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Non-perforating small bowel Crohn's disease assessed by MRI enterography: Derivation and histopathological validation of an MR-based activity index

Steward, MJ; Punwani, S; Adjei-Gyamfi, Y; Chatterjee, F; Halligan, S; Taylor, SA; ... Bloom, S; + view all (2012) Non-perforating small bowel Crohn's disease assessed by MRI enterography: Derivation and histopathological validation of an MR-based activity index. European Journal of Radiology , 81 (9) 2080 - 2088. 10.1016/j.ejrad.2011.07.013.

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Abstract

Objectives: To develop and validate a qualitative scoring system for enteric Crohn's disease activity using MR enterography (MRE). Methods: MRE was performed in 16 patients (mean age 33, 8 male) undergoing small bowel resection. Mural thickness, T2 signal, contrast enhancement, and perimural oedema were scored qualitatively (0-3) at 44 locations. Transmural histopathological scoring of acute inflammation (AIS) was performed at all locations (score 0-13). MRI parameters best predicting AIS were derived using multivariate analysis. The MRI activity index was applied to 26 Crohn's patients (mean age 32, range 13-69 years, 15 male) and correlated to terminal ileal biopsy scores of acute inflammation ("eAIS" score 1-6). Receiver operator characteristic curves were calculated. Results: Mural thickness (coefficient 1.34 (95% CI 0.36, 2.32)], p = 0.007) and T2 signal (coefficient 0.90 (95% CI -0.24, 2.04) p = 0.06) best predicted AIS (AIS = 1.79 + 1.34*mural thickness + 0.94*mural T2 score [R-squared 0.52]). There was a significant correlation between the MRI index and eAIS (Kendall's tau = 0.40, 95% CI 0.11-0.64, p = 0.02). The model achieved a sensitivity of 0.81 (95% CI 0.54-0.96), specificity of 0.70 (0.35-0.93) and AUC 0.77 for predicting acute inflammation (eAIS ≥2). Conclusions: A simple qualitative MRI Crohn's disease activity score appears predictive against a histopathological standard of reference. © 2011 Elsevier Ireland Ltd.

Type:Article
Title:Non-perforating small bowel Crohn's disease assessed by MRI enterography: Derivation and histopathological validation of an MR-based activity index
DOI:10.1016/j.ejrad.2011.07.013
UCL classification:UCL > School of Life and Medical Sciences > Faculty of Medical Sciences > Medicine (Division of) > Metabolism and Experimental Therapeutics

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