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Morimoto-Ishikawa D, Hyodo T, Komeda Y, Fukushima H, Itoh M, Ueda Y, Kudo M, Saito S, Ishii K. Quantitative Evaluation of Noncontrast Magnetic Resonance Enterography for Active Inflammation in Crohn Disease Using Native T1 and T2 Mapping. J Comput Assist Tomogr 2024:00004728-990000000-00346. [PMID: 39143666 DOI: 10.1097/rct.0000000000001654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
PURPOSE The aim of this study was to investigate the utility of native T1 and T2 mapping in the bowel to evaluate disease activity in Crohn disease (CD) using endoscopy as the reference standard. METHODS This was a prospective study. Magnetic resonance imaging was performed by using a 1.5-T Philips scanner. We used a modified look-locker inversion recovery and a multiecho gradient-spin-echo sequences for single breath-hold native T1 and T2 maps, respectively, for the short-axis image of the intestine, and the measurement at the most severe site was compared with partial Simple Endoscopic Score for Crohn's Disease (pSES-CD, assessed by an expert endoscopist). A pSES-CD ≥ 4 indicated active disease. Statistical analyses were performed using the Student t test, Spearman correlation, and receiver operating characteristic curve analysis. RESULTS A total of 27 patients (mean age ± standard deviation, 37 ± 18 years; 20 men, 7 women) were included in this study. The native T1 value of active disease was significantly higher than that of inactive disease (1170.8 ± 100.5 milliseconds vs 924.5 ± 95.3 milliseconds; P = 0.018), but the T2 value was not significantly different between active and inactive disease (76.1 ± 7.8 milliseconds vs 69.3 ± 10.9 milliseconds; P = 0.424). A good correlation was found between native T1 value and pSES-CD (ρ = 0.71; P < 0.001) but not between T2 value and pSES-CD (ρ = 0.06; P = 0.790). The area under the receiver operating characteristic curve for differentiating the disease activity was 0.96 (95% confidence interval [CI]: 0.90-1.00) for T1 values and 0.68 (95% confidence interval: 0.41-0.96) for T2 values. CONCLUSIONS Native T1 mapping could be potentially used as a noninvasive method to differentiate disease activity in patients with CD and may be superior to T2 mapping for this purpose.
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Affiliation(s)
| | | | - Yoriaki Komeda
- Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama
| | | | - Makoto Itoh
- From the Radiology Center, Kindai University Hospital, Osaka
| | - Yu Ueda
- Philips Japan, Minato-ku, Tokyo
| | - Masatoshi Kudo
- Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama
| | - Shigeyoshi Saito
- Division of Health Sciences, Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Rieder F, Baker ME, Bruining DH, Fidler JL, Ehman EC, Sheedy SP, Heiken JP, Ream JM, Holmes DR, Inoue A, Mohammadinejad P, Lee YS, Taylor SA, Stoker J, Zou G, Wang Z, Rémillard J, Carter RE, Ottichilo R, Atkinson N, Siddiqui MT, Sunkesula VC, Ma C, Parker CE, Panés J, Rimola J, Jairath V, Feagan BG, Fletcher JG. Reliability of MR Enterography Features for Describing Fibrostenosing Crohn Disease. Radiology 2024; 312:e233039. [PMID: 39105637 DOI: 10.1148/radiol.233039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
Background Clinical decision making and drug development for fibrostenosing Crohn disease is constrained by a lack of imaging definitions, scoring conventions, and validated end points. Purpose To assess the reliability of MR enterography features to describe Crohn disease strictures and determine correlation with stricture severity. Materials and Methods A retrospective study of patients with symptomatic terminal ileal Crohn disease strictures who underwent MR enterography at tertiary care centers (Cleveland Clinic: September 2013 to November 2020; Mayo Clinic: February 2008 to March 2019) was conducted by using convenience sampling. In the development phase, blinded and trained radiologists independently evaluated 26 MR enterography features from baseline and follow-up examinations performed more than 6 months apart, with no bowel resection performed between examinations. Follow-up examinations closest to 12 months after baseline were selected. Reliability was assessed using the intraclass correlation coefficient (ICC). In the validation phase, after five features were redefined, reliability was re-estimated in an independent convenience sample using baseline examinations. Multivariable linear regression analysis identified features with at least moderate interrater reliability (ICC ≥0.41) that were independently associated with stricture severity. Results Ninety-nine (mean age, 40 years ± 14 [SD]; 50 male) patients were included in the development group and 51 (mean age, 45 years ± 16 [SD]; 35 female) patients were included in the validation group. In the development group, nine features had at least moderate interrater reliability. One additional feature demonstrated moderate reliability in the validation group. Stricture length (ICC = 0.85 [95% CI: 0.75, 0.91] and 0.91 [95% CI: 0.75, 0.96] in development and validation phase, respectively) and maximal associated small bowel dilation (ICC = 0.74 [95% CI: 0.63, 0.80] and 0.73 [95% CI: 0.58, 0.87] in development and validation group, respectively) had the highest interrater reliability. Stricture length, maximal stricture wall thickness, and maximal associated small bowel dilation were independently (regression coefficients, 0.09-3.97; P < .001) associated with stricture severity. Conclusion MR enterography definitions and scoring conventions for reliably assessing features of Crohn disease strictures were developed and validated, and feature correlation with stricture severity was determined. © RSNA, 2024 Supplemental material is available for this article. See also the article by Rieder and Ma et al in this issue. See also the editorial by Galgano and Summerlin in this issue.
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Affiliation(s)
- Florian Rieder
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Mark E Baker
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - David H Bruining
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Jeff L Fidler
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Eric C Ehman
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Shannon P Sheedy
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Jay P Heiken
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Justin M Ream
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - David R Holmes
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Akitoshi Inoue
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Payam Mohammadinejad
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Yong S Lee
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Stuart A Taylor
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Jaap Stoker
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Guangyong Zou
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Zhongya Wang
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Julie Rémillard
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Rickey E Carter
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Ronald Ottichilo
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Norma Atkinson
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Mohamed Tausif Siddiqui
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Venkata C Sunkesula
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Christopher Ma
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Claire E Parker
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Julian Panés
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Jordi Rimola
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Vipul Jairath
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Brian G Feagan
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
| | - Joel G Fletcher
- From the Department of Inflammation and Immunity, Lerner Research Institute (F.R., R.O., N.A.), Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases (F.R., M.T.S., V.C.S.), and Program for Global Translational Inflammatory Bowel Disease Research (F.R., R.O.), Cleveland Clinic Foundation, Cleveland, Ohio; Section of Abdominal Imaging, Imaging, Digestive Diseases and Surgery and Cancer Institutes (M.E.B.) and Department of Diagnostic Radiology (J.M.R.) Cleveland Clinic Foundation, Cleveland, Ohio; Division of Gastroenterology and Hepatology (D.H.B.), Biomedical Imaging Resource (D.R.H.), and Department of Radiology (J.L.F., E.C.E., S.P.S., J.P.H., D.R.H., Y.S.L., J.G.F.), Mayo Clinic, 200 First St, Rochester, MN 55905; Department of Radiology, Shiga University of Medical Science, Shiga, Japan (A.I.); Department of Radiology, University of Texas Medical Branch, Galveston, Tex (P.M.); Centre for Medical Imaging, University College London, London, United Kingdom (S.A.T.); Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands (J.S.); Alimentiv, London, Ontario, Canada (G.Z., Z.W., J. Rémillard, C.M., C.E.P., V.J., B.G.F.); Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada (G.Z., V.J., B.G.F.); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Fla (R.E.C.); Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Departments of Gastroenterology (J.P.) and Radiology (J. Rimola), Hospital Clínic de Barcelona, Barcelona, Spain; and Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada (V.J., B.G.F.)
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Kumar S, Rao N, Bhagwanani A, Parry T, Hameed M, Rahman S, Fitzke HE, Holmes J, Barrow B, Bard A, Menys A, Bennett D, Mallett S, Taylor SA. Volumetric measurement of terminal ileal Crohn's disease by magnetic resonance enterography: a feasibility study. Eur Radiol 2024:10.1007/s00330-024-10880-8. [PMID: 39028375 DOI: 10.1007/s00330-024-10880-8] [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: 01/23/2024] [Revised: 04/04/2024] [Accepted: 05/02/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVES Magnetic resonance enterography (MRE) interpretation of Crohn's disease (CD) is subjective and uses 2D analysis. We evaluated the feasibility of volumetric measurement of terminal ileal CD on MRE compared to endoscopy and sMARIA, and the responsiveness of volumetric changes to biologics. METHODS CD patients with MRE and contemporaneous CD endoscopic index of severity-scored ileocolonoscopy were included. A centreline was placed through the terminal ileum (TI) lumen defining the diseased bowel length on the T2-weighted non-fat saturated sequence, used by two radiologists to independently segment the bowel wall to measure volume (phase 1). In phase 2, we measured disease volume in patients treated with biologics, who had undergone pre- and post-treatment MRE, with treatment response classified via global physician assessment. RESULTS Phase 1 comprised 30 patients (median age 29 (IQR 24, 34) years). Phase 2 included 12 patients (25 years (22, 38)). In phase 1, the mean of the radiologist-measured volumes was used for analysis. The median disease volume in those with endoscopically active CD was 20.9 cm3 (IQR 11.3, 44.0) compared to 5.7 cm3 (2.9, 9.8) with normal endoscopy. The mean difference in disease volume between the radiologists was 3.0 cm3 (limits of agreement -21.8, 15.9). The median disease volume of patients with active CD by sMARIA was 15.0 cm3 (8.7, 44.0) compared to 2.85 cm3 (2.6, 3.1) for those with inactive CD. Pre- and post-treatment median disease volumes were 28.5 cm3 (26.4, 31.2), 11 cm3 (4.8, 16.6), respectively in biological responders, vs 26.8 cm3 (12.3, 48.7), 40.1 cm3 (10, 56.7) in non-responders. CONCLUSION Volumetric measurement of terminal ileal CD by MRE is feasible, related to endoscopy and sMARIA activity, and responsive to biologics. CLINICAL RELEVANCE STATEMENT Measuring the whole volume of diseased bowel on MRE in CD is feasible, related to how biologically active the disease is when assessed by endoscopy and by existing MRE activity scores, and is sensitive to treatment response. KEY POINTS MRE reporting for CD is subjective and uses 2D images rather than assessing the full disease volume. Volumetric measurement of CD relates to endoscopic activity and shows reduced disease volumes in treatment responders. This technique is an objective biomarker that can assess disease activity and treatment response, warranting validation.
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Affiliation(s)
- Shankar Kumar
- Centre for Medical Imaging, University College London (UCL), London, UK
| | - Nikhil Rao
- Department of Radiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Anisha Bhagwanani
- Department of Radiology, Frimley Health NHS Foundation Trust, Frimley, United Kingdom
| | - Thomas Parry
- Centre for Medical Imaging, University College London (UCL), London, UK
| | - Maira Hameed
- Centre for Medical Imaging, University College London (UCL), London, UK
| | - Safi Rahman
- Department of Radiology, Frimley Health NHS Foundation Trust, Frimley, United Kingdom
| | - Heather E Fitzke
- Centre for Medical Imaging, University College London (UCL), London, UK
| | - Judith Holmes
- Centre for Medical Imaging, University College London (UCL), London, UK
| | | | | | - Alex Menys
- Motilent Limited, London, United Kingdom
| | | | - Sue Mallett
- Centre for Medical Imaging, University College London (UCL), London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London (UCL), London, UK.
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4
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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.
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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
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5
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Sakai NS, Bray TJP, Taylor SA. Quantitative Magnetic Resonance Imaging (qMRI) of the Small Bowel in Crohn's Disease: State-of-the-Art and Future Directions. J Magn Reson Imaging 2024. [PMID: 38970359 DOI: 10.1002/jmri.29511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 07/08/2024] Open
Abstract
Crohn's disease (CD) is a chronic inflammatory disease of the gastrointestinal tract in which repeated episodes of acute inflammation may lead to long-term bowel damage. Cross-sectional imaging is used in conjunction with endoscopy to diagnose and monitor disease and detect complications. Magnetic resonance imaging (MRI) has demonstrable utility in evaluating inflammatory activity. However, subjective interpretation of conventional MR sequences is limited in its ability to fully phenotype the underlying histopathological processes in chronic disease. In particular, conventional MRI can be confounded by the presence of mural fibrosis and muscle hypertrophy, which can mask or sometimes mimic inflammation. Quantitative MRI (qMRI) methods provide a means to better differentiate mural inflammation from fibrosis and improve quantification of these processes. qMRI may also provide more objective measures of disease activity and enable better tailoring of treatment. Here, we review quantitative MRI methods for imaging the small bowel in CD and consider the path to their clinical translation. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Naomi S Sakai
- Centre for Medical Imaging, University College London, London, UK
| | - Timothy J P Bray
- Centre for Medical Imaging, University College London, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
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6
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Buisson A, Junda J, Vignette J, Lecoq E, Bouguen G, Goutorbe F, Scanzi J, Coban D, Dodel M, Bazoge M, Pereira B, Hordonneau C. Development and Validation of a Score to Assess Transmural Healing and Response in Patients with Crohn's Disease. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00546-9. [PMID: 38908734 DOI: 10.1016/j.cgh.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND & AIMS Because transmural healing (TH) could be the best therapeutic target in Crohn's disease (CD), we aimed to build and validate a score to assess TH and transmural response (TR), and to confirm their association with favorable CD outcomes. METHODS DEVISE-CD project encompassed 2 retrospective cohorts (274 and 224 patients with CD for development and validation phase, retrospectively) and 1 multicenter prospective validation cohort (N = 46 patients). A step-by-step process was used to build the modified Clermont score (C-score). The primary end points were time to bowel damage progression, and steroid-free clinical remission with fecal calprotectin <250 at 1 year for retrospective and prospective validation cohorts, respectively. RESULTS Edema, ulcer, contrast enhancement, diffusion-weighted hyperintensity, fat wrapping, bowel thickening (>3 mm), and enlarged lymph nodes were associated to higher risk of bowel damage progression (P < .01). Edema, diffusion-weighted hyperintensity, post-gadolinium contrast enhancement, and bowel thickening were highly coexistent (>95%) and collinear (P < .0001). Bowel thickness had the highest sensitivity to change after treatment (standardized mean difference = 0.30 ± 1.0; P = .001). C-score was calculated as 0.2x(bowel thickness-3mm) + 1.5x enlarged lymph nodes + 2x ulcer. TH (C-score <0.5; hazard ratio [HR], 0.28 [0.13-0.63]; P = .002; adjusted HR [aHR], 0.15 [0.04-0.53]; P = .003), TR50 (50% decrease of C-score; HR, 0.30 [0.15-0.63]; P = .001; aHR, 0.36 [0.14-0.88]; P = .025), or TR25 (25% decrease of C-score; HR, 0.37 [0.19-0.71]; P = .003; aHR, 0.46 [0.23-0.94]; P = .034) prevented bowel damage progression in development and validation cohorts, respectively. In the prospective validation cohort, achieving TH (OR, 4.6 [1.3-15.6]; P = .016), TR50 (OR, 6.9 [1.8-26.0]; P = .008), or TR25 (OR, 6.0 [1.6-22.3]; P = .008) after 12 weeks of anti-tumor necrosis factor therapy led to higher rate of corticosteroid-free remission at 1 year. CONCLUSIONS C-score is a validated, reliable, and easy-to-use tool to assess TH and TR in patients with CD.
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Affiliation(s)
- Anthony Buisson
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastroentérologie, Clermont-Ferrand, France; Université Clermont Auvergne, Inserm U1071, M2iSH, USC-INRA 2018, Clermont-Ferrand, France.
| | - Jérémy Junda
- Université Clermont Auvergne, CHU Clermont-Ferrand, DRCI, Service de Radiologie, Clermont-Ferrand, France
| | - Jeanne Vignette
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastroentérologie, Clermont-Ferrand, France
| | - Emma Lecoq
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastroentérologie, Clermont-Ferrand, France
| | - Guillaume Bouguen
- CHU Rennes, Univ Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolisms and Cancer), Rennes, France
| | - Felix Goutorbe
- Centre Hospitalier de la Côte Basque, Service d'Hépato-Gastro Entérologie, Bayonne, France
| | - Julien Scanzi
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastroentérologie, Clermont-Ferrand, France; CH Thiers, Service d'Hépato-Gastro Entérologie, Thiers, France
| | - Dilek Coban
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastroentérologie, Clermont-Ferrand, France
| | - Marie Dodel
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastroentérologie, Clermont-Ferrand, France
| | - Maëva Bazoge
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastroentérologie, Clermont-Ferrand, France
| | - Bruno Pereira
- Université Clermont Auvergne, CHU Clermont-Ferrand, DRCI, Unité de Biostatistiques, Clermont-Ferrand, France
| | - Constance Hordonneau
- Université Clermont Auvergne, CHU Clermont-Ferrand, DRCI, Service de Radiologie, Clermont-Ferrand, France
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Fernández-Clotet A, Ordás I, Masamunt MC, Caballol B, Rodríguez S, Gallego M, Barastegui R, Saavedra AC, Panés J, Ricart E, Rimola J. Magnetic resonance enterography findings 46 weeks after initiation of biological therapy predict long-term adverse outcomes in Crohn's disease. Aliment Pharmacol Ther 2024; 59:1435-1445. [PMID: 38650481 DOI: 10.1111/apt.17968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND AND AIMS Magnetic resonance enterography (MRE) depicts transmural changes in response to biological treatment for Crohn's disease (CD); however, the long-term prognostic significance of these findings is unknown. The primary objective of this study was to identify findings on MRE 46 weeks after initiating biological treatment that predict adverse long-term outcomes. METHODS Patients with CD underwent MRE 46 weeks after initiating biological treatment and were prospectively followed for 2 years. A logistic regression analysis was performed to assess the prognostic value of different radiologic findings for various predefined adverse outcomes. RESULTS Of the 89 patients included, 46 (51.7%) had ≥1 adverse outcome during follow-up: 40 (44.9%) had clinical recurrence; 18 (20.2%) required surgery, 8 (9%) endoscopic balloon dilation, 12 (13.5%) hospitalization and 7 (7.8%) required corticosteroids. In the multivariate analysis, persistence of severe lesions (MaRIA ≥11) in any intestinal segment was associated with an increased risk of surgery [OR 11.6 (1.5-92.4)], of surgery and/or endoscopic balloon dilation [OR 6.3 (1.3-30.2)], and of clinical relapse [OR 4.6 (1.6-13.9)]. Penetrating lesions were associated with surgery [OR 3.4 (1.2-9.9)]. Creeping fat with hospitalization [OR 5.1 (1.1-25.0)] and corticosteroids requirement [OR 16.0 (1.2-210.0)]. The presence of complications (stricturing and/or penetrating lesions) was associated with having ≥1 adverse outcome [OR 3.35 (1.3-8.5)]. CONCLUSION MRE findings at week-46 after initiating biological therapy can predict long-term adverse outcomes in CD. Therapeutic intervention may be required in patients with persistence of severe inflammatory lesions, CD-associated complications, or creeping fat.
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Affiliation(s)
- Agnès Fernández-Clotet
- IBD Unit, Gastroenterology Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ingrid Ordás
- IBD Unit, Gastroenterology Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria Carme Masamunt
- IBD Unit, Gastroenterology Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Berta Caballol
- IBD Unit, Gastroenterology Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sonia Rodríguez
- IBD Unit, Radiology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Marta Gallego
- IBD Unit, Gastroenterology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Rebeca Barastegui
- IBD Unit, Gastroenterology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Julián Panés
- IBD Unit, Gastroenterology Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Elena Ricart
- IBD Unit, Gastroenterology Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jordi Rimola
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- IBD Unit, Radiology Department, Hospital Clinic de Barcelona, Barcelona, Spain
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8
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Song KD. Achieving high-quality magnetic resonance enterography is critical for assessing Crohn's disease activity. Intest Res 2024; 22:117-118. [PMID: 38720468 PMCID: PMC11079509 DOI: 10.5217/ir.2024.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/01/2024] [Indexed: 05/12/2024] Open
Affiliation(s)
- Kyoung Doo Song
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
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Bohra A, Connoley DJ, Con D, Segal JP, Niewiadomski O, Vasudevan A, Langenberg DRV, Kutaiba N. Assessing quality of magnetic resonance enterography and its impact on disease assessment of ileal Crohn's disease. Intest Res 2024; 22:152-161. [PMID: 38173229 PMCID: PMC11079513 DOI: 10.5217/ir.2023.00095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/01/2023] [Accepted: 11/01/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND/AIMS Assessment of quality of magnetic resonance enterography (MRE) in small bowel Crohn's disease (CD) activity evaluation has received little attention. We assessed the impact of bowel distention and motion artifact on MRE activity indices in ileal CD. METHODS A cohort of patients who underwent contemporaneous MRE and colonoscopy for ileal CD assessment between 2014 and 2021 at 2 centers were audited. An abdominal radiologist blinded to clinical data reviewed each MRE, graded bowel distention and motion artifact upon a pre-specified 3-point scale and calculated the original magnetic resonance index of activity (MaRIA) and simplified MaRIA (sMaRIA), London index and CD MRE index (CDMI). Ileal endoscopic activity was graded via the Simplified Endoscopy Score for CD (SES-CD). The performance of MRE indices in discriminating active disease (SES-CD ≥3) stratified by MRE quality was measured by receiver operator characteristic analyses. RESULTS One hundred and thirty-seven patients had MRE and colonoscopy within a median of 16 days (range, 0-30 days) with 63 (46%) exhibiting active disease (SES-CD ≥3). Forty-four MREs (32%) were deemed low quality due to motion artifact and/or moderate to poor distention. Low-quality MREs demonstrated reduced discriminative performance between ileal SES-CD ≥3 and MRE indices (MaRIA 0.838 vs. 0.634, sMaRIA 0.834 vs. 0.527, CDMI 0.850 vs. 0.595, London 0.748 vs. 0.511, P<0.05 for all). Individually the presence of any motion artifact markedly impacted the discriminative performance (e.g., sMaRIA area under the curve 0.544 vs. 0.814, P<0.05). CONCLUSIONS Image quality parameters can significantly impact MRE disease activity interpretation. Quality metrics should be reported, enabling cautious interpretation in lower-quality studies.
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Affiliation(s)
- Anuj Bohra
- Department of Gastroenterology, Box Hill Hospital, Box Hill, Australia
- Department of Gastroenterology, Northern Hospital, Epping, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Australia
| | - Declan J Connoley
- Department of Gastroenterology, Box Hill Hospital, Box Hill, Australia
| | - Danny Con
- Department of Gastroenterology, Box Hill Hospital, Box Hill, Australia
| | - Jonathan P Segal
- Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, Australia
| | - Olga Niewiadomski
- Department of Gastroenterology, Box Hill Hospital, Box Hill, Australia
| | - Abhinav Vasudevan
- Department of Gastroenterology, Box Hill Hospital, Box Hill, Australia
| | | | - Numan Kutaiba
- Department of Radiology, Box Hill Hospital, Box Hill, Australia
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10
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Rimola J, Beek KJ, Ordás I, Gecse KB, Cuatrecasas M, Stoker J. Contemporary Imaging Assessment of Strictures and Fibrosis in Crohn Disease, With Focus on Quantitative Biomarkers: From the AJR Special Series on Imaging of Fibrosis. AJR Am J Roentgenol 2024; 222:e2329693. [PMID: 37530400 DOI: 10.2214/ajr.23.29693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
Patients with Crohn disease commonly have bowel strictures develop, which exhibit varying degrees of inflammation and fibrosis. Differentiation of the distinct inflammatory and fibrotic components of strictures is key for the optimization of therapeutic management and for the development of antifibrotic drugs. Cross-sectional imaging techniques, including ultrasound, CT, and MRI, allow evaluation of the full thickness of the bowel wall as well as extramural complications and associated mesenteric abnormalities. Although promising data have been reported for a range of novel imaging biomarkers for detection of fibrosis and quantification of the degree of fibrosis, these biomarkers lack sufficient validation and standardization for clinical use. Additional methods, including PET with emerging radiotracers, artificial intelligence, and radiomics, are also under investigation for stricture characterization. In this review, we highlight the clinical relevance of identifying fibrosis in Crohn disease, review the histopathologic aspects of strictures in Crohn disease, summarize the morphologic imaging findings of strictures, and explore contemporary developments in the use of cross-sectional imaging techniques for detecting and characterizing intestinal strictures, with attention given to emerging quantitative biomarkers.
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Affiliation(s)
- Jordi Rimola
- Radiology Department, IBD Unit, Hospital Clínic de Barcelona, Villarroel 170, Escala 3, Planta 1, Barcelona 08036, Spain
- Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Kim J Beek
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ingrid Ordás
- Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Gastroenterology Department, IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Krisztina B Gecse
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Míriam Cuatrecasas
- Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Pathology Department, IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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11
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Gu P, Mendonca O, Carter D, Dube S, Wang P, Huang X, Li D, Moore JH, McGovern DPB. AI-luminating Artificial Intelligence in Inflammatory Bowel Diseases: A Narrative Review on the Role of AI in Endoscopy, Histology, and Imaging for IBD. Inflamm Bowel Dis 2024:izae030. [PMID: 38452040 DOI: 10.1093/ibd/izae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Indexed: 03/09/2024]
Abstract
Endoscopy, histology, and cross-sectional imaging serve as fundamental pillars in the detection, monitoring, and prognostication of inflammatory bowel disease (IBD). However, interpretation of these studies often relies on subjective human judgment, which can lead to delays, intra- and interobserver variability, and potential diagnostic discrepancies. With the rising incidence of IBD globally coupled with the exponential digitization of these data, there is a growing demand for innovative approaches to streamline diagnosis and elevate clinical decision-making. In this context, artificial intelligence (AI) technologies emerge as a timely solution to address the evolving challenges in IBD. Early studies using deep learning and radiomics approaches for endoscopy, histology, and imaging in IBD have demonstrated promising results for using AI to detect, diagnose, characterize, phenotype, and prognosticate IBD. Nonetheless, the available literature has inherent limitations and knowledge gaps that need to be addressed before AI can transition into a mainstream clinical tool for IBD. To better understand the potential value of integrating AI in IBD, we review the available literature to summarize our current understanding and identify gaps in knowledge to inform future investigations.
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Affiliation(s)
- Phillip Gu
- F. Widjaja Inflammatory Bowel Disease Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Dan Carter
- Department of Gastroenterology, Sheba Medical Center, Tel Aviv, Israel
| | - Shishir Dube
- F. Widjaja Inflammatory Bowel Disease Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Paul Wang
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Xiuzhen Huang
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Debiao Li
- Biomedical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jason H Moore
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Dermot P B McGovern
- F. Widjaja Inflammatory Bowel Disease Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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12
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Zhang YN, Liu YB, Xu J, Cao KM, Zhang XX, Wang YB, Liu F, Duan BS, Hu YD, Chu SG. Magnetic resonance Index of Activity (MaRIA) is reliable in assessing response to treatment in patients with Crohn's disease (CD). Clin Radiol 2024; 79:230-236. [PMID: 38092646 DOI: 10.1016/j.crad.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 02/15/2024]
Abstract
AIM To assess the accuracy of Magnetic Resonance Index of Activity (MaRIA) in evaluating therapeutic efficacy in Crohn's disease (CD) patients with different activity levels using ileocolonoscopy as the reference standard. MATERIALS AND METHODS Forty-eight patients underwent magnetic resonance enterography (MRE) and ileocolonoscopy at baseline, week 26, and week 52, along with the Simple Endoscopic Score for Crohn's Disease (SES-CD) and MaRIA scores. According to the SES-CD score at baseline, all patients were subdivided into mild, moderate, and severe activity subgroups. The identification of endoscopic mucosal healing (MH) was explored primarily. Moreover, the Crohn's Disease Activity Index (CDAI), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), and interleukin-6 (IL-6) levels were collected and analysed. RESULTS MaRIA correlated significantly with SES-CD and CRP at baseline, week 26, and week 52. The discrepancies in MaRIA and SES-CD were statistically significant before and after treatment. MaRIA = 24.43 and ΔMaRIA = 12.77 as the cut-off points were found to have high diagnostic accuracy for predicting MH. MaRIA (p<0.001), SES-CD (p<0.001), CRP (p<0.05), ESR (p<0.05), and CDAI score (p<0.05) in patients with MH were considerably decreased compared to those in patients without MH. CONCLUSIONS MRE has good application value in evaluating the therapeutic response of CD patients treated with biological agents. MaRIA is a reliable indicator in the follow-up of CD patients, which is strongly correlated with SES-CD, and it has high accuracy in predicting endoscopic MH.
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Affiliation(s)
- Y-N Zhang
- Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Y-B Liu
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - J Xu
- Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - K-M Cao
- Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - X-X Zhang
- Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Y-B Wang
- Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - F Liu
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - B-S Duan
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Y-D Hu
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - S-G Chu
- Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
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13
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Regensburger AP, Eckstein M, Wetzl M, Raming R, Paulus LP, Buehler A, Nedoschill E, Danko V, Jüngert J, Wagner AL, Schnell A, Rückel A, Rother U, Rompel O, Uder M, Hartmann A, Neurath MF, Woelfle J, Waldner MJ, Hoerning A, Knieling F. Multispectral optoacoustic tomography enables assessment of disease activity in paediatric inflammatory bowel disease. PHOTOACOUSTICS 2024; 35:100578. [PMID: 38144890 PMCID: PMC10746560 DOI: 10.1016/j.pacs.2023.100578] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/01/2023] [Accepted: 11/29/2023] [Indexed: 12/26/2023]
Abstract
Multispectral optoacoustic tomography (MSOT) allows non-invasive molecular disease activity assessment in adults with inflammatory bowel disease (IBD). In this prospective pilot-study, we investigated, whether increased levels of MSOT haemoglobin parameters corresponded to inflammatory activity in paediatric IBD patients, too. 23 children with suspected IBD underwent MSOT of the terminal ileum and sigmoid colon with standard validation (e.g. endoscopy). In Crohn`s disease (CD) and ulcerative colitis (UC) patients with endoscopically confirmed disease activity, MSOT total haemoglobin (HbT) signals were increased in the terminal ileum of CD (72.1 ± 13.0 a.u. vs. 32.9 ± 15.4 a.u., p = 0.0049) and in the sigmoid colon of UC patients (62.9 ± 13.8 a.u. vs. 35.1 ± 16.3 a.u., p = 0.0311) as compared to controls, respectively. Furthermore, MSOT haemoglobin parameters correlated well with standard disease activity assessment (e.g. SES-CD and MSOT HbT (rs =0.69, p = 0.0075). Summarizing, MSOT is a novel technology for non-invasive molecular disease activity assessment in paediatric patients with inflammatory bowel disease.
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Affiliation(s)
- Adrian P. Regensburger
- Department of Paediatrics and Adolescent Medicine and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Paediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Paediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Wetzl
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Roman Raming
- Department of Paediatrics and Adolescent Medicine and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Paediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Paediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Lars-Philip Paulus
- Department of Paediatrics and Adolescent Medicine and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Paediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Paediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Adrian Buehler
- Department of Paediatrics and Adolescent Medicine and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Paediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Paediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Emmanuel Nedoschill
- Department of Paediatrics and Adolescent Medicine and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Paediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Paediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Vera Danko
- Department of Paediatrics and Adolescent Medicine and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Paediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Paediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Jörg Jüngert
- Department of Paediatrics and Adolescent Medicine and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Alexandra L. Wagner
- Paediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Paediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Alexander Schnell
- Department of Paediatrics and Adolescent Medicine and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Aline Rückel
- Department of Paediatrics and Adolescent Medicine and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Ulrich Rother
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Oliver Rompel
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Uder
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Markus F. Neurath
- Department of Medicine 1 and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Joachim Woelfle
- Department of Paediatrics and Adolescent Medicine and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Maximilian J. Waldner
- Department of Medicine 1 and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - André Hoerning
- Department of Paediatrics and Adolescent Medicine and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Ferdinand Knieling
- Department of Paediatrics and Adolescent Medicine and German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Paediatric Experimental and Translational Imaging Laboratory (PETI-Lab), Department of Paediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
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14
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Rimola J, Colombel JF, Bressler B, Adsul S, Siegelman J, Cole PE, Lindner D, Danese S. Magnetic Resonance Enterography Assessment of Transmural Healing with Vedolizumab in Moderate to Severe Crohn's Disease: Feasibility in the VERSIFY Phase 3 Clinical Trial. Clin Exp Gastroenterol 2024; 17:9-23. [PMID: 38298861 PMCID: PMC10829592 DOI: 10.2147/ceg.s429039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/14/2024] [Indexed: 02/02/2024] Open
Abstract
Purpose The VERSIFY phase 3 trial in patients with Crohn's disease (CD) treated with vedolizumab was the first to include a substudy that used a standardized magnetic resonance enterography (MRE) protocol to assess features of transmural inflammation (bowel edema and wall thickness) and extramural disease activity (enlarged lymph nodes). Patients and Methods Patients received intravenous vedolizumab (300 mg) at weeks 0 (baseline), 2, and 6, and then every 8 weeks for 26 or 52 weeks. Post hoc analyses included a subpopulation with a Magnetic Resonance Index of Activity score of ≥7 in at least one bowel segment at baseline and at least one postbaseline MRE assessment. Changes in transmural inflammation, including intramural bowel edema and wall thickness, were evaluated. Patient-level and segment-level analyses were performed. Results MRE images were evaluated in 27 patients with 83 evaluable bowel segments at baseline and week 26, and 13 patients with 38 evaluable segments at baseline, week 26, and week 52. At baseline, all patients had bowel wall edema and wall thickness of >3 mm in at least one bowel segment. The proportion of patients with edema decreased at weeks 26 (17/27 [63.0%]) and 52 (4/13 [30.8%]) and the proportion with bowel wall thickness of >3 mm decreased at weeks 26 (25/27 [92.6%]) and 52 (10/13 [76.9%]). Conclusion In patients with CD treated with vedolizumab for 26 and 52 weeks, the number of patients, and bowel segments, with MRE-detected transmural inflammation was reduced. These results highlight the impact of vedolizumab on components of transmural inflammation in CD and demonstrate that using MRE in CD multicenter clinical trials is feasible. Trial Registration ClinicalTrials.gov NCT02425111, April 23, 2015, http://www.clinicaltrials.gov NCT02425111; EU Clinical Trials Register EudraCT 2014-003509-13, https://www.clinicaltrialsregister.eu.
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Affiliation(s)
- Jordi Rimola
- IBD Unit, Radiology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jean-Frédéric Colombel
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brian Bressler
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - Shashi Adsul
- Takeda Pharmaceuticals International, Zurich, Switzerland
| | | | | | - Dirk Lindner
- Takeda Pharmaceuticals International, Zurich, Switzerland
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
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15
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Caron B, Jairath V, Laurent V, Stoker J, Laghi A, D'Haens GR, Danese S, Peyrin-Biroulet L. Defining Magnetic Resonance Imaging Treatment Response and Remission in Crohn's Disease: A Systematic Review. J Crohns Colitis 2024; 18:162-170. [PMID: 37523157 DOI: 10.1093/ecco-jcc/jjad125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Magnetic resonance imaging is increasingly used to assess treatment response in Crohn's disease clinical trials. We aimed to describe the definition of MRI response and remission as assessed by magnetic resonance enterography [MRE] to evaluate treatment efficacy in these patients. METHODS Electronic databases were searched up to May 1, 2023. All published studies enrolling patients with inflammatory bowel disease and assessment of treatment efficacy with MRE were eligible for inclusion. RESULTS Eighteen studies were included. All studies were performed in patients with Crohn's disease. The study period ranged from 2008 to 2023. The majority of studies used endoscopy as the reference standard [61.1%]. MRE response was defined in 11 studies [61.1%]. Five scores and nine different definitions were proposed for MRE response. MRE remission was defined in 12 studies [66.7%]. Three scores and nine different definitions for MRE remission were described. The MaRIA score was the most frequent index used to evaluate MRE response [63.6%] and remission [41.7%]. MRE response was defined as MaRIA score <11 in 63.6% of studies using this index. In 60% of studies using the MaRIA score, MRE remission was defined as MaRIA score <7. In addition, 11 different time points of assessment were reported, ranging from 6 weeks to years. CONCLUSION In this systematic review, significant heterogeneity in the definition of MRE response and remission evaluated in patients with Crohn's disease was observed. Harmonization of eligibility and outcome criteria for MRE in Crohn's Disease clinical trials is needed.
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Affiliation(s)
- Bénédicte Caron
- Department of Gastroenterology, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- INSERM, NGERE, University of Lorraine, F-54000 Nancy, France
- INFINY Institute, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- FHU-CURE, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
| | - Vipul Jairath
- Department of Medicine, Division of Gastroenterology, Western University, London, ON, Canada
| | - Valérie Laurent
- Department of Radiology, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
- IADI, U12454, INSERM, Université de Lorraine, CHRU Nancy, Nancy, France
| | - Jaap Stoker
- Amsterdam UMC, location University of Amsterdam, Department of Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Andrea Laghi
- Department of Medical Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, University of Rome Sapienza, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Geert R D'Haens
- Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- INSERM, NGERE, University of Lorraine, F-54000 Nancy, France
- INFINY Institute, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- FHU-CURE, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
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16
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Na JE, Kim HS, Hong SN, Song KD, Kim JE, Kim ER, Kim YH, Chang DK. Comparison of an Endoscopic Scoring System and the Simplified Magnetic Resonance Index of Activity in Patients with Small Bowel Crohn's Disease. Gut Liver 2024; 18:97-105. [PMID: 37013455 PMCID: PMC10791503 DOI: 10.5009/gnl220422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/08/2023] [Accepted: 01/17/2023] [Indexed: 04/05/2023] Open
Abstract
Background/Aims The newly derived simplified magnetic resonance index of activity (MARIAs) has not been verified in comparison to balloon-assisted enteroscopy (BAE) for patients with small bowel Crohn's disease (CD). We studied the correlation of MARIAs with simple endoscopic scores for CD (SES-CD) of the ileum based on magnetic resonance enterography (MRE) and BAE in patients with small bowel CD. Methods Fifty patients with small bowel CD who underwent BAE and MRE concurrently within 3 months from September 2020 to June 2021 were enrolled in the study. The primary outcome was the correlation between the active score of ileal SES-CD (ileal SES-CDa)/ileal SES-CD and MARIAs based on BAE and MRE. The cutoff value for MARIAs identifying endoscopically active/severe disease, defined as ileal SES-CDa/ileal SES-CD of 5/7 or more, was analyzed. Results Ileal SES-CDa/ileal SES-CD and MARIAs showed strong associations (R=0.76, p<0.001; R=0.78, p<0.001). The area under the receiver operating characteristic curve of MARIAs for ileal SES-CDa ≥5 and ileal SES-CD ≥7 was 0.92 (95% confidence interval, 0.88 to 0.97) and 0.92 (95% confidence interval, 0.87 to 0.97). The cutoff value of MARIAs for detecting active/severe disease was 3. A MARIAs index value of ≥3 identified ileal SES-CDa ≥5 with a sensitivity of 85% and specificity of 87% and detected ileal SES-CD ≥7 with a sensitivity of 87% and specificity of 86%. Conclusions This study validated the applicability of MARIAs compared to BAE-based ileal SES-CDa/SES-CD.
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Affiliation(s)
- Ji Eun Na
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Hon Soul Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Noh Hong
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung Doo Song
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Eun Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Ran Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Ho Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Kyung Chang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Rimola J, Fernandez-Clotet A, Capozzi N, Caballol B, Rodríguez S, Gallego M, Masamunt MC, Panés J, Ricart E, Ordás I. ADC Values for Detecting Bowel Inflammation and Biologic Therapy Response in Patients With Crohn Disease: A Post Hoc Prospective Trial Analysis. AJR Am J Roentgenol 2024; 222:e2329639. [PMID: 37584507 DOI: 10.2214/ajr.23.29639] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
BACKGROUND. New biologic agents for Crohn disease (CD) create a need for noninvasive disease markers. DWI may assess bowel inflammation without contrast agents. OBJECTIVE. The purpose of this study was to evaluate ADC values for identifying bowel inflammation and therapeutic response in patients with CD treated with biologic therapy. METHODS. This study entailed post hoc analysis of prospective trial data. Analysis included 89 patients (median age, 37 years; 49 women, 40 men) with CD treated by biologic therapy who underwent MR enterography (MRE) at baseline and 46 weeks after therapy, from March 2013 to April 2021; 43 patients underwent ileocolonoscopy at both time points. Analysis was conducted at the level of small-bowel and colorectal segments (586 segments analyzed). MR index of activity (MaRIA) score and presence of endoscopic ulcers were determined at both time points. One observer measured bowel wall ADC. Diagnostic performance was evaluated. Dichotomous ADC assessments used a threshold of 1301 × 10-6 mm2/s based on initial ROC analysis; dichotomous MaRIA score assessments used a threshold of 11 (moderate to severe inflammation). A second observer repeated ADC measurements in 15 patients. RESULTS. At baseline, ADC had AUC of 0.92, sensitivity of 78.6%, specificity of 91.4%, and accuracy of 88.2% for detecting segments with MaRIA score 11 or greater. At baseline, AUC for detecting endoscopic ulcers was 0.96 for MaRIA score versus 0.87 for ADC (p < .001); sensitivity, specificity, and accuracy were 70.8%, 90.2%, and 85.1% for ADC and 86.2%, 96.2%, and 93.6% for MaRIA score. At follow-up, ADC had AUC of 0.87, sensitivity of 75.4%, specificity of 83.6%, and accuracy of 80.0% for detecting improvement in MaRIA score to less than 11. At follow-up, AUC for detecting endoscopic ulcer healing was 0.94 for MaRIA score versus 0.84 for ADC (p = .01); sensitivity, specificity, and accuracy were 70.7%, 95.8%, and 84.4% for ADC and 90.2%, 100.0%, and 95.6% for MaRIA score. Interobserver agreement for ADC, based on intraclass correlation coefficient, was 0.70 at baseline and 0.65 at follow-up. CONCLUSION. The findings do not support use of ADC rather than MaRIA scores for detecting biologic therapy response. CLINICAL IMPACT. ADC may have an adjunct role in assessing bowel inflammation in CD, but showed limited performance for detecting biologic therapy response.
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Affiliation(s)
- Jordi Rimola
- Radiology Department, IBD Unit, Hospital Clínic de Barcelona, Villarroel 170, Escala 3 Planta 1, 08036, Barcelona, Spain
- Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Nunzia Capozzi
- Radiology Department, IBD Unit, Hospital Clínic de Barcelona, Villarroel 170, Escala 3 Planta 1, 08036, Barcelona, Spain
- Radiology Department, Policlinico Universitario Sant'Orsola-Malpighi, Bologna, Italy
| | - Berta Caballol
- Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sonia Rodríguez
- Gastroenterology Department, IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Marta Gallego
- Gastroenterology Department, IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Maria Carme Masamunt
- Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Gastroenterology Department, IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Julian Panés
- Gastroenterology Department, IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Elena Ricart
- Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Gastroenterology Department, IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Ingrid Ordás
- Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Gastroenterology Department, IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
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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.
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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
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Park EJ, Lee Y, Lee J. Impact of Deep-Learning Based Reconstruction on Single-Breath-Hold, Single-Shot Fast Spin-Echo in MR Enterography for Crohn's Disease. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:1309-1323. [PMID: 38107694 PMCID: PMC10721413 DOI: 10.3348/jksr.2023.0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/18/2023] [Accepted: 05/06/2023] [Indexed: 12/19/2023]
Abstract
Purpose To assess the quality of four images obtained using single-breath-hold (SBH), single-shot fast spin-echo (SSFSE) and multiple-breath-hold (MBH) SSFSE with and without deep-learning based reconstruction (DLR) in patients with Crohn's disease. Materials and Methods This study included 61 patients who underwent MR enterography (MRE) for Crohn's disease. The following images were compared: SBH-SSFSE with (SBH-DLR) and without (SBH-conventional reconstruction [CR]) DLR and MBH-SSFSE with (MBH-DLR) and without (MBH-CR) DLR. Two radiologists independently reviewed the overall image quality, artifacts, sharpness, and motion-related signal loss using a 5-point scale. Three inflammatory parameters were evaluated in the ileum, the terminal ileum, and the colon. Moreover, the presence of a spatial misalignment was evaluated. Signal-to-noise ratio (SNR) was calculated at two locations for each sequence. Results DLR significantly improved the image quality, artifacts, and sharpness of the SBH images. No significant differences in scores between MBH-CR and SBH-DLR were detected. SBH-DLR had the highest SNR (p < 0.001). The inter-reader agreement for inflammatory parameters was good to excellent (κ = 0.76-0.95) and the inter-sequence agreement was nearly perfect (κ = 0.92-0.94). Misalignment artifacts were observed more frequently in the MBH images than in the SBH images (p < 0.001). Conclusion SBH-DLR demonstrated equivalent quality and performance compared to MBH-CR. Furthermore, it can be acquired in less than half the time, without multiple BHs and reduce slice misalignments.
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20
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Neurath MF, Vieth M. Different levels of healing in inflammatory bowel diseases: mucosal, histological, transmural, barrier and complete healing. Gut 2023; 72:2164-2183. [PMID: 37640443 DOI: 10.1136/gutjnl-2023-329964] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
Mucosal healing on endoscopy has emerged as a key prognostic parameter in the management of patients with IBD (Crohn's disease, ulcerative colitis/UC) and can predict sustained clinical remission and resection-free survival. The structural basis for this type of mucosal healing is a progressive resolution of intestinal inflammation with associated healing of ulcers and improved epithelial barrier function. However, in some cases with mucosal healing on endoscopy, evidence of histological activity in mucosal biopsies has been observed. Subsequently, in UC, a second, deeper type of mucosal healing, denoted histological healing, was defined which requires the absence of active inflammation in mucosal biopsies. Both levels of mucosal healing should be considered as initial events in the resolution of gut inflammation in IBD rather than as indicators of complete transmural healing. In this review, the effects of anti-inflammatory, biological or immunosuppressive agents as well as small molecules on mucosal healing in clinical studies are highlighted. In addition, we focus on the implications of mucosal healing for clinical management of patients with IBD. Moreover, emerging techniques for the analysis of mucosal healing as well as potentially deeper levels of mucosal healing such as transmural healing and functional barrier healing of the mucosa are discussed. Although none of these new levels of healing indicate a definitive cure of the diseases, they make an important contribution to the assessment of patients' prognosis. The ultimate level of healing in IBD would be a resolution of all aspects of intestinal and extraintestinal inflammation (complete healing).
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Affiliation(s)
- Markus F Neurath
- Medical Clinic 1 & Deutsches Zentrum Immuntherapie DZI, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Vieth
- Pathology Clinic, Klinikum Bayreuth GmbH, Friedrich-Alexander-Universität Erlangen-Nürnberg, Bayreuth, Germany
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21
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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.
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Affiliation(s)
- Maria Ingenerf
- Department of Radiology, University Hospital, LMU Munich, Ziemssenstr. 5, 80336, Munich, Germany
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22
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Kobeissy A, Merza N, Nawras Y, Bahbah EI, Al-Hillan A, Ahmed Z, Hassan M, Alastal Y. Evaluating the diagnostic accuracy of magnetic resonance imaging in distinguishing strictures in Crohn's disease: a systematic review and meta-analysis. Int J Colorectal Dis 2023; 38:258. [PMID: 37882852 DOI: 10.1007/s00384-023-04544-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE This systematic review and meta-analysis sought to assess the diagnostic accuracy of magnetic resonance imaging (MRI) in distinguishing fibrotic from inflammatory strictures in Crohn's disease (CD) patients. METHODS A rigorous and systematic exploration of five key databases yielded studies that met predefined criteria. Data were extracted for a comprehensive meta-analysis using MetaDiSC and MetaDTA software, providing diagnostic accuracy measures. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was utilized for evaluating the methodological quality and potential bias within the studies. RESULTS The systematic review involved the evaluation of 7437 records, culminating in the inclusion of 22 studies. In detecting fibrotic strictures in CD patients, MRI exhibited a pooled sensitivity of 85.20% (95% CI: 76.10-91.20%) and specificity of 96.00% (95% CI: 87.80-98.70%). For differentiating fibrotic strictures from inflammatory stenosis, the sensitivity was 81.5% (95% CI: 70.2-89.20%), and the specificity was 97.2% (95% CI: 90.0-99.3%). In terms of assessing the severity of strictures, sensitivity stood at 90.4% (95% CI: 78.1-96.1%) and specificity at 89.4% (95% CI: 57.4-98.2%). The consistency of the diagnostic accuracy was observed across different geographical locations and the various reference tests applied in the studies. CONCLUSIONS The results of this meta-analysis underscore the robust diagnostic accuracy of MRI in detecting fibrotic strictures, distinguishing between fibrotic and inflammatory strictures, and evaluating stricture severity in CD patients. These findings support the integration of MRI into standard diagnostic protocols for patients with CD. Further large-scale, multicenter trials are warranted to confirm these results and to identify any potential limitations associated with the application of MRI in this clinical setting.
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Affiliation(s)
- Abdallah Kobeissy
- Department of Gastroenterology, The University of Toledo, Toledo, OH, 43606, USA
| | - Nooraldin Merza
- Department of Internal Medicine, The University of Toledo, Toledo, OH, 43606, USA.
| | - Yusuf Nawras
- College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, 43606, USA
| | - Eshak I Bahbah
- Department of Internal Medicine, Al Azhar University, New Damietta, Egypt
| | - Alsadiq Al-Hillan
- Gastroenterology Department, Corewell Health/Willam Beaumont University Hospital, Royal Oak, MI, 48073, USA
| | - Zohaib Ahmed
- Department of Gastroenterology, The University of Toledo, Toledo, OH, 43606, USA
| | - Mona Hassan
- Department of Gastroenterology, The University of Toledo, Toledo, OH, 43606, USA
| | - Yaseen Alastal
- Department of Gastroenterology, The University of Toledo, Toledo, OH, 43606, USA
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Mignini I, Maresca R, Ainora ME, Larosa L, Scaldaferri F, Gasbarrini A, Zocco MA. Predicting Treatment Response in Inflammatory Bowel Diseases: Cross-Sectional Imaging Markers. J Clin Med 2023; 12:5933. [PMID: 37762874 PMCID: PMC10532020 DOI: 10.3390/jcm12185933] [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: 07/31/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
Therapeutic options for inflammatory bowel diseases (IBD) have largely expanded in the last decades, both in Crohn's disease and ulcerative colitis, including multiple biological drugs targeting different inflammation pathways. However, choosing the best treatment and timing for each patient is still an undeniable challenge for IBD physicians due to the marked heterogeneity among patients and disease behavior. Therefore, early prediction of the response to biological drugs becomes of utmost importance, allowing prompt optimization of therapeutic strategies and thus paving the way towards precision medicine. In such a context, researchers have recently focused on cross-sectional imaging techniques (intestinal ultrasound, computed tomography, and magnetic resonance enterography) in order to identify predictive markers of response or non-response to biologic therapies. In this review, we aim to summarize data about imaging factors that may early predict disease behavior during biological treatment, potentially helping to define more precise and patient-tailored strategies.
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Affiliation(s)
- Irene Mignini
- CEMAD Digestive Diseases Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy; (I.M.); (R.M.); (F.S.); (A.G.); (M.A.Z.)
| | - Rossella Maresca
- CEMAD Digestive Diseases Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy; (I.M.); (R.M.); (F.S.); (A.G.); (M.A.Z.)
| | - Maria Elena Ainora
- CEMAD Digestive Diseases Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy; (I.M.); (R.M.); (F.S.); (A.G.); (M.A.Z.)
| | - Luigi Larosa
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy;
| | - Franco Scaldaferri
- CEMAD Digestive Diseases Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy; (I.M.); (R.M.); (F.S.); (A.G.); (M.A.Z.)
| | - Antonio Gasbarrini
- CEMAD Digestive Diseases Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy; (I.M.); (R.M.); (F.S.); (A.G.); (M.A.Z.)
| | - Maria Assunta Zocco
- CEMAD Digestive Diseases Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy; (I.M.); (R.M.); (F.S.); (A.G.); (M.A.Z.)
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Maccioni F, La Rocca U, Milanese A, Busato L, Cleri A, Lopez M, Manganaro L, De Felice C, Di Gioia C, Vestri AR, Catalano C, Iori AP. Multi-parametric MRI in the diagnosis and scoring of gastrointestinal acute graft-versus-host disease. Eur Radiol 2023; 33:5911-5923. [PMID: 37071163 PMCID: PMC10415479 DOI: 10.1007/s00330-023-09563-7] [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: 05/26/2022] [Revised: 01/11/2023] [Accepted: 02/26/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVES Acute gastrointestinal graft-versus-host disease (GI-aGVHD) is a severe complication of allogeneic hematopoietic stem cell transplantation (HSCT). Diagnosis relies on clinical, endoscopic, and pathological investigations. Our purpose is to assess the value of magnetic resonance imaging (MRI) in the diagnosis, staging, and prediction of GI-aGVHD-related mortality. METHODS Twenty-one hematological patients who underwent MRI for clinical suspicion of acute GI-GVHD were retrospectively selected. Three independent radiologists, blinded to the clinical findings, reanalyzed MRI images. The GI tract was evaluated from stomach to rectum by analyzing fifteen MRI signs suggestive of intestinal and peritoneal inflammation. All selected patients underwent colonoscopy with biopsies. Disease severity was determined on the basis of clinical criteria, identifying 4 stages of increasing severity. Disease-related mortality was also assessed. RESULTS The diagnosis of GI-aGVHD was histologically confirmed with biopsy in 13 patients (61.9%). Using 6 major signs (diagnostic score), MRI showed 84.6% sensitivity and 100% specificity in identifying GI-aGVHD (AUC = 0.962; 95% confidence interval 0.891-1). The proximal, middle, and distal ileum were the segments most frequently affected by the disease (84.6%). Using all 15 signs of inflammation (severity score), MRI showed 100% sensitivity and 90% specificity for 1-month related mortality. No correlation with the clinical score was found. CONCLUSION MRI has proved to be an effective tool for diagnosing and scoring GI-aGVHD, with a high prognostic value. If larger studies will confirm these results, MRI could partly replace endoscopy, thus becoming the primary diagnostic tool for GI-aGVHD, being more complete, less invasive, and more easily repeatable. KEY POINTS • We have developed a new promising MRI diagnostic score for GI-aGVHD with a sensitivity of 84.6% and specificity of 100%; results are to be confirmed by larger multicentric studies. • This MRI diagnostic score is based on the six MRI signs most frequently associated with GI-aGVHD: small-bowel inflammatory involvement, bowel wall stratification on T2-w images, wall stratification on post-contrast T1-w images, ascites, and edema of retroperitoneal fat and declivous soft tissues. • A broader MRI severity score based on 15 MRI signs showed no correlation with clinical staging but high prognostic value (100% sensitivity, 90% specificity for 1-month related mortality); these results also need to be confirmed by larger studies.
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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.
| | - Ursula La Rocca
- Department of Translational and Precision Medicine, Policlinico Umberto I Hospital, Sapienza University of Rome, Via Benevento 6, 00161, Rome, RM, Italy
| | - Alberto Milanese
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, 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
| | - Arianna Cleri
- Department of Radiological Sciences, Pathology and Oncology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Mariangela Lopez
- Department of Radiological Sciences, Pathology and Oncology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Lucia Manganaro
- Department of Radiological Sciences, Pathology and Oncology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Carlo De Felice
- Department of Radiological Sciences, Pathology and Oncology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Cira Di Gioia
- Department of Radiological Sciences, Pathology and Oncology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Anna Rita Vestri
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, 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
| | - Anna Paola Iori
- Department of Translational and Precision Medicine, Policlinico Umberto I Hospital, Sapienza University of Rome, Via Benevento 6, 00161, Rome, RM, Italy
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Minordi LM, Larosa L, Barbaro B, Angelino A, Broglia D, Cipri C, Scaldaferri F, Manfredi R, Natale L. How the Radiologist Must Reason for a Correct Diagnosis in Patients With Small Bowel Mural Thickening Studied by CT or MRI: A Pictorial Review. Curr Probl Diagn Radiol 2023; 52:393-411. [PMID: 37137738 DOI: 10.1067/j.cpradiol.2023.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/06/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023]
Abstract
Conditions that lead to small bowel mural thickening fall into a broad spectrum of diseases, including inflammatory, infectious, vascular or neoplastic. Computed tomography (CT) and Magnetic Resonance Imaging (MRI), especially CT-enterography and MR-enterography, permit evaluation of both entire small bowel and extraluminal structures. In CT/MR-enterography, the main prerequisite for the correct evaluation of small bowel is to obtain optimal intestinal distension. In fact, most errors are related to poor intestinal distension of the bowel which can lead to interpret as pathological a small bowel segment that is not very distended (false positive), or not to recognize presence of pathology in a collapsed segment (false negative). Once the examination has been performed, the images are analyzed in order to identify the presence of small bowel pathology. Pathology of the small bowel can manifest as endoluminal alteration and/or intestinal wall thickening. Once bowel wall thickening has been identified, the radiologist's first objective is trying to define benign or malignant nature of the alteration, using also patient's history and clinical features. Once the suspicion of benign or malignant pathology has been raised, the radiologist must try to formulate a diagnosis of nature. In this pictorial review we describe how the radiologist must reason for a correct diagnosis by answering a pattern of sequential questions in a patient with suspected small bowel disease studied by CT or MRI.
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Affiliation(s)
- Laura Maria Minordi
- Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Radiodiagnostica addominale, Roma, Italy.
| | - Luigi Larosa
- Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Radiodiagnostica addominale, Roma, Italy
| | - Brunella Barbaro
- Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Radiodiagnostica addominale, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | | | | | - Carla Cipri
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Franco Scaldaferri
- Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Area Medicina Interna, Gastroenterologia e Oncologia Medica, UOC di Medicina Interna e Gastroenterologia, CEMAD (Centro Malattie Apparato Digerente), Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Riccardo Manfredi
- Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Radiodiagnostica addominale, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Luigi Natale
- Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Radiodiagnostica addominale, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
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Dolinger MT. The Role of Noninvasive Surrogates of Inflammation in Monitoring Pediatric Inflammatory Bowel Diseases: The Old and the New. Gastroenterol Clin North Am 2023; 52:497-515. [PMID: 37543396 DOI: 10.1016/j.gtc.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
Effectiveness of limited available therapies for pediatric inflammatory bowel disease has reached stagnation. Previous non-invasive monitoring strategies have relied upon cumbersome tools to evaluate clinical symptoms and biochemical markers that do not reflect endoscopic activity or respond quickly to treatments. Novel, patient-centric, and highly accurate, monitoring strategies with a focus on intestinal ultrasound for a direct, precise monitoring of activity to achieve disease modification are now possible. Ultimately, research on the optimal tight control monitoring strategies, individualized to each pediatric inflammatory bowel disease patient, are in development and offer a hope to potential therapeutic ceiling breakthrough on the horizon.
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Affiliation(s)
- Michael Todd Dolinger
- Division of Pediatric Gastroenterology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Inniss S, Fragkos KC, Whitley L, Wimpory R, Rebello E, Lisboa A, Khetan T, Hassan J, Simpson K, Bhagwanani A, Vega R, Parisi I, Harrow P, Seward E, McCartney S, Bloom S, Smith AM, Plumb A, Rahman FZ. Two-year real-world outcome data from a single tertiary centre shows reduced ustekinumab persistence in a non-bio-naïve Crohn's disease cohort with penetrating disease, -ostomies and sarcopenia. Ther Adv Chronic Dis 2023; 14:20406223231189072. [PMID: 37601038 PMCID: PMC10434845 DOI: 10.1177/20406223231189072] [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: 09/12/2022] [Accepted: 07/03/2023] [Indexed: 08/22/2023] Open
Abstract
Background Ustekinumab was approved in 2016 for the treatment of moderate-severe Crohn's disease (CD). Clinical trials and real-world studies have suggested ustekinumab to be a safe and effective treatment; however, studies to date infrequently use imaging techniques to predict response to biologics in CD. Objectives We assessed the 2-year real-world effectiveness and safety of ustekinumab in a tertiary CD cohort with the use of novel imaging techniques. Design Retrospective cohort study. Methods Retrospective data were collected between 2016 and 2021. Study end points included ustekinumab persistence, biological and/or clinical response and remission at 12, 18 and 24 months. Statistical analysis included demographic and inferential analyses. Results In all, 131 CD patients [57.3% female, median age of 26.0 (21.0-37.0)] were included. Patients were non-bio naïve, and the majority received ustekinumab as third- or fourth-line treatment. At 24 months, 61.0% (80/131) persisted with ustekinumab [52.7% (69/131) steroid free]. Clinical response was reported in 55.2% (37/67), clinical remission in 85.7% (57/67), biological response in 46.8% (22/47) and biological remission in 31.9% (15/47) of patients at 24 months. The low outcome numbers were attributable to missing data. Improvements in routine disease markers, including C-reactive protein and Harvey-Bradshaw Index, were also reflected in magnetic resonance imaging-derived disease scores. The presence of penetrating CD, an -ostomy and sarcopenia were all predictors of poorer ustekinumab outcomes (p < 0.05). Conclusion Ustekinumab is effective in non-bio-naïve CD patients with non-stricturing, non-penetrating disease with an unremarkable safety profile but may be less effective in those with penetrating disease, -ostomies and sarcopenia.
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Affiliation(s)
- Saskia Inniss
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
- Eastman Dental Institute, University College London, London, UK
| | - Konstantinos C. Fragkos
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Lisa Whitley
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rachel Wimpory
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Eleanor Rebello
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ana Lisboa
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tanvi Khetan
- UCL Medical School, University College London, London, UK
- Department of Radiology, University College London Hospital, London, UK
| | - Jasmine Hassan
- UCL Medical School, University College London, London, UK
- Department of Radiology, University College London Hospital, London, UK
| | - Kate Simpson
- Division of Medicine, University College London, London, UK
| | - Anisha Bhagwanani
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Roser Vega
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ioanna Parisi
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Paul Harrow
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Edward Seward
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sara McCartney
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stuart Bloom
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Andrew M. Smith
- Eastman Dental Institute, University College London, London, UK
| | - Andrew Plumb
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Farooq Z. Rahman
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, Ground Floor West, 250 Euston Road, London, NW1 2PG, UK
- Eastman Dental Institute, University College London, London, UK
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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: 1] [Impact Index Per Article: 1.0] [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.
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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
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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.
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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
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30
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Lee WE, Weng MT, Wei SC, Shih IL. Comparison of the magnetic resonance scoring systems for Crohn's disease activity: MaRIA, simplified MaRIA, and Nancy scores. Abdom Radiol (NY) 2023; 48:2228-2236. [PMID: 37129624 DOI: 10.1007/s00261-023-03926-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE The most widely used score for assessing the activity of Crohn's disease (CD) is the Magnetic Resonance Index of Activity (MaRIA) score, but it is time-consuming. The aim of this study was to compare the diagnostic accuracy of MaRIA score to the other two easily calculated scores. METHODS Between January 2011 and May 2021, 67 patients with CD who underwent MRE and ileocolonoscopy within 2 weeks were enrolled. The MRE-based scores including the MaRIA score, simplified MaRIA (sMaRIA) score, and Nancy score for each colonic segment and terminal ileum were calculated and correlated with the ileocolonoscopic findings. The simplified endoscopic score for Crohn's disease (SES-CD) was considered the gold standard. RESULTS A total of 343 intestinal segments were included in the analysis, of which 109 (31.8%) showed active inflammation on ileocolonoscopy. The areas under the receiver operating characteristic curve (AUC) of the MaRIA, sMaRIA, and Nancy scores for detecting active disease were 0.752, 0.764, and 0.765, respectively. In the sub-analysis for different indications, the MaRIA and sMaRIA scores showed a higher AUC (0.721 and 0.741) than the Nancy score (0.652) for disease monitoring. CONCLUSION The sMARIA and Nancy scores showed comparable diagnostic accuracy to the MaRIA score, and thus could be used as alternatives to the MaRIA score. Furthermore, considering the range of application, especially for disease monitoring, the sMaRIA score may be more suitable for use in clinical practice.
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Affiliation(s)
- Wei-En Lee
- Department of Medical Imaging, National Taiwan University Hospital, No.7, Chung-Shan South Road, Taipei, 100, Taiwan
- Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Meng-Tzu Weng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shu-Chen Wei
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - I-Lun Shih
- Department of Medical Imaging, National Taiwan University Hospital, No.7, Chung-Shan South Road, Taipei, 100, Taiwan.
- Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan.
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D'Haens GR, Lee S, Taylor SA, Serone A, Rimola J, Colombel JF. Filgotinib for the Treatment of Small Bowel Crohn's Disease: The DIVERGENCE 1 Trial. Gastroenterology 2023; 165:289-292.e3. [PMID: 37054757 DOI: 10.1053/j.gastro.2023.03.234] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/17/2023] [Accepted: 03/27/2023] [Indexed: 04/15/2023]
Affiliation(s)
- Geert R D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
| | - Scott Lee
- Division of Gastroenterology, University of Washington, Seattle, Washington
| | - Stuart A Taylor
- Center for Medical Imaging, University College London, London, United Kingdom
| | | | - Jordi Rimola
- Inflammatory Bowel Disease Unit, Department of Radiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Jean-Frederic Colombel
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
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Zulqarnain F, Rhoads SF, Syed S. Machine and deep learning in inflammatory bowel disease. Curr Opin Gastroenterol 2023; 39:294-300. [PMID: 37144491 PMCID: PMC10256313 DOI: 10.1097/mog.0000000000000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE OF REVIEW The Management of inflammatory bowel disease (IBD) has evolved with the introduction and widespread adoption of biologic agents; however, the advent of artificial intelligence technologies like machine learning and deep learning presents another watershed moment in IBD treatment. Interest in these methods in IBD research has increased over the past 10 years, and they offer a promising path to better clinical outcomes for IBD patients. RECENT FINDINGS Developing new tools to evaluate IBD and inform clinical management is challenging because of the expansive volume of data and requisite manual interpretation of data. Recently, machine and deep learning models have been used to streamline diagnosis and evaluation of IBD by automating review of data from several diagnostic modalities with high accuracy. These methods decrease the amount of time that clinicians spend manually reviewing data to formulate an assessment. SUMMARY Interest in machine and deep learning is increasing in medicine, and these methods are poised to revolutionize the way that we treat IBD. Here, we highlight the recent advances in using these technologies to evaluate IBD and discuss the ways that they can be leveraged to improve clinical outcomes.
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Affiliation(s)
- Fatima Zulqarnain
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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Kitazume Y, Takenaka K, Ohtsuka K, Ozawa Y, Kimura K, Watanabe R, Tsuchiya J, Fujii T, Nagahori M, Watanabe M, Tateishi U. Motility Mapping Quantification Using the Classical Optical Flow Algorithm for Small Bowel Crohn's Disease: Comparison with Balloon-assisted Enteroscopy Findings. Magn Reson Med Sci 2023; 22:325-334. [PMID: 35545505 PMCID: PMC10449560 DOI: 10.2463/mrms.mp.2021-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/05/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To quantify bowel motility shown on cine MRI using the classical optical flow algorithm and compare it with balloon-assisted enteroscopy (BAE) findings in patients with Crohn's disease (CD). METHODS This retrospective study included 29 consecutive patients with CD who had undergone MR enterocolonography (MREC) and BAE between March and May 2017. We developed computer software to present motion vector magnitudes between consecutive cine MR images as bowel motility maps via a classical optical flow algorithm using the Horn-Schunck method. Cine MR images were acquired with a balanced steady-state free precession sequence in the coronal direction to capture small bowel motility. The small bowels were divided into three segments. In total, 63 bowel segments were assessed via BAE and MREC. Motility scores on the maps, simplified MR index of activity (sMaRIA), and MREC score derived from a 5-point MR classification were assessed independently by two radiologists and compared with the CD endoscopic index of severity (CDEIS). Correlations were assessed using Spearman's rank coefficient. The areas under the receiver-operating characteristic curve (AUCs) of motility score for differentiating CDEIS was calculated; a P value < 0.05 was considered statistically significant. RESULTS Motility score was negatively correlated with CDEIS (r = -0.59 [P < 0.001] and -0.54 [P < 0.001]), and the AUCs of motility scores for detecting CDEIS ≥ 3 were 88.2% and 78.6% for observers 1 and 2, respectively. There were no significant differences in the AUC for detecting CDEIS ≥ 3 and CDEIS ≥ 12 between motility and sMaRIA or MREC score. CONCLUSION The motility map was feasible for locally quantifying the bowel motility. In addition, the motility score on the map reflected the endoscopic inflammatory activity of each small bowel segment in patients with CD; hence, it could be used as a tool in objectively interpreting cine MREC to predict inflammatory activity in CD.
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Affiliation(s)
- Yoshio Kitazume
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, 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
| | - Yasuo Ozawa
- Systems Laboratories Corporation, Yokohama, Kanagawa, Japan
| | - Koichiro Kimura
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryosuke Watanabe
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junichi Tsuchiya
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshimitsu Fujii
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masakazu Nagahori
- 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 Tateishi
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Brodersen JB, Jensen MD, Juel MA, Kjeldsen J, Knudsen T, Rafaelsen SR. Intestinal ultrasound in patients with suspected Crohn's disease - results of a prospective evaluation by trainees. Scand J Gastroenterol 2023; 58:1405-1411. [PMID: 37459054 DOI: 10.1080/00365521.2023.2234538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/05/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND AND AIMS Intestinal ultrasound (IUS) performed by experts is a valuable tool for the diagnostic work-up and monitoring of Crohn's disease (CD). However, concern about insufficient training and perceived high inter-observer variability limit the adoption of IUS in CD. We examined the diagnostic accuracy of trainee-performed IUS in patients with suspected CD. METHOD Patients recruited to a prospective trial investigating the diagnostic accuracy of magnetic resonance enterocolonography (MREC) in patients with clinically suspected CD underwent IUS performed by trainees. The primary end-point was IUS per-patient sensitivity and specificity for ileocolonic CD determined by ileocolonoscopy. RESULTS 129 patients with clinically suspected CD and a complete IC and IUS were included in the analysis. IUS detected signs of CD in 49 cases (small bowel 31, colon 15, small bowel, and colon 3). The sensitivity and specificity for detection of ileocolonic CD by trainee performed IUS improved during the first to the second half of the study period from 57.1% (CI 34.0-78.2) to 73.1% (CI 52.2-88.4) and 76.5% (CI 58.8-89.3) to 89.7% (CI 72.6-97.8). The overall sensitivity and specificity of diagnosing CD with IUS were 65.4% (CI 50.9-78.0) and 80.5% (CI 69.9-88.7). There was no difference in diagnostic performance between IUS and MREC for the detection of CD. CONCLUSION Trainees improved during the study, and IUS performance in disease detection corresponded to expert-evaluated MREC.Registered at ClinicalTrials.gov (NCT03134586).
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Affiliation(s)
- Jacob Broder Brodersen
- Department of Internal Medicine, Section of Gastroenterology, Esbjerg Hospital - University Hospital of Southern Denmark, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Michael Dam Jensen
- Department of Regional Health Research, University of Southern Denmark, Denmark
- Department of Internal Medicine, Section of Gastroenterology, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
| | - Mie Agerbæk Juel
- Department of Internal Medicine, Section of Gastroenterology, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
| | - Jens Kjeldsen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
- Research Unit of Medical Gastroenterology, Department of Clinical Research, University of Southern, Denmark
- OPEN Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Torben Knudsen
- Department of Internal Medicine, Section of Gastroenterology, Esbjerg Hospital - University Hospital of Southern Denmark, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Søren Rafael Rafaelsen
- Department of Regional Health Research, University of Southern Denmark, Denmark
- Department of Radiology, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
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Choi SY, Kwon Y, Choi S, Lee SM, Choe BH, Kang B. Infliximab trough levels are associated with endoscopic healing but not with transmural healing at one year treatment with infliximab in pediatric patients with Crohn's disease. Front Immunol 2023; 14:1192827. [PMID: 37426637 PMCID: PMC10326720 DOI: 10.3389/fimmu.2023.1192827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/12/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction It is well known that infliximab (IFX) trough levels (TLs) are associated with endoscopic healing (EH) in Crohn's disease (CD). We investigated whether IFX TLs are associated with transmural healing (TH) in pediatric patients with CD following 1-year treatment. Methods Pediatric patients with CD treated with IFX were included in this single-center prospective study. IFX TL tests, magnetic resonance enterography (MRE), and colonoscopies were simultaneously conducted after 1-year IFX treatment. TH was defined as a wall thickness of ≤3 mm without inflammatory signs evaluated using MRE. EH was defined as a Simple Endoscopic Score for Crohn's disease of <3 points on colonoscopy. Results Fifty-six patients were included. EH and TH were observed in 60.7% (34/56) and 23.2% (13/56) of patients, respectively. IFX TLs were higher in patients with EH (median, 5.6 vs. 3.4 µg/mL, P = 0.002), whereas IFX TLs showed no significant difference in patients with and without TH (median, 5.4 vs. 4.7 µg/mL, P = 0.574). No significant difference was observed in EH and TH between patients whose intervals were shortened or not. Multivariate logistic regression analysis showed that IFX TLs and disease duration to IFX initiation were associated with EH (odds ratio [OR] = 1.82, P = 0.001, and OR = 0.43, P = 0.02, respectively). Discussion In pediatric patients with CD, IFX TLs were associated with EH but not with TH. Further studies investigating long-term TH and proactive dosing based on therapeutic drug monitoring may clarify whether an association between IFX TLs and TH exists.
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Affiliation(s)
- So Yoon Choi
- Department of Pediatrics, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Yiyoung Kwon
- Department of Pediatrics, School of Medicine, Inha University, Incheon, Republic of Korea
| | - Sujin Choi
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - So Mi Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Byung-Ho Choe
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ben Kang
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Focht G, Kuint RC, Greer MLC, Pratt LT, Castro DA, Church PC, Navas-López VM, Baldassano RN, Mortensen JH, Rieder F, Yerushalmi B, Ilivitzki A, Konen O, Griffiths AM, Turner D. Prospective Validation of the Lémann Index in Children: A Report From the Multicentre Image Kids Study. J Crohns Colitis 2023; 17:943-949. [PMID: 36756849 PMCID: PMC11004934 DOI: 10.1093/ecco-jcc/jjad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND The Lémann Index [LI] and the recently updated LI are tools for measuring structural bowel damage in adults with Crohn's disease [CD] but have not been evaluated in children. We aimed to validate the updated LI in the prospective multicentre ImageKids study of paediatric CD. METHODS We included children with CD undergoing magnetic resonance enterography [MRE], pelvic magnetic resonance imaging [MRI] and ileocolonoscopy. Half were followed for 18 months, when MRE was repeated. Serum was collected for fibrosis-related proteomic markers. The LI was calculated by central readers from the MRE, ileocolonoscopy, physical examination and surgical data. Reliability and construct validity were assessed at baseline, while responsiveness and test-retest reliability were explored longitudinally. RESULTS In total, 240 children were included (mean age, 14.2 ± 2.5 years; median disease duration, 2.2 years [interquartile range, IQR 0.25-4.42]; median baseline LI, 4.23 [IQR 2.0-8.8]). The updated LI had excellent inter-observer reliability (interclass correlation coefficient [ICC] = 0.94, 95% confidence interval [CI] 0.92-0.95) but poor, although statistically significant, correlation with radiologist and gastroenterologist global assessments of damage and with serum proteomic levels of fibrotic markers [rho = 0.15-0.30, most p < 0.05]. The updated LI had low discriminative validity for detecting damage (area under the receiver operating characteristic curve [AUC-ROC] 0.69, 95% CI 0.62-0.75). In 116 repeated MREs, responsiveness was suboptimal for differentiating improved from unchanged disease [AUC-ROC 0.58, 95% CI 0.45-0.71]. Test-retest reliability was high among stable patients [ICC = 0.84, 95% CI 0.72-0.91]. CONCLUSION Overall, the updated LI had insufficient psychometric performance for recommending its use in children. An age-specific index may be needed for children with shorter disease duration than typical adult cohorts.
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Affiliation(s)
- Gili Focht
- Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel
- The Hebrew University of Jerusalem, Israel
| | - Ruth Cytter Kuint
- Radiology Department, Shaare Zedek Medical Center, Jerusalem, Israel
- The Hebrew University of Jerusalem, Israel
| | - Mary-Louise C Greer
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Li-Tal Pratt
- Pediatric Imaging Unit, Imaging Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Denise A Castro
- Department of Diagnostic Radiology, Kingston Health Science Centre, Queen’s University, Kingston, Canada
| | - Peter C Church
- Department of Gastroenterology, Hospital for Sick Children, University of Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Víctor Manuel Navas-López
- Pediatric Gastroenterology and Nutrition Unit, Regional University Hospital of Málaga, Málaga, Spain
| | - Robert N Baldassano
- Division of Gastroenterology, Hepatology, and Nutrition, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Florian Rieder
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Baruch Yerushalmi
- Pediatric Gastroenterology Unit, Soroka University Medical Center, Soroka, Israel
| | - Anat Ilivitzki
- Pediatric Radiology Unit, Ruth Rappaport Children’s Hospital, Haifa, Israel
- The Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Osnat Konen
- Imaging Department, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
| | - Anne M Griffiths
- Department of Gastroenterology, Hospital for Sick Children, University of Toronto, Canada
| | - Dan Turner
- Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel
- The Hebrew University of Jerusalem, Israel
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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.
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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:
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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.
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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
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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.
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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
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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.
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Chirra P, Sharma A, Bera K, Cohn HM, Kurowski JA, Amann K, Rivero MJ, Madabhushi A, Lu C, Paspulati R, Stein SL, Katz JA, Viswanath SE, Dave M. Integrating Radiomics With Clinicoradiological Scoring Can Predict High-Risk Patients Who Need Surgery in Crohn's Disease: A Pilot Study. Inflamm Bowel Dis 2023; 29:349-358. [PMID: 36250776 PMCID: PMC9977224 DOI: 10.1093/ibd/izac211] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Early identification of Crohn's disease (CD) patients at risk for complications could enable targeted surgical referral, but routine magnetic resonance enterography (MRE) has not been definitively correlated with need for surgery. Our objective was to identify computer-extracted image (radiomic) features from MRE associated with risk of surgery in CD and combine them with clinical and radiological assessments to predict time to intervention. METHODS This was a retrospective single-center pilot study of CD patients who had an MRE within 3 months prior to initiating medical therapy. Radiomic features were extracted from annotated terminal ileum regions on MRE and combined with clinical variables and radiological assessment (via Simplified Magnetic Resonance Index of Activity scoring for wall thickening, edema, fat stranding, ulcers) in a random forest classifier. The primary endpoint was high- and low-risk groups based on need for surgery within 1 year of MRE. The secondary endpoint was time to surgery after treatment. RESULTS Eight radiomic features capturing localized texture heterogeneity within the terminal ileum were significantly associated with risk of surgery within 1 year of treatment (P < .05); yielding a discovery cohort area under the receiver-operating characteristic curve of 0.67 (n = 50) and validation cohort area under the receiver-operating characteristic curve of 0.74 (n = 23). Kaplan-Meier analysis of radiomic features together with clinical variables and Simplified Magnetic Resonance Index of Activity scores yielded the best hazard ratio of 4.13 (P = (7.6 × 10-6) and concordance index of 0.71 in predicting time to surgery after MRE. CONCLUSIONS Radiomic features on MRE may be associated with risk of surgery in CD, and in combination with clinicoradiological scoring can yield an accurate prognostic model for time to surgery.
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Affiliation(s)
- Prathyush Chirra
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Anamay Sharma
- Division of Gastroenterology, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kaustav Bera
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - H Matthew Cohn
- Long Island Digestive Disease Consultants, Northwell Health Physician Partners, Setauket, NY, USA
| | - Jacob A Kurowski
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Katelin Amann
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Marco-Jose Rivero
- Division of Gastroenterology, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Anant Madabhushi
- Wallace H. Coulter Department of Biomedical Engineering, Radiology and Imaging Sciences, Biomedical Informatics (BMI) and Pathology, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
- Research Health Scientist, Atlanta Veterans Administration Medical Center, Atlanta, GA, USA
| | - Cheng Lu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Rajmohan Paspulati
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sharon L Stein
- Department of General Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USAand
| | - Jeffrey A Katz
- Division of Gastroenterology, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Satish E Viswanath
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Maneesh Dave
- Division of Gastroenterology, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, UC Davis Medical Center, UC Davis School of Medicine, Sacramento, CA, USA
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Diagnostic accuracy of different cross-sectional imaging techniques for disease location and activity in Crohn's disease and external validation and comparison of MARIAs and IBUS-SAS. Abdom Radiol (NY) 2023; 48:821-832. [PMID: 36525049 DOI: 10.1007/s00261-022-03751-7] [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: 08/07/2022] [Revised: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The comparative accuracy of cross-sectional imaging techniques for evaluating Crohn's disease (CD) remains uncertain. This study aimed to assess diagnostic accuracy of disease location and activity in different cross-sectional images and validate and compare International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) and Simplified Magnetic Resonance Index of Activity (MARIAs). METHODS CD patients were retrospectively included from August 2018 to May 2021. We compared accuracy of B-mode intestinal ultrasound (B-IUS), computed tomography enterography (CTE), and magnetic resonance enterography (MRE) for the identification of disease location. Meanwhile, disease activity was compared on B-IUS, color Doppler imaging, CTE, and MRE. ROC analyses were used to validate MARIAs and IBUS-SAS. Spearman rank correlation was performed to evaluate the relationships between MARIAs/IBUS-SAS and CDAI, SES-CD, and inflammatory indicators. RESULTS A total of 115 CD patients were evaluated. The diagnostic accuracy of MRE in detecting small bowel disease was superior to that of B-IUS/CTE, showing sensitivity (89.3%), specificity (71.4%), and AUC (0.820). B-IUS had the highest sensitivity (81.2%), specificity (84.8%), and AUC (0.830) for detecting terminal ileal lesions. The diagnostic accuracy for colonic disease and disease activity was not significantly different among these techniques. In the validation of IBUS-SAS, the AUC was 0.860, with an optimal cutoff value to predict active disease of 46.7. MARIAs and IBUS-SAS showed no significant differences in the correlations of CDAI, SES-CD, and inflammatory indicators. CONCLUSION MRE and B-IUS are more sensitive for detecting small bowel CD and terminal ileal CD, respectively. IBUS-SAS has potential for precisely defining CD activity.
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Iborra M, Moret I, Busó E, García-Giménez JL, Ricart E, Gisbert JP, Cabré E, Esteve M, Márquez-Mosquera L, García-Planella E, Guardiola J, Pallardó FV, Serena C, Algaba-Chueca F, Domenech E, Nos P, Beltrán B. The Genetic Diversity and Dysfunctionality of Catalase Associated with a Worse Outcome in Crohn's Disease. Int J Mol Sci 2022; 23:ijms232415881. [PMID: 36555526 PMCID: PMC9785615 DOI: 10.3390/ijms232415881] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/05/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022] Open
Abstract
Chronic gut inflammation in Crohn’s disease (CD) is associated with an increase in oxidative stress and an imbalance of antioxidant enzymes. We have previously shown that catalase (CAT) activity is permanently inhibited by CD. The purpose of the study was to determine whether there is any relationship between the single nucleotide polymorphisms (SNPs) in the CAT enzyme and the potential risk of CD associated with high levels of oxidative stress. Additionally, we used protein and regulation analyses to determine what causes long-term CAT inhibition in peripheral white mononuclear cells (PWMCs) in both active and inactive CD. We first used a retrospective cohort of 598 patients with CD and 625 age-matched healthy controls (ENEIDA registry) for the genotype analysis. A second human cohort was used to study the functional and regulatory mechanisms of CAT in CD. We isolated PWMCs from CD patients at the onset of the disease (naïve CD patients). In the genotype-association SNP analysis, the CAT SNPs rs1001179, rs475043, and rs525938 showed a significant association with CD (p < 0.001). Smoking CD patients with the CAT SNP rs475043 A/G genotype had significantly more often penetrating disease (p = 0.009). The gene expression and protein levels of CAT were permanently reduced in the active and inactive CD patients. The inhibition of CAT activity in the PWMCs of the CD patients was related to a low concentration of CAT protein caused by the downregulation of CAT-gene transcription. Our study suggests an association between CAT SNPs and the risk of CD that may explain permanent CAT inhibition in CD patients together with low CAT gene and protein expression.
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Affiliation(s)
- Marisa Iborra
- Gastroenterology Department, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain
- Correspondence:
| | - Inés Moret
- Medical Research Institute Hospital La Fe (IIS La Fe), 46026 Valencia, Spain
| | - Enrique Busó
- Central Unit for Research in Medicine (UCIM), Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain
| | - José Luis García-Giménez
- INCLIVA Biomedical Research Institute, Spanish Institute of Health Carlos III, Department of Physiology, Faculty of Medicine and Dentistry, University of Valencia, Center for Biomedical Research Network on Rare Diseases (CIBERER), 46010 Valencia, Spain
| | - Elena Ricart
- Inflammatory Bowel Disease Unit, Gastroenterology Department, Hospital Clìnic de Barcelona, CIBEREHD, IDIBAPS, 08036 Barcelona, Spain
| | - Javier P. Gisbert
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), CIBEREHD, 28006 Madrid, Spain
| | - Eduard Cabré
- Gastroenterology Department, Hospital Germans Trias i Pujol, CIBEREHD, 08916 Badalona, Spain
| | - Maria Esteve
- Gastroenterology Department, Hospital Universitari Mutua de Terrassa, CIBEREHD, 08221 Barcelona, Spain
| | - Lucía Márquez-Mosquera
- Servei de Digestiu, Hospital del Mar, Barcelona, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - Esther García-Planella
- Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain
| | - Jordi Guardiola
- Gastroenterology Department, Hospital Universitari de Bellvitge, Hospital de Llobregat-Barcelona, 08901 Barcelona, Spain
| | - Federico V. Pallardó
- INCLIVA Biomedical Research Institute, Spanish Institute of Health Carlos III, Department of Physiology, Faculty of Medicine and Dentistry, University of Valencia, Center for Biomedical Research Network on Rare Diseases (CIBERER), 46010 Valencia, Spain
| | - Carolina Serena
- Institut d’Investigació Sanitària Pere Virgili, Hospital Universitari Joan XXIII, 43007 Tarragona, Spain
| | | | - Eugeni Domenech
- Gastroenterology Department, Hospital Germans Trias i Pujol, CIBEREHD, 08916 Badalona, Spain
| | - Pilar Nos
- Gastroenterology Department, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain
| | - Belén Beltrán
- Hospital Vithas Virgen del Consuelo, 46007 Valencia, Spain
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44
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Wang Y, Zhang R, Mao R, Li X. Inflammatory bowel disease cross-sectional imaging: What's new? United European Gastroenterol J 2022; 10:1179-1193. [PMID: 36461914 PMCID: PMC9752287 DOI: 10.1002/ueg2.12343] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/13/2022] [Indexed: 12/07/2022] Open
Abstract
Cross-sectional imaging-ultrasonography, computed tomography enterography, and magnetic resonance enterography-is a routine and indispensable tool for patients with Crohn's disease (CD) that helps to detect or monitor disease characteristics before, during, and after CD treatment. New emerging radiological technologies may have further clinical applications in the management of CD. In this review article, we focus on the latest developments in cross-sectional imaging in CD research, including its role in intra- and extra-luminal lesion detection, intestinal inflammation and fibrosis grading, therapeutic response assessment and outcome prediction, postoperative recurrence detection and prediction, and the gut-brain axis.
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Affiliation(s)
- Yang‐di Wang
- Department of RadiologyThe First Affiliated Hospital, Sun Yat‐Sen UniversityGuangzhouPeople's Republic of China
| | - Ruo‐nan Zhang
- Department of RadiologyThe First Affiliated Hospital, Sun Yat‐Sen UniversityGuangzhouPeople's Republic of China
| | - Ren Mao
- Department of GastroenterologyThe First Affiliated Hospital, Sun Yat‐Sen UniversityGuangzhouPeople's Republic of China
| | - Xue‐hua Li
- Department of RadiologyThe First Affiliated Hospital, Sun Yat‐Sen UniversityGuangzhouPeople's Republic of China
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Rimola J, Torres J, Kumar S, Taylor SA, Kucharzik T. Recent advances in clinical practice: advances in cross-sectional imaging in inflammatory bowel disease. Gut 2022; 71:2587-2597. [PMID: 35927032 PMCID: PMC9664122 DOI: 10.1136/gutjnl-2021-326562] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/20/2022] [Indexed: 12/17/2022]
Abstract
Endoscopy remains the reference standard for the diagnosis and assessment of patients with inflammatory bowel disease (IBD), but it has several important limitations. Cross-sectional imaging techniques such as magnetic resonance enterography (MRE) and intestinal ultrasound (IUS) are better tolerated and safer. Moreover, they can examine the entire bowel, even in patients with stenoses and/or severe inflammation. A variety of cross-sectional imaging activity scores strongly correlate with endoscopic measures of mucosal inflammation in the colon and terminal ileum. Unlike endoscopy, cross-sectional techniques allow complete visualisation of the small-bowel and assess for extraintestinal disease, which occurs in nearly half of patients with IBD. Extramural findings may predict outcomes better than endoscopic mucosal assessment, so cross-sectional techniques might help identify more relevant therapeutic targets. Coupled with their high sensitivity, these advantages have made MRE and IUS the primary non-invasive options for diagnosing and monitoring Crohn's disease; they are appropriate first-line investigations, and have become viable alternatives to colonoscopy. This review discusses cross-sectional imaging in IBD in current clinical practice as well as research lines that will define the future role of these techniques.
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Affiliation(s)
- Jordi Rimola
- IBD Unit, Radiology Department, Hospital Clínic de Barcelona, Barcelona, Spain .,IDIBAPS, Barcelona, Spain
| | - Joana Torres
- Gastroenterology Division, Hospital Beatriz Ângelo, Loures, Portugal,Gastroenterology Division, Hospital da Luz, Lisboa, Portugal
| | - Shankar Kumar
- Centre for Medical Imaging, University College London, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Torsten Kucharzik
- Department of Gastroenterology, Stadtisches Klinikum Luneburg gGmbH, Luneburg, Germany
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46
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Hanžel J, Jairath V, Ma C, Guizzetti L, Zou G, Santillan CS, Taylor SA, van Viegen T, D'Haens GR, Feagan BG, Panés J, Rimola J. Responsiveness of Magnetic Resonance Enterography Indices for Evaluation of Luminal Disease Activity in Crohn's Disease. Clin Gastroenterol Hepatol 2022; 20:2598-2606. [PMID: 35149220 DOI: 10.1016/j.cgh.2022.01.055] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/20/2021] [Accepted: 01/31/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Magnetic resonance enterography (MRE) is having an increasing role in Crohn's disease; however, fully validated indices are needed. We evaluated the responsiveness of 4 MRE indices in luminal Crohn's disease. METHODS Paired MRE images (pretreatment and post-treatment at weeks 12 or 14) from 41 patients were scored by 3 blinded radiologists. Disease activity was scored for 4 MRE indices (magnetic resonance index of activity [MaRIA], simplified MaRIA, London index, and London extended index) and a 100-mm visual analog scale (VAS) of overall disease activity. The criterion for change was an improvement by at least one half of an SD in the VAS after treatment. Responsiveness was evaluated using the standardized effect size (SES). Longitudinal validity was evaluated using correlations between changes in MRE index scores and disease activity measures including endoscopy and the VAS. RESULTS The SES was 1.17 (95% CI, 0.56-1.77) for the simplified MaRIA, 0.98 (95% CI, 0.42-1.55) for the MaRIA, 0.95 (95% CI, 0.38-1.51) for the London extended index, and 0.85 (95% CI, 0.31-1.39) for the London index. The simplified MaRIA was significantly more responsive than the London index (ΔSES, 0.32; 95% CI, 0.05-0.58) but not the MaRIA (ΔSES, 0.18; 95% CI, -0.01 to 0.38) or the London extended index (ΔSES, 0.22; 95% CI, -0.05 to 0.50). Correlations with endoscopy (simplified MaRIA: r = 0.72) were not different from correlations with the VAS (London extended index: r = 0.70). CONCLUSIONS Evaluated MRE indices showed moderate-to-large responsiveness and are suitable for use in clinical trials. The simplified MaRIA may be preferred because of its responsiveness and nonreliance on gadolinium administration.
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Affiliation(s)
- Jurij Hanžel
- Department of Gastroenterology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Alimentiv, Inc, London, Ontario, Canada; Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, Academic Medical Centre, Amsterdam, The Netherlands
| | - Vipul Jairath
- Alimentiv, Inc, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Division of Gastroenterology, Western University, London, Ontario, Canada.
| | - Christopher Ma
- Alimentiv, Inc, London, Ontario, Canada; Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | | | - Guangyong Zou
- Alimentiv, Inc, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Cynthia S Santillan
- Department of Radiology, University of California San Diego, La Jolla, California
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, United Kingdom
| | | | - Geert R D'Haens
- Alimentiv, Inc, London, Ontario, Canada; Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, Academic Medical Centre, Amsterdam, The Netherlands
| | - Brian G Feagan
- Alimentiv, Inc, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Julián Panés
- Hospital Clinic Barcelona, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Jordi Rimola
- Hospital Clinic Barcelona, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Barcelona, Spain
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47
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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: 7] [Impact Index Per Article: 3.5] [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.).
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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.
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48
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Dolinger MT, Dubinsky MC. The Pediatric Inflammatory Crohn's Magnetic Resonance Enterography Index: A Step Forward for Transmural Pediatric Crohn's Disease Monitoring and Healing. Gastroenterology 2022; 163:1166-1167. [PMID: 36067818 DOI: 10.1053/j.gastro.2022.08.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/25/2022] [Accepted: 08/27/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Michael Todd Dolinger
- Division of Pediatric Gastroenterology, Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marla C Dubinsky
- Division of Pediatric Gastroenterology, Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York.
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49
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Bohra A, Vasudevan A, Kutaiba N, Van Langenberg DR. Challenges and Strategies to Optimising the Quality of Small Bowel Magnetic Resonance Imaging in Crohn’s Disease. Diagnostics (Basel) 2022; 12:diagnostics12102533. [PMID: 36292222 PMCID: PMC9600769 DOI: 10.3390/diagnostics12102533] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/03/2022] [Accepted: 10/17/2022] [Indexed: 11/21/2022] Open
Abstract
Magnetic resonance enterography (MRE) is one of the most highly utilised tools in the assessment of patients with small bowel Crohn’s disease (CD). As a non-invasive modality, it has both patient and procedure-related advantages over ileocolonoscopy which is the current gold standard for Crohn’s disease activity assessment. MRE relies upon high-quality images to ensure accurate disease activity assessment; however, few studies have explored the impact of image quality on the accuracy of small bowel CD activity assessment. Bowel distension and motion artifacts are two key imaging parameters that impact the quality of images obtained through MRE. Multiple strategies have been employed to both minimise the effects of motion artifacts and improve bowel distension. This review discusses the definitions of bowel distension and motion artifacts within the literature with a particular focus on current strategies to improve bowel distension and limit motion artifacts in MRE.
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Affiliation(s)
- Anuj Bohra
- Department of Gastroenterology, Eastern Health, Box Hill 3128, Australia
- Correspondence:
| | - Abhinav Vasudevan
- Department of Gastroenterology, Eastern Health, Box Hill 3128, Australia
| | - Numan Kutaiba
- Department of Radiology, Eastern Health, Box Hill 3128, Australia
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50
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Kakkar C, Singh A, Mahajan R, Midha V, Goyal S, Narang V, Gupta K, Singh D, Bansal N, Saggar K, Sood A. Correlation between magnetic resonance enterography and ileo-colonoscopy for assessment of disease activity in terminal ileal Crohn's disease. Indian J Gastroenterol 2022; 41:465-474. [PMID: 36357600 DOI: 10.1007/s12664-022-01242-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Magnetic resonance enterography (MRE) has emerged as a novel tool for the assessment of disease activity in Crohn's disease (CD). Real world data from Indian subcontinent on performance of MRE in terminal ileal CD are lacking. METHODS Retrospective analysis of patients with terminal ileal CD who underwent both ileo-colonoscopy and MRE was performed. Ileo-colonoscopy was considered the gold standard for assessment of disease activity. On ileo-colonoscopy, a simple endoscopic score for Crohn's disease (SES-CD) ≥2 was considered active disease; presence of ulcers indicated severe disease. MRE scoring of the disease activity was performed using magnetic resonance index of activity (MARIA) and simplified MARIA (MARIAs). The measure of agreement between ileo-colonoscopy and MRE and comparison of MARIA and MARIAs for assessment of disease activity and sensitivity of MRE to detect mucosal ulcerations were calculated. RESULTS Seventy patients with terminal ileal CD (mean age 40.74±15.56 years; 71.4% males [n=50]) were evaluated. The sensitivities of MARIA and MARIAs scores to detect active disease were 0.76 and 0.84, respectively. The area under the receiver operating characteristic curve (AUROC) for detecting severe disease was 0.836 (p<0.0001) for MARIA and 0.861 (p<0.0001) for MARIAs. For mild active disease, there was no agreement between SES-CD and MARIA or MARIAs; however, for severe disease, the agreement was fair and moderate for MARIA and MARIAs, respectively. MARIA and MARIAs were comparable for identification of active and severe disease (κ 0.759, p<0.0001 and κ 0.840, p<0.0001, respectively). MRE was 68.18% sensitive to detect mucosal ulcers. CONCLUSION MRE is a reliable and sensitive tool for detection of endoscopically severe, but not mild, terminal ileal CD.
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Affiliation(s)
- Chandan Kakkar
- Department of Radiology and Radiodiagnosis, Dayanand Medical College, Ludhiana, 141 001, India
| | - Arshdeep Singh
- Department of Gastroenterology, Dayanand Medical College, Ludhiana, 141 001, India
| | - Ramit Mahajan
- Department of Gastroenterology, Dayanand Medical College, Ludhiana, 141 001, India
| | - Vandana Midha
- Department of Internal Medicine, Dayanand Medical College, Ludhiana, 141 001, India
| | - Shriya Goyal
- Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Vikram Narang
- Department of Pathology, Dayanand Medical College, Ludhiana, 141 001, India
| | - Kamini Gupta
- Department of Radiology and Radiodiagnosis, Dayanand Medical College, Ludhiana, 141 001, India
| | - Dharmatma Singh
- Department of Gastroenterology, Dayanand Medical College, Ludhiana, 141 001, India
| | - Namita Bansal
- Research and Development Center, Dayanand Medical College, Ludhiana, 141 001, India
| | - Kavita Saggar
- Department of Radiology and Radiodiagnosis, Dayanand Medical College, Ludhiana, 141 001, India
| | - Ajit Sood
- Department of Gastroenterology, Dayanand Medical College, Ludhiana, 141 001, India.
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