluated. The relationship between the stiffness value and the occurrence of clinical events was also investigated. RESULTS A total of 69 patients were included. The stiffness value measured by magnetic resonance elastography was correlated with the degree of fibrosis (p < 0.001). A bowel stiffness ≥ 3.57 kPa predicted the occurrence of clinical events with an area under the curve of 0.82 (95% CI 0.71-0.93). Bowel stiffness ≥ 3.57 kPa was associated with an increased risk of clinical events (p < 0.0001). CONCLUSION In Crohn's disease, magnetic resonance elastography is a reliable tool for detecting intestinal fibrosis and predicting a worse disease outcome.
Collapse
Affiliation(s)
- François Avila
- Department of Radiology, University Hospital of Nancy, Vandœuvre-lès-Nancy, France
| | - Bénédicte Caron
- Department of Gastroenterology and NGERE, U1256 INSERM, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Gabriela Hossu
- CIC 1433 Innovation Technologique, INSERM, Université de Lorraine, , CHRU Nancy, Nancy, France.,IADI, U12454, INSERM, Université de Lorraine, CHRU Nancy, Nancy, France
| | | | | | - Freddy Odille
- CIC 1433 Innovation Technologique, INSERM, Université de Lorraine, , CHRU Nancy, Nancy, France.,IADI, U12454, INSERM, Université de Lorraine, CHRU Nancy, Nancy, France
| | - Jacques Felblinger
- CIC 1433 Innovation Technologique, INSERM, Université de Lorraine, , CHRU Nancy, Nancy, France.,IADI, U12454, INSERM, Université de Lorraine, CHRU Nancy, Nancy, France
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milano, Italy
| | - Myriam Choukour
- Department of Gastroenterology and NGERE, U1256 INSERM, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Valérie Laurent
- Department of Radiology, University Hospital of Nancy, Vandœuvre-lès-Nancy, France.,IADI, U12454, INSERM, Université de Lorraine, CHRU Nancy, Nancy, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and NGERE, U1256 INSERM, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France.
| |
Collapse
|
20
|
Ding H, Li J, Jiang K, Gao C, Lu L, Zhang H, Chen H, Gao X, Zhou K, Sun Z. Assessing the inflammatory severity of the terminal ileum in Crohn disease using radiomics based on MRI. BMC Med Imaging 2022; 22:118. [PMID: 35787255 PMCID: PMC9254684 DOI: 10.1186/s12880-022-00844-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 06/21/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Evaluating inflammatory severity using imaging is essential for Crohn's disease, but it is limited by potential interobserver variation and subjectivity. We compared the efficiency of magnetic resonance index of activity (MaRIA) collected by radiologists and a radiomics model in assessing the inflammatory severity of terminal ileum (TI). METHODS 121 patients were collected from two centers. Patients were divided into ulcerative group and mucosal remission group based on the TI Crohn's disease Endoscopic Severity Index. The consistency of bowel wall thickness (BWT), relative contrast enhancement (RCE), edema, ulcer, MaRIA and features of the region of interest between radiologists were described by weighted Kappa test and intraclass correlation coefficient (ICC), and developed receiver operating curve of MaRIA. The radiomics model was established using reproducible features of logistic regression based on arterial staging of T1WI sequences. Delong test was used to compare radiomics with MaRIA. RESULTS The consistency between radiologists were moderate in BWT (ICC = 0.638), fair in edema (κ = 0.541), RCE (ICC = 0.461), MaRIA (ICC = 0.579) and poor in ulcer (κ = 0.271). Radiomics model was developed by 6 reproducible features (ICC = 0.93-0.96) and equivalent to MaRIA which evaluated by the senior radiologist (0.872 vs 0.883 in training group, 0.824 vs 0.783 in validation group, P = 0.847, 0.471), both of which were significantly higher than MaRIA evaluated by junior radiologist (AUC: 0.621 in training group, 0.557 in validation group, all, P < 0.05). CONCLUSION The evaluation of inflammatory severity could be performed by radiomics objectively and reproducibly, and was comparable to MaRIA evaluated by the senior radiologist. Radiomics may be an important method to assist junior radiologists to assess the severity of inflammation objectively and accurately.
Collapse
Affiliation(s)
- Honglei Ding
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Shangcheng District, Hangzhou, 310006, People's Republic of China
| | - Jiaying Li
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Shangcheng District, Hangzhou, 310006, People's Republic of China
| | - Kefang Jiang
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China.,Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Chen Gao
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Shangcheng District, Hangzhou, 310006, People's Republic of China
| | - Liangji Lu
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Huani Zhang
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Shangcheng District, Hangzhou, 310006, People's Republic of China
| | - Haibo Chen
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Shangcheng District, Hangzhou, 310006, People's Republic of China
| | - Xuning Gao
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Shangcheng District, Hangzhou, 310006, People's Republic of China
| | - Kefeng Zhou
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Shangcheng District, Hangzhou, 310006, People's Republic of China.
| | - Zhichao Sun
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Shangcheng District, Hangzhou, 310006, People's Republic of China.
| |
Collapse
|
21
|
Kucharzik T, Tielbeek J, Carter D, Taylor SA, Tolan D, Wilkens R, Bryant RV, Hoeffel C, De Kock I, Maaser C, Maconi G, Novak K, Rafaelsen SR, Scharitzer M, Spinelli A, Rimola J. ECCO-ESGAR Topical Review on Optimizing Reporting for Cross-Sectional Imaging in Inflammatory Bowel Disease. J Crohns Colitis 2022; 16:523-543. [PMID: 34628504 DOI: 10.1093/ecco-jcc/jjab180] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS The diagnosis and follow up of patients with inflammatory bowel disease [IBD] requires cross-sectional imaging modalities, such as intestinal ultrasound [IUS], magnetic resonance imaging [MRI] and computed tomography [CT]. The quality and homogeneity of medical reporting are crucial to ensure effective communication between specialists and to improve patient care. The current topical review addresses optimized reporting requirements for cross-sectional imaging in IBD. METHODS An expert consensus panel consisting of gastroenterologists, radiologists and surgeons convened by the ECCO in collaboration with ESGAR performed a systematic literature review covering the reporting aspects of MRI, CT, IUS, endoanal ultrasonography and transperineal ultrasonography in IBD. Practice position statements were developed utilizing a Delphi methodology incorporating two consecutive rounds. Current practice positions were set when ≥80% of the participants agreed on a recommendation. RESULTS Twenty-five practice positions were developed, establishing standard terminology for optimal reporting in cross-sectional imaging. Assessment of inflammation, complications and imaging of perianal CD are outlined. The minimum requirements of a standardized report, including a list of essential reporting items, have been defined. CONCLUSIONS This topical review offers practice recommendations to optimize and homogenize reporting in cross-sectional imaging in IBD.
Collapse
Affiliation(s)
- Torsten Kucharzik
- Department of Gastroenterology, Klinikum Lüneburg, University of Hamburg, Bögelstr. 1, 21339 Lüneburg, Germany
| | - Jeroen Tielbeek
- Department of Radiology, Spaarne Gasthuis, Boerhaavelaan 22, Haarlem, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Dan Carter
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hasomher, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Damian Tolan
- Radiology Department, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, UK
| | - Rune Wilkens
- Gastrounit, Division of Medicine, Hvidovre University Hospital, Copenhagen, Denmark; Copenhagen Centre for Inflammatory Bowel Disease in Children, Adolescents and Adults, University of Copenhagen, Hvidovre Hospital, Copenhagen, Denmark
| | - Robert V Bryant
- Department of Gastroenterology, The Queen Elizabeth Hospital, Adelaide, South Australia
| | - Christine Hoeffel
- Department of Abdominal Radiology, CHU Reims and CRESTIC, URCA, 51100 Reims, France
| | - Isabelle De Kock
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Christian Maaser
- Outpatient Department of Gastroenterology, Department of Geriatrics, Klinikum Lüneburg, University of Hamburg, Bögelstr. 1, 21339 Lüneburg, Germany
| | - Giovanni Maconi
- Gastroenterology Unit, 'Luigi Sacco' University Hospital, Milan, Italy
| | - Kerri Novak
- Department of Radiology and Medicine, Division of Gastroenterology, University of Calgary, Alberta, Canada
| | - Søren R Rafaelsen
- Department of Radiology, University Hospital of Southern Denmark, Vejle, Denmark
| | - Martina Scharitzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Division of Colon and Rectal Surgery, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Jordi Rimola
- IBD unit, Radiology Department, Hospital Clínic Barcelona, Barcelona, Catalonia, Spain
| |
Collapse
|
22
|
Schaefer M, Laurent V, Grandmougin A, Vuitton L, Bourreille A, Luc A, Clerc-Urmes I, Orry X, Frampas E, De Billy M, Pouillon L, Le Berre C, Gay C, Meyer J, Baumann C, Peyrin-Biroulet L. A Magnetic Resonance Imaging Index to Predict Crohn's Disease Postoperative Recurrence: The MONITOR Index. Clin Gastroenterol Hepatol 2022; 20:e1040-e1049. [PMID: 34216820 DOI: 10.1016/j.cgh.2021.06.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/01/2021] [Accepted: 06/25/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS We developed and validated a magnetic resonance imaging-based index to predict Crohn's disease (CD) postoperative recurrence (POR). METHODS Patients with CD who underwent a postoperative evaluation for recurrence (with colonoscopy and MRI no longer than 105 days apart) were included between 2006 and 2016 in University Hospital of Nancy, France. MRI items with good levels of intra-rater and inter-rater agreement (Gwet's coefficient ≥0.5) were selected. The MRI in Crohn's Disease to Predict Postoperative Recurrence (MONITOR) index's performance was assessed in terms of the area under the receiver operating characteristic curve (AUROC) and accuracy, by considering the Rutgeerts score as the gold standard. The MONITOR index was validated with a bootstrap method and an independent cohort. RESULTS Seventy-three MRI datasets were interpreted by 2 radiologists. Seven items (bowel wall thickness, contrast enhancement, T2 signal increase, diffusion-weighted signal increase, edema, ulcers, and the length of the diseased segment) had a Gwet's coefficient ≥0.5 and were significantly associated with the Rutgeerts score, leading to their inclusion in the MONITOR index. All the items had a weighting of 1, except the "ulcers" item weighting 2.5, reflecting the higher adjusted odds ratio. The AUROC [95% confidence interval] for the prediction of endoscopic POR (Rutgeerts score >i1) was 0.80 [0.70-0.90]. The optimal threshold was a MONITOR index ≥1, giving a sensitivity of 79%, a specificity of 55%, a predictive positive value of 68%, and a predictive negative value of 68%. The bootstrap validation gave an AUROC of 0.85 [0.73-0.97]. In the validation cohort, a MONITOR index ≥1 gave a sensitivity of 87%, a specificity of 75%, a predictive positive value of 84.6%, and a predictive negative value of 75%. CONCLUSIONS The MONITOR index is an efficient, reliable, easy-to-apply tool that can be used in clinical practice to predict the POR of CD.
Collapse
Affiliation(s)
- Marion Schaefer
- Department of Hepatogastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy
| | - Valérie Laurent
- Central Department of Radiology, Nancy University Hospital, Vandoeuvre-lès-Nancy
| | - Aurélie Grandmougin
- Central Department of Radiology, Nancy University Hospital, Vandoeuvre-lès-Nancy
| | - Lucine Vuitton
- Department of Gastroenterology, Besançon University Hospital, Besancon
| | | | - Amandine Luc
- Unit of Methodology, Data Management and Statistic, Nancy University Hospital, Vandoeuvre-lès-Nancy
| | - Isabelle Clerc-Urmes
- Unit of Methodology, Data Management and Statistic, Nancy University Hospital, Vandoeuvre-lès-Nancy
| | - Xavier Orry
- Central Department of Radiology, Nancy University Hospital, Vandoeuvre-lès-Nancy
| | - Eric Frampas
- Department of Radiology, Nantes University Hospital, Nantes
| | | | - Lieven Pouillon
- Department of Hepatogastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy
| | | | - Claire Gay
- Department of Gastroenterology, Besançon University Hospital, Besancon
| | - Jeremy Meyer
- Department of Radiology, Nantes University Hospital, Nantes
| | - Cédric Baumann
- Unit of Methodology, Data Management and Statistic, Nancy University Hospital, Vandoeuvre-lès-Nancy
| | - Laurent Peyrin-Biroulet
- Department of Hepatogastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy; INSERM U1256, Nutrition-Génétique et Exposition aux Risques Environnementaux, Faculté de Médecine, Université de Lorraine, Vandoeuvre-les-Nancy, France.
| |
Collapse
|
23
|
Hyun HK, Yu J, Kang EA, Park J, Park SJ, Park JJ, Kim TI, Kim WH, Cheon JH. Radiology plus ileocolonoscopy versus radiology alone in Crohn's disease: prognosis prediction and mutual agreement. Korean J Intern Med 2022; 37:567-578. [PMID: 34695881 PMCID: PMC9082435 DOI: 10.3904/kjim.2021.233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/30/2021] [Accepted: 08/17/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND/AIMS The optimal tools for monitoring Crohn's disease (CD) are controversial. We compared radiology plus ileocolonoscopy and radiology alone in terms of prognosis prediction and evaluated the agreement between radiologic and ileocolonoscopic findings in patients with CD. METHODS Patients with CD who were followed up with computed tomography enterography (CTE) or magnetic resonance enterography (MRE) alone or CTE or MRE plus ileocolonoscopy were retrospectively recruited. Time to relapse was investigated to evaluate the difference in prognosis using the log-rank and Cox regression tests, and the agreement between radiologic and ileocolonoscopic findings was determined using a kappa value. RESULTS A total of 501 patients with CD in clinical remission who underwent CTE or MRE and/or ileocolonoscopy were analyzed. Of these, 372 (74.3%) patients underwent CTE or MRE alone and 129 (25.7%) patients underwent CTE or MRE plus ileocolonoscopy. The cumulative maintenance rate of clinical remission between the two groups was not significantly different (p = 0.526, log-rank test). In multivariate analysis, age <40 years (hazard ratio [HR], 2.756; 95% confidence interval [CI], 1.263 to 6.013) and a history of steroid use (HR, 2.212; 95% CI, 1.258 to 3.577) were found to independently predict an increased risk for clinical relapse in patients with CD in clinical remission. Radiologic and ileocolonoscopic findings had a moderate degree of agreement (κ = 0.401, -0.094 to 0.142). The comparison of agreement between radiologic and ileocolonoscopic findings was the highest in the anastomotic site (κ = 0.749, -0.168 to 0.377). CONCLUSION Radiology plus ileocolonoscopy was not superior to radiology alone in predicting the prognosis of CD.
Collapse
Affiliation(s)
- Hye Kyung Hyun
- Department of Gastroenterology and Institute of Gastroenterology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin,
Korea
| | - Jongwook Yu
- Department of Gastroenterology and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul,
Korea
| | - Eun Ae Kang
- Department of Gastroenterology and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul,
Korea
| | - Jihye Park
- Department of Gastroenterology and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul,
Korea
| | - Soo Jung Park
- Department of Gastroenterology and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul,
Korea
| | - Jae Jun Park
- Department of Gastroenterology and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul,
Korea
| | - Tae Il Kim
- Department of Gastroenterology and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul,
Korea
| | - Won Ho Kim
- Department of Gastroenterology and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul,
Korea
| | - Jae Hee Cheon
- Department of Gastroenterology and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul,
Korea
| |
Collapse
|
24
|
Bouhnik Y, Le Berre C, Zappa M, Lewin M, Boudiaf M, Zagdanski AM, Frampas E, Oudjit A, Scotto B, Tissier M, Annet L, Aufort S, Yzet T, Cuilleron M, Baudin G, Abitbol V, Cosnes J, Bourreille A, Mary J, Dupas JL, Marteau P, Picon L, Pelletier AL, Altwegg R, Dewit O, Filippi J, Roblin X, Stéfanescu C. Development of a New Index to Assess Small Bowel Inflammation Severity in Crohn's Disease Using Magnetic Resonance Enterography. CROHN'S & COLITIS 360 2022; 4:otac004. [PMID: 36777552 PMCID: PMC9802414 DOI: 10.1093/crocol/otac004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Indexed: 11/14/2022] Open
Abstract
Background The severity of small bowel (SB) inflammation in Crohn's disease (CD) patients is a key component of the therapeutic choice. We aimed to develop a SB-CD Magnetic Resonance Enterography (MRE) index of Inflammation Severity (CDMRIS). Methods Each gastroenterologist/radiologist pair in 13 centers selected MREs from 6 patients with SB-CD stratified on their perceived MRE inflammation severity. The 78 blinded MREs were allocated through balanced incomplete block design per severity stratum to these 13 pairs for rating the presence/severity of 13 preselected items for each SB 20-cm diseased segment. Global inflammation severity was evaluated using a 100-cm visual analog scale. Reproducibility of recorded items was evaluated. The CDMRIS was determined through linear mixed modeling as a combination of the numbers of segments with lesions highly correlated to global inflammation severity. Results Four hundred and forty-two readings were available. Global inflammation severity mean ± SD was 21.0 ± 16.2. The independent predictors explaining 54% of the global inflammation severity variance were the numbers of segments with T1 mild-moderate and severe intensity of enhancement, deep ulceration without fistula, comb sign, fistula, and abscess. Unbiased correlation between CDMRIS and global inflammation severity was 0.76. Conclusions The CDMRIS is now available to evaluate the severity of SB-CD inflammation. External validation and sensitivity-to-change are mandatory next steps.
Collapse
Affiliation(s)
- Yoram Bouhnik
- Service de gastro-entérologie-MICI, AP-HP, Hôpital Beaujon, Clichy, France
| | - Catherine Le Berre
- Institut des Maladies de l’Appareil Digestif, Nantes University Hospital, Nantes, France,Address correspondence to: Catherine Le Berre, MD, Institut des Maladies de l’Appareil Digestif, Nantes University Hospital, 1 place Alexis Ricordeau, 44093 Nantes Cedex 1, France ()
| | - Magaly Zappa
- Service de radiologie, AP-HP, Hôpital Beaujon, Clichy, France
| | - Maïté Lewin
- Service de radiologie, AP-HP, Hôpital Paul Brousse, Villejuif, France
| | - Mourad Boudiaf
- Service de radiologie, AP-HP, Hôpital Cochin, Paris, France
| | | | - Eric Frampas
- Service central de radiologie et imagerie médicale, Nantes University Hospital, Nantes, France
| | - Ammar Oudjit
- Service de radiologie, AP-HP, Hôpital Cochin, Paris, France
| | - Béatrice Scotto
- Service de radiologie, University Hospital of Tours, Tours, France
| | - Muriel Tissier
- Service de radiologie, AP-HP, Hôpital Bichat, Paris, France
| | - Laurence Annet
- Medical Imaging Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - Sophie Aufort
- Service de radiologie, Clinique du Parc, Castelnau Le Lez, France
| | - Thierry Yzet
- Service de radiologie digestive, University Hospital of Amiens-Picardie, Hôpital Sud, Amiens, France
| | - Muriel Cuilleron
- Service de radiologie, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Guillaume Baudin
- Service d’imagerie diagnostique et interventionnelle, Hôpital de L’Archet, Nice, France
| | - Vered Abitbol
- Service d’hépato-gastro-entérologie, AP-HP, Hôpital Cochin, Paris, France
| | - Jacques Cosnes
- Service de gastroentérologie, AP-HP, Hôpital Saint-Antoine, Paris, France
| | - Arnaud Bourreille
- Institut des Maladies de l’Appareil Digestif, Nantes University Hospital, Nantes, France
| | - Jean Yves Mary
- UMR-S-1153 Inserm, Denis Diderot-Paris 7 University, Hôpital Saint-Louis, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Kim PH, Yoon HM, Jung AY, Lee JS, Cho YA. Diagnostic Performance of Diffusion-weighted Imaging for Evaluation of Bowel Inflammation in Paediatric Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. J Crohns Colitis 2022; 16:68-78. [PMID: 34159379 DOI: 10.1093/ecco-jcc/jjab111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS The diagnostic performance of diffusion-weighted imaging magnetic resonance enterography [DWI-MRE] has not been clearly established in a paediatric population. We systematically evaluated the diagnostic performance of DWI-MRE for the detection of bowel inflammation in paediatric patients with suspected or known inflammatory bowel disease [IBD]. METHODS MEDLINE/PubMed, EMBASE, Web of science and the Cochrane library were searched for articles investigating the diagnostic performance of DWI-MRE for the detection of bowel inflammation in paediatric patients with suspected or known IBD up to December 31, 2020. Pooled sensitivity and specificity were calculated using a bivariate random-effects model. Pooled inter-reader agreement for the interpretation of DWI-MRE was also calculated. This study was registered as PROSPERO CRD42021228754. RESULTS Nine studies covering 400 paediatric patients were included. The pooled sensitivity and specificity of DWI-MRE for the detection of bowel inflammation were 0.93 (95% confidence interval [CI], 0.88-0.96) and 0.96 [95% CI, 0.87-0.99], respectively. Substantial heterogeneity was noted in both sensitivity [I2 = 66%; p < 0.01] and specificity [I2 = 94%; p < 0.01]. Meta-regression analysis identified that the use of spasmolytics contributed to higher specificity [0.89-0.99] and that quantitative assessment with an apparent diffusion coefficient cut-off value contributed to lower sensitivity [0.93-0.85] and specificity [0.98-0.72]. The pooled coefficient of inter-reader agreement, including four studies using visual assessment, was 0.97 [95% CI, 0.78-1.00]. CONCLUSIONS DWI-MRE, especially when used with spasmolytics, is accurate for the detection of bowel inflammation in paediatric patients with suspected or known IBD. Quantitative measurement of ADC is not practical for this purpose.
Collapse
Affiliation(s)
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Republic of Korea
| | - Ah Young Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Republic of Korea
| | - Jin Seong Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Republic of Korea
| | - Young Ah Cho
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Republic of Korea
| |
Collapse
|
26
|
Avoiding contrast-enhanced sequences does not compromise the precision of the simplified MaRIA for the assessment of non-penetrating Crohn's disease activity. Eur Radiol 2022; 32:3334-3345. [PMID: 35031844 DOI: 10.1007/s00330-021-08392-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/14/2021] [Accepted: 10/07/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Patients with Crohn's disease (CD) require multiple assessments with magnetic resonance enterography (MRE) from a young age. Standard MRE protocols for CD include contrast-enhanced sequences. Gadolinium deposits in brain tissue suggest avoiding gadolinium could benefit patients with CD. This study aimed to compare the accuracy of the simplified Magnetic Resonance Index of Activity (sMaRIA) calculated with and without contrast-enhanced sequences in determining the response to biologic drugs in patients with CD. METHODS This post hoc analysis of a prospective study included patients with CD with endoscopic ulceration in ≥ 1 intestinal segment starting biologic drug therapy. Two blinded radiologists used the sMaRIA to score images obtained at baseline and week 46 of treatment first using only unenhanced sequences (T2-sMaRIA) and 1 month later using both unenhanced and enhanced images (CE-sMaRIA). We calculated the rates of agreement between T2-sMaRIA, CE-sMaRIA, and ileocolonoscopy for different conceptualizations of therapeutic response. RESULTS A total of 46 patients (median age, 36 years [IQR: 28-47]) were included. Agreement with ileocolonoscopy was similar for CE-sMaRIA and T2-sMaRIA in identifying ulcer healing (kappa = 0.74 [0.55-0.93] and 0.70 [0.5-0.9], respectively), treatment response (kappa = 0.53 [0.28-0.79] and 0.44 [0.17 - 0.71]), and remission (kappa = 0.48 [0.22-0.73] and 0.43 [0.17-0.69]). The standardized effect size was moderate for both CE-sMaRIA = 0.63 [0.41-0.85] p < 0.001 and T2-sMaRIA = 0.58 [0.36-0.80] p < 0.001. CONCLUSIONS sMaRIA with and without contrast-enhanced images accurately classified the response according to different therapeutic endpoints determined by ileocolonoscopy. KEY POINTS • The simplified Magnetic Resonance Index of Activity is accurate for the assessment of Crohn's disease activity, severity, and therapeutic response, using four dichotomic components that can be evaluated without the need of using contrast-enhanced sequences, representing a practical and safety advantage, but concerns have been expressed as to whether the lack of contrast sequences may compromise precision. • The simplified Magnetic Resonance Index of Activity can assess the response to biologic therapy in patients with Crohn's disease without the need for intravenous contrast agents obtaining comparable results without and with contrast-enhanced sequences. • Avoiding intravenous contrast agents could reduce the duration of the MRE examination and its cost and would increase the acceptance and safety of MRE in clinical research in patients with Crohn's disease.
Collapse
|
27
|
Alfarone L, Dal Buono A, Craviotto V, Zilli A, Fiorino G, Furfaro F, D’Amico F, Danese S, Allocca M. Cross-Sectional Imaging Instead of Colonoscopy in Inflammatory Bowel Diseases: Lights and Shadows. J Clin Med 2022; 11:353. [PMID: 35054047 PMCID: PMC8778036 DOI: 10.3390/jcm11020353] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 12/10/2022] Open
Abstract
International guidelines recommend a treat-to-target strategy with a close monitoring of disease activity and therapeutic response in inflammatory bowel diseases (IBD). Colonoscopy (CS) represents the current first-line procedure for evaluating disease activity in IBD. However, as it is expensive, invasive and poorly accepted by patients, CS is not appropriate for frequent and repetitive reassessments of disease activity. Recently, cross-sectional imaging techniques have been increasingly shown as reliable tools for assessing IBD activity. While computed tomography (CT) is hampered by radiation risks, routine implementation of magnetic resonance enterography (MRE) for close monitoring is limited by its costs, low availability and long examination time. Novel magnetic resonance imaging (MRI)-based techniques, such as diffusion-weighted imaging (DWI), can overcome some of these weaknesses and have been shown as valuable options for IBD monitoring. Bowel ultrasound (BUS) is a noninvasive, highly available, cheap, and well accepted procedure that has been demonstrated to be as accurate as CS and MRE for assessing and monitoring disease activity in IBD. Furthermore, as BUS can be quickly performed at the point-of-care, it allows for real-time clinical decision making. This review summarizes the current evidence on the use of cross-sectional imaging techniques as cost-effective, noninvasive and reliable alternatives to CS for monitoring patients with IBD.
Collapse
Affiliation(s)
- Ludovico Alfarone
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy; (L.A.); (A.D.B.); (V.C.); (F.F.)
| | - Arianna Dal Buono
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy; (L.A.); (A.D.B.); (V.C.); (F.F.)
| | - Vincenzo Craviotto
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy; (L.A.); (A.D.B.); (V.C.); (F.F.)
| | - Alessandra Zilli
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, MI, Italy; (A.Z.); (G.F.); (F.D.); (S.D.)
| | - Gionata Fiorino
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, MI, Italy; (A.Z.); (G.F.); (F.D.); (S.D.)
| | - Federica Furfaro
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy; (L.A.); (A.D.B.); (V.C.); (F.F.)
| | - Ferdinando D’Amico
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, MI, Italy; (A.Z.); (G.F.); (F.D.); (S.D.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, MI, Italy
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, MI, Italy; (A.Z.); (G.F.); (F.D.); (S.D.)
| | - Mariangela Allocca
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, MI, Italy; (A.Z.); (G.F.); (F.D.); (S.D.)
| |
Collapse
|
28
|
Li X, Liang D, Huang B. Reply. Gastroenterology 2021; 161:2066-2067. [PMID: 34416275 DOI: 10.1053/j.gastro.2021.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/09/2021] [Accepted: 08/14/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Xuehua Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Dong Liang
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, People's Republic of China
| | - Bingsheng Huang
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, People's Republic of China
| |
Collapse
|
29
|
Ahmad R, Ajlan AM, Eskander AA, Alhazmi TA, Khashoggi K, Wazzan MA, Abduljabbar AH. Magnetic resonance imaging in the management of Crohn's disease: a systematic review and meta-analysis. Insights Imaging 2021; 12:118. [PMID: 34406519 PMCID: PMC8374012 DOI: 10.1186/s13244-021-01064-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/27/2021] [Indexed: 12/11/2022] Open
Abstract
Objectives Crohn’s disease (CD) is a condition that can occur in any part of the gastrointestinal tract, although usually forms in the colon and terminal ileum. Magnetic resonance imaging (MRI) has become a beneficial modality in the evaluation of small bowel activity. This study reports on a systematic review and meta-analysis of magnetic resonance enterography for the prediction of CD activity and evaluation of outcomes and possible complications. Methods Following the PRISMA guidelines, a total of 25 low-risk studies on established CD were selected, based on a QUADAS-II score of ≥ 9. Results A sensitivity of 90% was revealed in a pooled analysis of the 19 studies, with heterogeneity of χ2 = 81.83 and I2 of 80.3%. Also, a specificity of 89% was calculated, with heterogeneity of χ2 = 65.12 and I2 of 70.0%. Conclusion It was concluded that MRI provides an effective alternative to CT enterography in the detection of small bowel activity in CD patients under supervision of radiologist for assessment of disease activity and its complications. Its advantages include the avoidance of radiation exposure and good diagnostic accuracy.
Collapse
Affiliation(s)
- Rani Ahmad
- Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Amr M Ajlan
- Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ayman A Eskander
- Department of Medicine, Umm Al Qura University, Makkah, Saudi Arabia
| | - Turki A Alhazmi
- Department of Medicine, Umm Al Qura University, Makkah, Saudi Arabia
| | - Khalid Khashoggi
- Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammad A Wazzan
- Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed H Abduljabbar
- Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
30
|
Chang HC, Chen G, Chung HW, Wu PY, Liang L, Juan CJ, Liu YJ, Tse MLD, Chan A, Zhang S, Chiu KWH. Multi-shot Diffusion-Weighted MRI With Multiplexed Sensitivity Encoding (MUSE) in the Assessment of Active Inflammation in Crohn's Disease. J Magn Reson Imaging 2021; 55:126-137. [PMID: 34169600 DOI: 10.1002/jmri.27801] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Single-shot diffusion-weighted imaging (ssDWI) has been shown useful for detecting active bowel inflammation in Crohn's disease (CD) without MRI contrast. However, ssDWI suffers from geometric distortion and low spatial resolution. PURPOSE To compare conventional ssDWI with higher-resolution ssDWI (HR-ssDWI) and multi-shot DWI based on multiplexed sensitivity encoding (MUSE-DWI) for evaluating bowel inflammation in CD, using contrast-enhanced MR imaging (CE-MRI) as the reference standard. STUDY TYPE Prospective. SUBJECTS Eighty nine patients with histological diagnosis of CD from previous endoscopy (55 male/34 female, age: 17-69 years). FIELD STRENGTH/SEQUENCES: ssDWI (2.7 mm × 2.7 mm), HR-ssDWI (1.8 mm × 1.8 mm), MUSE-DWI (1.8 mm × 1.8 mm) based on echo-planar imaging, T2-weighted imaging, and CE-MRI sequences, all at 1.5 T. ASSESSMENT Five raters independently evaluated the tissue texture conspicuity, geometry accuracy, minimization of artifacts, diagnostic confidence, and overall image quality using 5-point Likert scales. The diagnostic performance (sensitivity, specificity and accuracy) of each DWI sequences was assessed on per-bowel-segment basis. STATISTICAL TESTS Inter-rater agreement for qualitative evaluation of each parameter was measured by the intra-class correlation coefficient (ICC). Paired Wilcoxon signed-rank tests were performed to evaluate the statistical significance of differences in qualitative scoring between DWI sequences. A P value <0.05 was considered to be statistically significant. RESULTS Tissue texture conspicuity, geometric distortions, and overall image quality were significantly better for MUSE-DWI than for ssDWI and HR-ssDWI with good agreement among five raters (ICC: 0.70-0.89). HR-ssDWI showed significantly poorer performance to ssDWI and MUSE-DWI for all qualitative scores and had the worst diagnostic performance (sensitivity of 57.0% and accuracy of 87.3%, with 36 undiagnosable cases due to severe artifacts). MUSE-DWI showed significantly higher sensitivity (97.5% vs. 86.1%) and accuracy (98.9% vs. 95.1%) than ssDWI for detecting bowel inflammation. DATA CONCLUSION MUSE-DWI was advantageous in assessing bowel inflammation in CD, resulting in improved spatial resolution and image quality. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 2.
Collapse
Affiliation(s)
- Hing-Chiu Chang
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Guangtao Chen
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Hsiao-Wen Chung
- Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
| | - Philip Yuguang Wu
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Liyuan Liang
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Chun-Jung Juan
- Department of Medical Imaging, Chinese Medical University Hsinchu Hospital, Hsinchu, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Medical Imaging, Chinese Medical University Hospital, Taichung, Taiwan
| | - Yi-Jui Liu
- Department of Automatic Control Engineering, Feng Chia University, Taichung, Taiwan
| | | | - Arren Chan
- Department of Radiology, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Sailong Zhang
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Keith Wan-Hang Chiu
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| |
Collapse
|
31
|
Abstract
ABSTRACT In this review article, we present the latest developments in quantitative imaging biomarkers based on magnetic resonance imaging (MRI), applied to the diagnosis, assessment of response to therapy, and assessment of prognosis of Crohn disease. We also discuss the biomarkers' limitations and future prospects. We performed a literature search of clinical and translational research in Crohn disease using diffusion-weighted MRI (DWI-MRI), dynamic contrast-enhanced MRI (DCE-MRI), motility MRI, and magnetization transfer MRI, as well as emerging topics such as T1 mapping, radiomics, and artificial intelligence. These techniques are integrated in and combined with qualitative image assessment of magnetic resonance enterography (MRE) examinations. Quantitative MRI biomarkers add value to MRE qualitative assessment, achieving substantial diagnostic performance (area under receiver-operating curve = 0.8-0.95). The studies reviewed show that the combination of multiple MRI sequences in a multiparametric quantitative fashion provides rich information that may help for better diagnosis, assessment of severity, prognostication, and assessment of response to biological treatment. However, the addition of quantitative sequences to MRE examinations has potential drawbacks, including increased scan time and the need for further validation before being used in therapeutic drug trials as well as the clinic.
Collapse
|
32
|
Wilkens R, Novak KL, Maaser C, Panaccione R, Kucharzik T. Relevance of monitoring transmural disease activity in patients with Crohn's disease: current status and future perspectives. Therap Adv Gastroenterol 2021; 14:17562848211006672. [PMID: 33948115 PMCID: PMC8053830 DOI: 10.1177/17562848211006672] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/11/2021] [Indexed: 02/04/2023] Open
Abstract
Treatment targets of inflammatory bowel diseases (IBD), ulcerative colitis (UC) and Crohn's disease (CD) have evolved over the last decade. Goals of therapy consisting of symptom control and steroid sparing have shifted to control of disease activity with endoscopic remission being an important endpoint. Unfortunately, this requires ileocolonoscopy, an invasive procedure. Biomarkers [C-reactive protein (CRP) and fecal calprotectin (FCP)] have emerged as surrogates for endoscopic remission and disease activity, but also have limitations. Despite this evolution, we must not lose sight that CD involves transmural inflammation, not fully appreciated with ileocolonoscopy. Therefore, transmural assessment of disease activity by cross-sectional imaging, in particular with magnetic resonance enterography (MRE) and intestinal ultrasonography (IUS), is vital to fully understand disease control. Bowel-wall thickness (BWT) is the cornerstone in assessment of transmural inflammation and BWT normalization, with or without bloodflow normalization, the key element demonstrating resolution of transmural inflammation, namely transmural healing (TH) or transmural remission (TR). In small studies, achievement of TR has been associated with improved long-term clinical outcomes, including reduced hospitalization, surgery, escalation of treatment, and a decrease in clinical relapse over endoscopic remission alone. This review will focus on the existing literature investigating the concept of TR or residual transmural disease and its relation to other existing treatment targets. Current data suggest that TR may be the next logical step in the evolution of treatment targets.
Collapse
Affiliation(s)
- Rune Wilkens
- Gastrounit, Division of Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Copenhagen, Denmark
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, University of Copenhagen, Hvidovre Hospital, Denmark
| | - Kerri L. Novak
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada
| | - Christian Maaser
- Inflammatory Bowel Disease Outpatient Unit, Department of Geriatric Medicine, University Teaching Hospital Lueneburg, Lueneburg, Germany
| | - Remo Panaccione
- Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada
| | - Torsten Kucharzik
- Department of Gastroenterology, University Teaching Hospital Lueneburg, Bögelstraße 1, Lueneburg 21339, Germany
| |
Collapse
|
33
|
Mainenti PP, Castiglione F, Rispo A, Laccetti E, Guarino S, Romeo V, Testa A, Pace L, Maurea S. MR-enterography in Crohn's disease: what MRE mural parameters are associated to one-year therapeutic management outcome? Br J Radiol 2021; 94:20200844. [PMID: 33186053 DOI: 10.1259/bjr.20200844] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To investigate the association of mural parameters of MR-enterography (MRE) with one-year therapeutic management of Crohn's disease (CD) patients. METHODS CD patients, undergone MRE with diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps between January 2017 and June 2018, were retrospectively enrolled. Extramural complications represented an exclusion criterion because of their potential influence on the intrinsic characteristic of the bowel wall. Two groups of patients were defined on the base of the therapeutic management adopted at 1-year follow-up: Medical-group and surgical-group. The following MRE parameters were evaluated: wall-thickening, longitudinal-extension, T2-fat-suppression-mural-signal, ulcers, mural-oedema, wall-enhancement-rate/pattern, DWI-scores, ADC-values, strictures. RESULTS 70 CD patients were enrolled. 57/70 (81.4%) were included in Medical-group and 13/70 (18.6%) in Surgical-group. ADCmean and strictures resulted to be significantly (p < 0.01) different between the two groups. The ADCmean showed to be significantly associated to conservative management [p < 0.01; OR: 0.0003; 95% CI (0.00-0.13)], while the strictures to surgical management [p < 0.01; OR: 29.7; 95% CI (4.9-179.7)]. ROC curves for ADCmean showed that AUC was 0.717 [95% CI (0.607-0.810), p < 0.01] with an optimal cut-off value of 1.081 × 10-3 mm2 s-1. A negative predictive value of 90.2% was observed associating ADCmean values > 1.081 × 10-3 mm2 s-1 to conservative therapy. 13/17 (76%) strictures with an ADCmean > 1.081 × 10-3 mm2 s-1 benefited of conservative therapy. CONCLUSION ADCmean values calculated on DWI-MRE may be associated to 1-year conservative medical therapy in patients with CD without extramural complications. ADVANCES IN KNOWLEDGE ADC maps may be proposed to select CD patients with a lower burden of mural active inflammatory cells and/or fibrosis benefiting of 1-year conservative treatment.
Collapse
Affiliation(s)
- Pier Paolo Mainenti
- Institute of Biostructures and Bioimaging of the National Council of Research (CNR), Naples, Italy
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Naples, Italy
| | - Antonio Rispo
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Naples, Italy
| | - Ettore Laccetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Salvatore Guarino
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Valeria Romeo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Anna Testa
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Naples, Italy
| | - Leonardo Pace
- Department of Medicine and Surgery, University of Salerno, Fisciano, Italy
| | - Simone Maurea
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| |
Collapse
|
34
|
Shaoul R, Day AS. An Overview of Tools to Score Severity in Pediatric Inflammatory Bowel Disease. Front Pediatr 2021; 9:615216. [PMID: 33912519 PMCID: PMC8075054 DOI: 10.3389/fped.2021.615216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 03/15/2021] [Indexed: 01/07/2023] Open
Abstract
Background and Aims: The management of IBD entails the use of various treatments (nutrition, medications, and surgery) in order to induce and maintain remission. The assessment of IBD disease activity is based on a combination of symptoms, clinical findings, imaging, and endoscopic procedures. As in any disease, reliable assessment of disease activity or severity is required in order to plan relevant follow-up, decide on appropriate investigations, determine the best treatment option and subsequently assess response to treatment. It is important for proper documentation, follow-up, assessment of response to treatment and communication, especially in patients with IBD, to talk the same language by using validated and widely used scores for disease activity, endoscopic and radiologic activity, and patient reported outcomes both for clinical practice and research. This review aims to highlight key tools available for the assessment of disease activity or severity in individuals (especially children) with IBD. Methods: A literature search was performed using MEDLINE, Pubmed, and the Cochrane Library with the last search date of August 2020. Tools evaluating disease severity across various aspects (clinical, endoscopic, and radiological) were identified and discussed. Those tools validated and specific for children with IBD were included were available. Results: Over time a number of scoring systems have been developed to quantify clinical, endoscopic and imaging assessments in individuals with IBD. While some are exclusively for children or adults, others appear to have relevance to all age groups. In addition, some tools developed in adult populations are utilized in children, but have not expressly been validated in this age group. Conclusions: Although some available scoring tools are appropriate for children with IBD, others require consideration. The development and use of pediatric-specific tools is relevant and appropriate to optimal care of children and adolescents with IBD.
Collapse
Affiliation(s)
- Ron Shaoul
- Pediatric Gastroenterology & Nutrition Institute, Ruth Children's Hospital of Haifa, Rambam Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Andrew S Day
- Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
| |
Collapse
|
35
|
Scott RA, Williams HG, Hoad CL, Alyami A, Ortori CA, Grove JI, Marciani L, Moran GW, Spiller RC, Menys A, Aithal GP, Gowland PA. MR Measures of Small Bowel Wall
T2
Are Associated With Increased Permeability. J Magn Reson Imaging 2020; 53:1422-1431. [DOI: 10.1002/jmri.27463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/24/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Robert A. Scott
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre at the Nottingham University Hospitals NHS Trust and University of Nottingham Nottingham UK
- Nottingham Digestive Diseases Centre University of Nottingham Nottingham UK
| | - Hannah G. Williams
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre at the Nottingham University Hospitals NHS Trust and University of Nottingham Nottingham UK
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy University of Nottingham Nottingham UK
| | - Caroline L. Hoad
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre at the Nottingham University Hospitals NHS Trust and University of Nottingham Nottingham UK
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy University of Nottingham Nottingham UK
| | - Ali Alyami
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre at the Nottingham University Hospitals NHS Trust and University of Nottingham Nottingham UK
| | - Catherine A. Ortori
- Centre for Analytical Bioscience, School of Pharmacy University of Nottingham Nottingham UK
| | - Jane I. Grove
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre at the Nottingham University Hospitals NHS Trust and University of Nottingham Nottingham UK
- Nottingham Digestive Diseases Centre University of Nottingham Nottingham UK
| | - Luca Marciani
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre at the Nottingham University Hospitals NHS Trust and University of Nottingham Nottingham UK
- Nottingham Digestive Diseases Centre University of Nottingham Nottingham UK
| | - Gordon W. Moran
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre at the Nottingham University Hospitals NHS Trust and University of Nottingham Nottingham UK
- Nottingham Digestive Diseases Centre University of Nottingham Nottingham UK
| | - Robin C. Spiller
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre at the Nottingham University Hospitals NHS Trust and University of Nottingham Nottingham UK
- Nottingham Digestive Diseases Centre University of Nottingham Nottingham UK
| | | | - Guruprasad P. Aithal
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre at the Nottingham University Hospitals NHS Trust and University of Nottingham Nottingham UK
- Nottingham Digestive Diseases Centre University of Nottingham Nottingham UK
| | - Penny A. Gowland
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre at the Nottingham University Hospitals NHS Trust and University of Nottingham Nottingham UK
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy University of Nottingham Nottingham UK
| |
Collapse
|
36
|
Rodrigues BL, Mazzaro MC, Nagasako CK, Ayrizono MDLS, Fagundes JJ, Leal RF. Assessment of disease activity in inflammatory bowel diseases: Non-invasive biomarkers and endoscopic scores. World J Gastrointest Endosc 2020; 12:504-520. [PMID: 33362904 PMCID: PMC7739141 DOI: 10.4253/wjge.v12.i12.504] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/06/2020] [Accepted: 11/05/2020] [Indexed: 02/05/2023] Open
Abstract
Inflammatory bowel diseases (IBD) comprise two major forms: Crohn's disease and ulcerative colitis. The diagnosis of IBD is based on clinical symptoms combined with results found in endoscopic and radiological examinations. In addition, the discovery of biomarkers has significantly improved the diagnosis and management of IBD. Several potential genetic, serological, fecal, microbial, histological and immunological biomarkers have been proposed for IBD, and they have been evaluated for clinical routine and clinical trials. Ileocolonoscopy, especially with biopsy collection, has been considered the standard method to diagnose IBD and to assess clinical activity of the disease, but it is limited to the colon and terminal ileum and is considered invasive. For this reason, non-invasive biomarkers are necessary for this type of chronic inflammatory disease, which affects mostly young individuals, as they are expected to have a long follow-up.
Collapse
Affiliation(s)
- Bruno Lima Rodrigues
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-878, São Paulo, Brazil
| | - Márcia Carolina Mazzaro
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-878, São Paulo, Brazil
| | - Cristiane Kibune Nagasako
- Department of Gastroenterology, Gastrocenter, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-878, São Paulo, Brazil
| | - Maria de Lourdes Setsuko Ayrizono
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-878, São Paulo, Brazil
| | - João José Fagundes
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-878, São Paulo, Brazil
| | - Raquel Franco Leal
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-878, São Paulo, Brazil
| |
Collapse
|
37
|
Messadeg L, Hordonneau C, Bouguen G, Goutorbe F, Reimund JM, Goutte M, Boucher AL, Scanzi J, Reymond M, Allimant C, Dapoigny M, Pereira B, Bommelaer G, Buisson A. Early Transmural Response Assessed Using Magnetic Resonance Imaging Could Predict Sustained Clinical Remission and Prevent Bowel Damage in Patients with Crohn's Disease Treated with Anti-Tumour Necrosis Factor Therapy. J Crohns Colitis 2020; 14:1524-1534. [PMID: 32533769 DOI: 10.1093/ecco-jcc/jjaa098] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Magnetic resonance imaging [MRI] is a promising tool to evaluate therapeutic efficacy in ileocolonic Crohn's disease [CD]. AIMS We aimed to assess the feasibility of early MRI evaluation (week 12 [W12]) to predict corticosteroid-free remission [CFREM] at W52 and prevent long-term bowel damage. METHODS All patients with active CD needing anti-tumour necrosis factor [anti-TNF] therapy were consecutively enrolled in this multicentre prospective study. MRI was performed before starting therapy, at W12 and W52. CFREM was defined as Crohn's Disease Activity Index < 150, C-reactive protein < 5 mg/L and faecal calprotectin < 250 µg/g, with no switch of anti-TNF agents, no bowel resection and no therapeutic intensification between W12 and W52. RESULTS Among 46 patients, 22 [47.8%] achieved CFREM at W52. Anti-TNF agents were able to heal almost all CD lesions as soon as W12 [p < 0.05]. Early transmural response defined as a 25% decrease of either Clermont score (odds ratio [OR] = 7.7 [1.7-34.0], p < 0.001) or Magnetic Resonance Index of Activity (OR = 4.2 [1.3-13.3], p = 0.015) was predictive of CFREM at W52. Achieving at least two items on W12-MRI among ulceration healing, disappearance of enlarged lymph nodes or sclerolipomatosis, ΔADC [apparent diffusion coefficient] > +10% or ΔRCE [relative contrast enhancement] > -30% was associated with a likelihood of CFREM at W52 of 84.6% vs 37.5% in patients without transmural response [p < 0.001]. Early transmural response could prevent bowel damage progression over time using Clermont score (hazard ratio = 0.21 [0.0-0.9]; p = 0.037). CONCLUSION Evaluation of early transmural response by MRI is feasible and is a promising end point to monitor therapeutic efficacy in patients with CD.
Collapse
Affiliation(s)
- L Messadeg
- Université Clermont Auvergne, CHU Clermont-Ferrand, Service de Radiologie, Clermont-Ferrand, France
| | - C Hordonneau
- Université Clermont Auvergne, CHU Clermont-Ferrand, Service de Radiologie, Clermont-Ferrand, France
| | - G Bouguen
- CHU Rennes, Univ Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolisms and Cancer), F-35000 Rennes, France
| | - F Goutorbe
- Centre Hospitalier de la côte basque, Service d'Hépato-Gastro Entérologie, Bayonne, France
| | - J M Reimund
- Université de Strasbourg, INSERM UMR_1113 IRFAC, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Service d'Hépato-Gastro Entérologie et d'Assistance Nutritive, Strasbourg, France
| | - M Goutte
- Clermont Auvergne, INSERM, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France
| | - A L Boucher
- CH Issoire, Service d'Hépato-Gastro Entérologie, Issoire, France
| | - J Scanzi
- CH Thiers, Service d'Hépato-Gastro Entérologie, Thiers, France
| | - M Reymond
- Clermont Auvergne, INSERM, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France
| | - C Allimant
- Clermont Auvergne, INSERM, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France
| | - M Dapoigny
- Clermont Auvergne, INSERM, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France
| | - B Pereira
- Université Clermont Auvergne, CHU Clermont-Ferrand, DRCI, Unité de Biostatistiques, Clermont-Ferrand, France
| | - G Bommelaer
- Clermont Auvergne, INSERM, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France
| | - A Buisson
- Clermont Auvergne, INSERM, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France
| |
Collapse
|
38
|
Kitazume Y, Tsuchiya J, Takenaka K, Ohtsuka K, Kimura K, Watanabe R, Fujioka T, Fujii T, Watanabe M, Tateisi U. High b-value computed diffusion-weighted imaging for differentiating bowel inflammation in Crohn's disease. Eur J Radiol 2020; 133:109362. [PMID: 33129103 DOI: 10.1016/j.ejrad.2020.109362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/13/2020] [Accepted: 10/18/2020] [Indexed: 11/27/2022]
Abstract
Purpose This study evaluated whether high b-value computed diffusion-weighted imaging (cDWI) can improve detection and differentiation of bowel inflammation in patients with Crohn's disease (CD). Methods Fifty-four consecutive CD patients who had undergone magnetic resonance enterography (MRE) and ileocolonoscopy (ICS) or balloon-assisted enteroscopy (BAE) were retrospectively studied; cDWI with a b-value = 1500s/mm2 (cDWI1500) was generated using DWI acquired with b-values of 0 and 800 s/mm2 (aDWI800). Overall, 366 bowel segments were evaluated. The signal intensities (SIs) of the bowel lumina were visually assessed on DWI. Bowel wall-to-iliopsoas muscle SI ratios on aDWI800 and cDWI1500 images and apparent diffusion coefficient (ADC) values were measured; visual assessments for lesion detection were performed using a 5-point Likert-like scale on plain MRE with aDWI800, plain MRE with cDWI1500, and contrast-enhanced (CE)-MRE without DWI. The area under the receiver-operating characteristic curve (AUC) was calculated to compare quantitative and qualitative assessments. Results SIs of the intraluminal fluid were shown as comparable to, or lower than background SIs on 157 (44.7 %) and 345 (98.3 %) of 351 segments on aDWI800 and cDWI1500, respectively. AUCs of SI ratios on cDWI1500 images (82.0 %, [95 % confidence interval: 76.6-87.3 %]) were greater than on aDWI800 (75.2 %, [68.2-82.3 %]; p < 0.001), and were close to the ADC values (81.5 % [76.3-86.7 %]; p = 0.76). The AUCs of CE-MRE images were largest, followed by plain MRE with cDWI1500, and plain MRE with aDWI800. Conclusions As it suppresses the SIs of intraluminal fluid and improves contrast between severe and non-severe inflammation, cDWI1500 helps with CD evaluation.
Collapse
Affiliation(s)
- Yoshio Kitazume
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Junichi Tsuchiya
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Kento Takenaka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuo Ohtsuka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koichiro Kimura
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Ryosuke Watanabe
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Tomoyuki Fujioka
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Toshimitsu Fujii
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mamoru Watanabe
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan; TMDU Advanced Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ukihide Tateisi
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| |
Collapse
|
39
|
Greer MLC, Cytter-Kuint R, Pratt LT, Soboleski D, Focht G, Castro DA. Clinical-stage Approaches for Imaging Chronic Inflammation and Fibrosis in Crohn's Disease. Inflamm Bowel Dis 2020; 26:1509-1523. [PMID: 32946578 DOI: 10.1093/ibd/izaa218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Indexed: 02/06/2023]
Abstract
The number of imaging-based indices developed for inflammatory bowel disease as research tools, objectively measuring ileocolonic and perianal activity and treatment response, has expanded in the past 2 decades. Created primarily to assess Crohn's disease (CD), there is increasing adoption of these indices into the clinical realm to guide patient care. This translation has been facilitated by validation in adult and pediatric populations, prompted by simplification of score calculations needed for practical application outside the research environment. The majority of these indices utilize magnetic resonance imaging (MRI), specifically MR enterography (MRE) and pelvic MRI, and more recently ultrasound. This review explores validated indices by modality, anatomic site and indication, including for documentation of the presence and extent of CD, disease progression, complications, and treatment response, highlighting those in clinical use or with the potential to be. As well, it details index imaging features used to quantify chronic inflammatory activity, severity, and to lesser extent fibrosis, in addition to their reference standards and any modifications. Validation in the pediatric population of indices primarily developed in adult cohorts such as the Magnetic Resonance Index of Activity (MaRIA), the Simplified Magnetic Resonance Index of Activity (MARIAs), and the MRE global score (MEGS), together with newly developed pediatric-specific indices, are discussed. Indices that may be predictive of disease course and investigational techniques with the potential to provide future imaging biomarkers, such as multiparametric MRI, are also briefly considered.
Collapse
Affiliation(s)
- Mary-Louise C Greer
- Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | | | - Li-Tal Pratt
- Pediatric Imaging Unit, Imaging Division, Sourasky Medical Center, Tel Aviv, Israel
| | - Don Soboleski
- Department of Diagnostic Imaging, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Gili Focht
- The Juliet Keidan Institute of Pediatric Gastroenterology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Denise A Castro
- Department of Diagnostic Imaging, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
40
|
Capozzi N, Ordás I, Fernandez-Clotet A, Castro-Poceiro J, Rodríguez S, Alfaro I, Sapena V, Masamunt MC, Ricart E, Panés J, Rimola J. Validation of the Simplified Magnetic Resonance Index of Activity [sMARIA] Without Gadolinium-enhanced Sequences for Crohn's Disease. J Crohns Colitis 2020; 14:1074-1081. [PMID: 32080712 DOI: 10.1093/ecco-jcc/jjaa030] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Gadolinium-enhanced sequences are not included in the simplified Magnetic Resonance Index of Activity [sMARIA], but in the derivation of this index readers had access to these sequences. The current study aimed to validate the sMARIA without gadolinium-enhanced sequences for assessing disease activity, severity, and response to treatment in patients with Crohn's disease. METHODS We prospectively included patients with active Crohn's disease and at least one segment with severe inflammation [ulcers] at ileocolonoscopy, who required treatment with biologic drugs. Patients were evaluated by both magnetic resonance enterography [MRE] and ileocolonoscopy at baseline and 46 weeks after initiation of medical treatment. We compared the quantification of disease activity and response to treatment with sMARIA versus with ileocolonoscopy Crohn's Disease Index of Severity [CDEIS], considered the gold standard. RESULTS Data from both MRE and ileocolonoscopy 46 weeks after treatment initiation were available for 39 of the 50 patients. As in the derivation study, the optimal cutoffs were sMARIA ≥1 for predicting active disease (area under the curve [AUC] 0.92) and sMARIA ≥2 for predicting the presence of ulcers at ileocolonoscopy [AUC 0.93]. In evaluating the response to treatment, the sMARIA detected endoscopic ulcer healing at the segment level [sMARIA <2] with 89.5% sensitivity and 87.5% specificity. The sMARIA decreased significantly [p <0.001] in segments achieving endoscopic ulcer healing, but did not change [p = 0.222] in segments with persistent ulceration. CONCLUSIONS The sMARIA is accurate and reliable in quantifying disease activity and response to treatment in luminal Crohn's disease, without the need for gadolinium-enhanced sequences.
Collapse
Affiliation(s)
- Nunzia Capozzi
- Radiology Department IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Radiology Department, Policlinico Universitario Sant'Orsola-Malpighi, Bologna, Italy
| | - Ingrid Ordás
- Gastroenterology Department. IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Hepaticas y Digestivas [CIBERehd], Spain.,University of Barcelona, Barcelona, Spain
| | | | - Jesús Castro-Poceiro
- Gastroenterology Department. IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Sonia Rodríguez
- Radiology Department IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ignacio Alfaro
- Gastroenterology Department. IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Gastroenterology Department, Hospital Regional de Concepción, Concepción, Chile
| | - Víctor Sapena
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria Carme Masamunt
- Gastroenterology Department. IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Elena Ricart
- Gastroenterology Department. IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Hepaticas y Digestivas [CIBERehd], Spain.,University of Barcelona, Barcelona, Spain
| | - Julian Panés
- Gastroenterology Department. IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Hepaticas y Digestivas [CIBERehd], Spain.,University of Barcelona, Barcelona, Spain
| | - Jordi Rimola
- Radiology Department IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Hepaticas y Digestivas [CIBERehd], Spain
| |
Collapse
|
41
|
Radiological Response Is Associated with Better Outcomes and Should Be Considered a Therapeutic Target in Crohn's Disease. Dig Dis Sci 2020; 65:2664-2674. [PMID: 31811438 DOI: 10.1007/s10620-019-05979-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/27/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of the study was to identify factors associated with a radiological response and to assess the impact of radiological improvement in long-term outcomes in small bowel (SB) Crohn's disease (CD) patients. METHODS We performed a retrospective study from June 2011 to June 2017 in the tertiary center, Claude Huriez Hospital in Lille, France. All SB CD patients, who underwent two magnetic resonance enterographies (MRE) 3-12 months apart, with at least 1-year follow-up after the second MRE, were included. Signs of radiological inflammation were identified by two expert radiologists in CD. Patients were classified as radiological responders (RR) and non-responders (NR). Hospitalization rates, adjustment of treatment, and surgical or endoscopic interventions were assessed and compared between RR and NR. Factors associated with a radiological response were also studied using the Cox model. RESULTS One hundred and fifteen SB CD patients were included with a median follow-up of 17 months (IQR 11.6-28.3). There were 54 (47%) RR and 61 (53%) NR. The risk of surgical or endoscopic intervention was higher in NR than RR (p = 0.04), and the median delay until a surgical or endoscopic intervention was shorter in NR (p = 0.04). Multifocal disease, a hypersignal on diffusion-weighted or dynamic contrast-enhanced imaging, a stricture, or a fistula was significantly associated with a decreased probability of a radiological response (p < 0.05). CONCLUSION This study shows that a radiological response is associated with a decreased risk of surgical or endoscopic intervention and should be considered as a therapeutic target in CD patients.
Collapse
|
42
|
Abstract
BACKGROUND Intestinal fibrosis is a key feature of Crohn's Disease lesions, and mucosal biopsies do not exactly represent transmural damage. Magnetic resonance enterography (MRE) allows for a panoramic study of the bowel loops. Diffusion-weighted imaging (DWI) through the restriction of the apparent diffusion coefficient (ADC) allows for an accurate evaluation of disease activity in Crohn's Disease patients avoiding contrast agents. The aim of this study was to investigate whether DWI sequences were able to identify intestinal fibrosis in candidates for surgery, using histopathology as the gold standard. MATERIALS AND METHODS Thirty Crohn's Disease patients undergoing surgery for stricturing ileo-colonic disease were consecutively enrolled from October 2010 to November 2015. All patients underwent MRE with DWI before surgery. Radiological parameters were calculated in the stenotic segment and in the ileum proximal to the stenosis. The histopathological examination was performed using a histological score for fibrosis and inflammation. RESULTS ADC value correlated with the fibrosis score (r = -0.648; p < 0.0001), inflammation score (r = -0.763; p < 0.0001) and percentage of gain (r = -0.687; p < 0.0001). A correlation emerged between wall thickness and fibrosis score (r = 0.671; p < 0.0001). The threshold of wall thickness for fibrosis was > 6.3 mm (AUC 0.89, specificity 100% and sensitivity 69.23%). The cut-off of ADC value for fibrosis was < 1.1 × 10-3 mm2 s-1 with a sensitivity of 72% and specificity of 94% (AUC = 0.83). CONCLUSIONS The DWI sequence with ADC value could be useful to identify fibrosis in the intestinal wall of Crohn's Disease patients.
Collapse
|
43
|
Roseira J, Ventosa AR, de Sousa HT, Brito J. 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. United European Gastroenterol J 2020; 8:1208-1216. [PMID: 32664824 DOI: 10.1177/2050640620943089] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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.
Collapse
Affiliation(s)
- Joana Roseira
- Gastroenterology Department, Centro Hospitalar Universitário do Algarve, Portimão, Portugal.,ABC - Algarve Biomedical Center, Portimão, Portugal
| | - Ana Rita Ventosa
- ABC - Algarve Biomedical Center, Portimão, Portugal.,Radiology Department, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - Helena Tavares de Sousa
- Gastroenterology Department, Centro Hospitalar Universitário do Algarve, Portimão, Portugal.,ABC - Algarve Biomedical Center, Portimão, Portugal
| | - Jorge Brito
- ABC - Algarve Biomedical Center, Portimão, Portugal.,Radiology Department, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| |
Collapse
|
44
|
Minordi LM, Larosa L, Papa A, Cimino G, Bevere A, Brizi MG, Manfredi R. A review of Magnetic Resonance Enterography classification and quantitative evaluation of active disease in patients with Crohn's disease. Clin Imaging 2020; 69:50-62. [PMID: 32653818 DOI: 10.1016/j.clinimag.2020.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/04/2020] [Accepted: 06/01/2020] [Indexed: 12/21/2022]
Abstract
Crohn's disease (CD) is a chronic inflammation of the gastro-intestinal system in which episodes of clinical worsening alternate with episodes of clinical regression. Monitoring of disease is mandatory to evaluate the efficacy of therapy and it is usually performed using a combination of clinical symptoms, laboratory tests, endoscopy and radiological exams, such as MR enterography or CT enterography. MR enterography should be preferred to CT enterography because of the absence of ionizing radiation, a very high soft tissue contrast, and a lower incidence of adverse events. In 2003, Maglinte introduced a radiological classification to identify patients in different stages of disease (active inflammatory, fibrostenotic and fistulising/perforating subtypes), based on following parameters: oedema, ulcers, stenosis, mural thickening, stratified contrast enhancement, engorged vasa recta, fistulae/abscess and mesenteric inflammation. In general, medical therapy is efficient in reducing inflammation while fibrotic disease and fistulising subtypes usually require surgery. Moreover, in patients with active CD it is important to quantify disease activity in order to adequately plan therapy and to monitor drug effects, by using some MR enterography indexes such as MaRIA score, Clermont index, and others. In this review we describe how to apply Maglinte's classification in MR enterography exams and how to quantify active disease.
Collapse
Affiliation(s)
- Laura Maria Minordi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia Diagnostica e Interventistica Generale, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Largo Francesco Vito, 1, 00168 Roma, Italy.
| | - Luigi Larosa
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia Diagnostica e Interventistica Generale, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Largo Francesco Vito, 1, 00168 Roma, Italy
| | - Alfredo Papa
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Largo Francesco Vito, 1, 00168 Roma, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Gastroenterologia, Largo Francesco Vito, 1, 00168 Roma, Italy
| | - Giovanni Cimino
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Largo Francesco Vito, 1, 00168 Roma, Italy
| | - Antonio Bevere
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Largo Francesco Vito, 1, 00168 Roma, Italy
| | - Maria Gabriella Brizi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia Diagnostica e Interventistica Generale, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Largo Francesco Vito, 1, 00168 Roma, Italy; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Largo Francesco Vito, 1, 00168 Roma, Italy
| | - Riccardo Manfredi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia Diagnostica e Interventistica Generale, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Largo Francesco Vito, 1, 00168 Roma, Italy; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Largo Francesco Vito, 1, 00168 Roma, Italy
| |
Collapse
|
45
|
Which MRI Score and Technique Should Be Used for Assessing Crohn's Disease Activity? J Clin Med 2020; 9:jcm9061691. [PMID: 32498279 PMCID: PMC7355690 DOI: 10.3390/jcm9061691] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/13/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023] Open
Abstract
Magnetic resonance (MR) enterography is assuming an increasingly important and central role in the management of patients with Crohn’s disease, as it is not only involved in diagnosis and staging of the disease but also allows for patients’ follow-up, evaluating the response to therapy, and predicting disease outcomes. Several MR scores have been developed but unfortunately there is no globally accepted score. The most widely used scores are the Magnetic Resonance Index of Activity (MaRIA) score, the London score, the Nancy score, and the Clermont score; however, there are multiple differences between these tools in terms of the assessed radiological items, fasting, administration of oral or intravenous contrast, and the use of diffusion-weighted images. Here we reviewed the main characteristics of each MR scoring system to clarify which is the most appropriate score for monitoring disease activity in both clinical practice and clinical trials.
Collapse
|
46
|
Nachand D, Gandhi NS. Imaging of bowel in patients requiring surgery for Crohn's disease. SEMINARS IN COLON AND RECTAL SURGERY 2020. [DOI: 10.1016/j.scrs.2020.100741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
47
|
Apine I, Pitura R, Franckevica I, Pokrotnieks J, Krumina G. Comparison between Diffusion-Weighted Sequences with Selective and Non-Selective Fat Suppression in the Evaluation of Crohn's Disease Activity: Are They Equally Useful? Diagnostics (Basel) 2020; 10:diagnostics10060347. [PMID: 32471191 PMCID: PMC7345577 DOI: 10.3390/diagnostics10060347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 11/17/2022] Open
Abstract
Background: We compared the efficiency of two MRI diffusion weighted imaging (DWI) techniques: DWI with SPIR (DWISPIR) and DWI with STIR (DWISTIR), to estimate their eligibility for quantitative assessment of Crohn’s disease activity in children and adults. Methods: In inflamed terminal ileum segments (n = 32 in adults, n = 46 in children), Magnetic Resonance Index of Activity (MaRIA) was calculated, ADC values of both DWI techniques were measured, and the corresponding Clermont scores calculated. ADC values of both DWI techniques were compared between both and within each patient group, assessing their mutual correlation. Correlations between MaRIA and the corresponding ADC values, and Clermont scores based on both DWI techniques were estimated. Results: No correlation between ADC of DWISPIR and DWISTIR was observed (rho = 0.27, p = 0.13 in adults, rho = 0.20, p = 0.17 in children). The correlation between MaRIA and Clermont scores was strong in both techniques—in SPIR, rho = 0.93; p < 0.0005 in adults, rho = 0.98, p < 0.0005 in children, and, in STIR, rho = 0.89; p < 0.0005 in adults, rho = 0.95, p < 0.0005 in children. The correlation between ADC and MaRIA was moderate negative for DWISTIR (rho = 0.93, p < 0.0005 in adults, rho = 0.95, p < 0.0005 in children), but, in DWISTIR, no correlation between ADC and MaRIA score was observed in adults (rho = −0.001, p = 0.99), whereas children presented low negative correlation (rho = −0.374, p = 0.01). Conclusions: DWISTIR is not suitable for quantitative assessment of Crohn’s disease activity both in children and adult patients.
Collapse
Affiliation(s)
- Ilze Apine
- Children Clinical University Hospital of Riga, LV 1004 Riga, Latvia;
- Department of Radiology, Riga Stradin’s University, LV 1004 Riga, Latvia; (R.P.); (G.K.)
- Correspondence: ; Tel.: +371-2946-1616
| | - Reinis Pitura
- Department of Radiology, Riga Stradin’s University, LV 1004 Riga, Latvia; (R.P.); (G.K.)
| | - Ivanda Franckevica
- Children Clinical University Hospital of Riga, LV 1004 Riga, Latvia;
- Department of Pathology, Riga Stradin’s University, LV 1007 Riga, Latvia
| | - Juris Pokrotnieks
- Department of Internal Diseases, Riga Stradin’s University, LV 1007 Riga, Latvia;
| | - Gaida Krumina
- Department of Radiology, Riga Stradin’s University, LV 1004 Riga, Latvia; (R.P.); (G.K.)
| |
Collapse
|
48
|
Allocca M, Danese S, Laurent V, Peyrin-Biroulet L. Use of Cross-Sectional Imaging for Tight Monitoring of Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol 2020; 18:1309-1323.e4. [PMID: 31812657 DOI: 10.1016/j.cgh.2019.11.052] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/06/2019] [Accepted: 11/15/2019] [Indexed: 02/07/2023]
Abstract
A treat-to-target strategy with close monitoring of intestinal inflammation is recommended in inflammatory bowel disease (IBD). Ileocolonoscopy remains the gold standard for assessing disease activity in IBD but is a relatively invasive procedure and is impossible to repeat in the context of tight monitoring strategies. In addition to biomarkers, cross-sectional imaging increasingly is used in these patients. Computed tomography is limited by the use of radiation, while the use of magnetic resonance enterography (MRE) is limited by its cost and access. There is growing interest in bowel ultrasound that represents a cost-effective, noninvasive, and well-tolerated modality in clinical practice, but it is operator dependent. Compared with ileocolonoscopy and MRE, bowel US has been shown to have the same level of accuracy in assessing and monitoring disease activity for both CD and UC and thus can be considered a point-of-care test. Diffusion-weighted imaging (DWI) is a MR imaging technique that increasingly is used in both IBD and non-IBD conditions and has been shown to be a valuable and accurate tool for assessing and monitoring IBD activity. Compared with conventional MRE, DWI is quicker, less time consuming, may not require intravenous contrast agent, fasting, bowel cleansing, oral preparation, or rectal preparation. This review discusses the role of these cross-sectional imaging techniques for the management of patients with IBD. In the near future, the value of DWI and ultrasound in assessing IBD will require further investigation in the era of transmural healing in CD and complete mucosal healing, including histologic remission, in ulcerative colitis.
Collapse
Affiliation(s)
- Mariangela Allocca
- Inflammatory Bowel Disease Centre, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Silvio Danese
- Inflammatory Bowel Disease Centre, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Valérie Laurent
- Department of Radiology, Nancy University Hospital, Lorraine University, Vandœuvre-lès-Nancy, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Inserm NGERE, University Hospital of Nancy, Lorraine University, Nancy, France.
| |
Collapse
|
49
|
Durayski E, Watte G, Pacini GS, Roman DH, Machado MB, Marchiori E, Hochhegger B, Baldisserotto M. Diffusion-weighted imaging and apparent diffusion coefficient values for evaluating terminal ileitis in patients with Crohn's disease. Radiol Bras 2020; 52:361-367. [PMID: 32047329 PMCID: PMC7007048 DOI: 10.1590/0100-3984.2019.0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective: To determine the accuracy of diffusion-weighted imaging (DWI) in identifying terminal ileitis in patients with Crohn’s disease. Materials and Methods: This was a retrospective study of 38 consecutive patients with Crohn’s disease who underwent magnetic resonance enterography with DWI in a 3.0 T scanner. The patients were divided into two groups, on the basis of colonoscopy and biopsy findings: active inflammation; and inactive disease. Apparent diffusion coefficient (ADC) values were determined, as were the magnetic resonance index of activity (MaRIA) and the Clermont score. Results: Of the 38 patients evaluated, 18 (47%) had active inflammation. The patients with active inflammation showed greater restricted diffusion, more pronounced mucosal edema, greater wall thickening, a higher MaRIA, and a higher Clermont score than did those with inactive disease. The level of interobserver agreement (intraclass correlation coefficient) was excellent for the MaRIA and the Clermont score, whereas it was substantial for the ADC values. For identifying colonoscopy-proven inflammation, the best ADC cut-off point was 2.1 × 10−3 mm2/s, which had a sensitivity of 88.8% and a specificity of 95.0%, whereas DWI presented an overall accuracy of 89.4%, with a sensitivity of 88.9% and a specificity of 90.0%. Conclusion: Visual analysis of the DWI sequence has good accuracy in detecting terminal ileitis in patients with Crohn’s disease. In addition, low ADC values have good sensitivity for detecting colonoscopy-proven inflammation.
Collapse
Affiliation(s)
- Evandra Durayski
- School of Medicine, Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Guilherme Watte
- School of Medicine, Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.,Medical Imaging Research Lab (Labimed), Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Gabriel Sartori Pacini
- Medical Imaging Research Lab (Labimed), Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Diego Hermindo Roman
- School of Medicine, Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Marta Brenner Machado
- School of Medicine, Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Edson Marchiori
- Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Bruno Hochhegger
- School of Medicine, Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.,Medical Imaging Research Lab (Labimed), Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Matteo Baldisserotto
- School of Medicine, Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| |
Collapse
|
50
|
Guimarães LS, Greer MLC, Dillman JR, Fletcher JG. Magnetic Resonance in Crohn’s Disease. Magn Reson Imaging Clin N Am 2020; 28:31-44. [DOI: 10.1016/j.mric.2019.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|