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Diagnostic performance of magnetic resonance enterography disease activity indices compared with a histological reference standard for adult terminal ileal Crohn's disease: experience from the METRIC trial

Kumar, Shankar; Parry, Thomas; Mallett, Sue; Bhatnagar, Gauraang; Plumb, Andrew; Walsh, Shaun; Scott, Nigel; ... Taylor, Stuart; + view all (2022) Diagnostic performance of magnetic resonance enterography disease activity indices compared with a histological reference standard for adult terminal ileal Crohn's disease: experience from the METRIC trial. Journal of Crohn's and Colitis 10.1093/ecco-jcc/jjac062. (In press).

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Abstract

BACKGROUND AND AIMS: The simplified magnetic resonance enterography (MRE) index (sMARIA), London and "extended" London scoring systems are widely used in Crohn's disease (CD) to assess disease activity, although validation studies have usually been single centre, retrospective and/or used few readers. Here, we evaluated these MRE indices within a prospective multicentre, multireader diagnostic accuracy trial. METHODS: A subset of participants (newly diagnosed or suspected of relapse) recruited to the METRIC trial with available terminal ileal (TI) biopsies was included. Using pre-specified thresholds, the sensitivity and specificity of sMARIA, London and "extended" London scores for active and severe (sMARIA) TI CD were calculated using different thresholds for the histological activity index (HAI). RESULTS: We studied 111 patients (median 29 years, interquartile range 21-41, 75 newly diagnosed, 36 suspected relapse) from 7 centres, of whom 22 had no active TI CD (HAI=0), 39 mild (HAI=1), 13 moderate (HAI=2), and 37 severe CD activity (HAI=3). In total, 26 radiologists prospectively scored MRE datasets as per their usual clinical practice. Sensitivity and specificity for active disease (HAI>0) were 83% (95% confidence interval 74-90%) and 41% (23-61%) for sMARIA, 76% (67-84%) and 64% (43-80%) for the London score, and 81% (72-88%) and 41% (23-61%) for the "extended" London score, respectively. The sMARIA had 84% (69-92%) sensitivity and 53% (41-64%) specificity for severe CD. CONCLUSIONS: When tested at their proposed cut-offs in a real-world setting, sMARIA, London and "extended" London indices achieve high sensitivity for active TI disease against a histological reference standard, but specificity is low.

Type: Article
Title: Diagnostic performance of magnetic resonance enterography disease activity indices compared with a histological reference standard for adult terminal ileal Crohn's disease: experience from the METRIC trial
Location: England
DOI: 10.1093/ecco-jcc/jjac062
Publisher version: https://doi.org/10.1093/ecco-jcc/jjac062
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Crohn’s disease, imaging, magnetic resonance enterography
UCL classification: UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Department of Imaging
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute > Research Department of Pathology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute
URI: https://discovery.ucl.ac.uk/id/eprint/10147961
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