Diagnostic accuracy of magnetic resonance enterography and small bowel ultrasound for the extent and activity of newly diagnosed and relapsed Crohn's disease (METRIC): a multicentre trial

Taylor, Stuart A.; Mallett, Susan; Bhatnagar, Gauraang; Baldwin-Cleland, Rachel; Bloom, Stuart; Gupta, Arun; Hamlin, P. J.; Hart, Ailsa; Higginson, Antony; Jacobs, Ilan; McCartney, Sara; Miles, Anne; Murray, Charles; Plumb, Andrew; Pollok, Richard; Punwani, Shonit; Quinn, Laura; Rodriguez‐Justo, Manuel; Shabir, Zainib; Slater, Andrew; Tolan, Damian; Travis, Simon; Windsor, Alastair; Wylie, Peter; Zealley, Ian; Halligan, Steve; Dyer, Jade; Veeramalla, Pranitha; Tebbs, S; Hibbert, Steve; Ellis, Richard; Thursby‐Pelham, Fergus; Beable, Richard; Gibbons, Nicola J.; Ward, Claire; OʼConnor, Anthony; Lambie, Hannah; Hyland, Rachel E; Scott, Nigel; Lapham, Roger; Quartey, Doris; Scrimshaw, Deborah; Bungay, Helen; Betts, Maggie; Fourie, Simona; Power, Niall; Ilangovan, Rajapandian; Patel, Uday; Mainta, Evgenia; Lung, Phillip F. C.; Johnston, Ian; Naghibi, M.; Moorghen, Morgan; Martínez, A.; Porté, François; Alexakis, Christopher; Pilcher, James; Rahman, Anisur; Vlahos, Jonny; Greenhalgh, Rebecca; Wale, Anita; Beeston, Teresita; Piga, Wivijin; Clemente, Joey; Rahman, Farooq; de, Simona; Mehta, Shameer; Vega, Roser; Jastrub, Roman; Sidhu, Harbir; Rafiee, Hameed; Tennent, Mairead; Innes, Caron; Mowat, Craig; Duncan, Graeme; Morris, Steve

doi:10.1016/s2468-1253(18)30161-4

Cited by 180 publications

(198 citation statements)

References 41 publications

Supporting

Mentioning

178

Contrasting

Unclassified

Order By: Relevance

“…METRIC was a multicentre, prospective cohort trial comparing diagnostic accuracy of MRE and SBUS for the presence, extent and activity of enteric Crohn's disease [4,14]. The trial recruited two patient cohorts: (1)…”

Section: Study Populationmentioning

confidence: 99%

“…Meta-analyses suggest that small bowel ultrasound (SBUS) achieves a high sensitivity for the presence and extent of small bowel Crohn's disease (CD), recently confirmed in a prospective multicentre trial setting by the METRIC trial [1][2][3][4]. SBUS has several advantages over Magnetic resonance enterography (MRE).…”

Section: Introductionmentioning

confidence: 99%

“…A proportion of patients recruited to the METRIC trial [4] underwent repeat SBUS by a different practitioner specifically to assess inter-observer variability for detection, extent and descriptive features of small bowel and colonic CD. Our findings are reported here.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Observer agreement for small bowel ultrasound in Crohn’s disease: results from the METRIC trial

Bhatnagar

Quinn²,

Higginson

et al. 2020

Abdom Radiol

Self Cite

View full text Add to dashboard Cite

Purpose To prospectively evaluate interobserver agreement for small bowel ultrasound (SBUS) in newly diagnosed and relapsing Crohn's disease. Methods A subset of patients recruited to a prospective trial comparing the diagnostic accuracy of MR enterography and SBUS underwent a second SBUS performed by one of a pool of six practitioners, who recorded the presence, activity and location of small bowel and colonic disease. Detailed segmental mural and extra-mural observations were also scored. Interobserver variability was expressed as percentage agreement with a construct reference standard, split by patient cohort, grouping disease as present or absent. Prevalence adjusted bias adjusted kappa (PABAK), and simple percentage agreement between practitioners, irrespective of the reference standard, were calculated. Results Thirty-eight patients (11 new diagnosis, 27 relapse) were recruited from two sites. Overall percentage agreement for small bowel disease presence against the consensus reference was 82% (52-95% (95%CI)), kappa coefficient (κ) 0.64, (substantial agreement) for new diagnosis and 81%, κ 0.63 (substantial agreement) for the relapsing cohort. Agreement for colonic disease presence was 64%, κ 0.27 (fair agreement) in new diagnosis and 78%,κ 0.56 (moderate agreement) in the relapsing cohort. Simple agreement between practitioners was 84% and 87% for small bowel and colonic disease presence respectively. Practitioners agreed on small bowel disease activity in 24/27 (89%) where both identified disease. Kappa agreement for detailed mural observations ranged from κ 0.00 to 1.00. Conclusion There is substantial practitioner agreement for small bowel disease presence in newly diagnosed and relapsing CD patients, supporting wider dissemination of enteric US.

show abstract

Section: Study Populationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Observer agreement for small bowel ultrasound in Crohn’s disease: results from the METRIC trial

Bhatnagar

Quinn²,

Higginson

et al. 2020

Abdom Radiol

Self Cite

View full text Add to dashboard Cite

show abstract

“…Our findings support its wider adoption in this age group. Further dedicated prospective comparative studies of SICUS and MRE, such as the United Kingdom‐based MR Enterography or ulTrasound In Crohn's disease (METRIC) trial in adults, are now needed in children …”

Section: Discussionmentioning

confidence: 99%

Comparison of small intestinal contrast ultrasound with magnetic resonance enterography in pediatric Crohn's disease

et al. 2019

Self Cite

View full text Add to dashboard Cite

Aim To compare the diagnostic yield of small intestinal contrast ultrasonography (SICUS) with magnetic resonance enterography (MRE) in routine clinical practice in a cohort of pediatric patients investigated for Crohn's disease (CD) attending a UK tertiary center. Methods and Results Patients with suspected or established CD who underwent SICUS were identified retrospectively. SICUS was compared to conventional transabdominal ultrasound (TUS), ileocolonoscopy (IC), and MRE. The accuracy and agreement of SICUS in detecting small bowel lesions and CD‐related complications were assessed using kappa (κ) coefficient statistics. A total of 93 patients (median age 15 years, range 2–17, 49 male) underwent SICUS; 58 had suspected and 35 had established CD. In suspected CD, sensitivity and specificity of SICUS in detecting CD small bowel lesions were 81.8 and 100% and for TUS 85.7 and 87.5%, respectively. In established CD, sensitivity and specificity of SICUS were 98.7 and 100% and TUS 80 and 100%, respectively. Agreement between SICUS and IC was substantial for the presence of lesions (κ = 0.73) but fair in TUS (κ = 0.31). Agreement between SICUS and IC was almost perfect for detecting strictures (κ = 0.84), with a sensitivity of 100% and specificity of 97.6%. When comparing SICUS and TUS with MRE, agreement for the presence of lesions was substantial (κ = 0.63) and moderate (κ = 0.53), respectively. Agreement between SICUS and MRE was substantial for detecting strictures (κ = 0.77) and dilatation (κ = 0.68). Conclusions SICUS offers a radiation‐free alternative for assessing pediatric small bowel CD, with diagnostic accuracy that is comparable to MRE and IC, supporting its wider use in routine practice.

show abstract

“…Crohn’s disease and ulcerative colitis are the two principal subtypes of IBD and involve chronic immunological response in the gastrointestinal mucosa. Ileocolonoscopy with biopsies is still considered the gold standard for initial diagnosis, disease activity monitoring and assessment of therapeutic response( 3 ). Unfortunately, this procedure is costly, causes significant patient discomfort, can lead to intestinal perforation and is limited to the evaluation of the lower part of the gastrointestinal mucosa (rectum, colon and terminal ileum)( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Ultrasensitive Molecular Imaging of Mucosal Inflammation Using Leucocyte-Mimicking Particles Targeted to MAdCAM-1

Fournier

Lizarrondo

Rateau

et al. 2019

Preprint

View full text Add to dashboard Cite

One Sentence Summary: Molecular magnetic resonance imaging allows non-invasive evaluation of mucosal inflammation in clinically relevant experimental models. ABSTRACTMucosal tissues line the digestive, respiratory, urinary, mammary and reproductive tracts and play critical roles in health and disease as the primary barrier between the external world and the inner body. Clinical evaluation of mucosal tissues is currently performed using endoscopy, such as ileocolonoscopy for the intestinal mucosa, that causes significant patient discomfort and can lead to organ damage. Here, we developed a new contrast agent for molecular magnetic resonance imaging (MRI) that is targeted to mucosal vascular addressin cell adhesion molecule 1 (MAdCAM-1), an adhesion molecule overexpressed by inflamed mucosal tissues. We investigated the diagnostic performance of molecular MRI of MAdCAM-1 to detect mucosal inflammation in several models of acute and chronic intestinal inflammation in mice. We demonstrated that molecular MRI of MAdCAM-1 reveals disease activity and can evaluate the response to inflammatory treatments along the whole intestinal mucosa in clinically relevant models of inflammatory bowel diseases. We also provide evidence that this new technique can detect low, subclinical levels of mucosal inflammation.Molecular MRI of MAdCAM-1 has thus potential applications in early diagnosis, longitudinal follow-up and therapeutic response monitoring in diseases affecting mucosal tissues, such as inflammatory bowel diseases.Recently, we and others reported the use of a new family of contrast agents for molecular MRI based on micro-sized particles of iron oxide (MPIO) that displays a dramatically higher sensitivity than classically used nano-sized particles(9-12). Thanks to an artefact known as the blooming effect, MPIO appear around 50 times larger than their actual size on iron sensitive T2*-weighted images (12). This characteristic of MPIO makes them particularly interesting for imaging mucosal tissues, since these tissues measure only a few hundred micrometers of thickness in physiological conditions and are thus hardly visible on unenhanced MRI. In the present study in mice, we developed a new MPIO-based contrast agent for MRI targeted to MAdCAM-1 (thereafter named MPIO-αMAdCAM-1). In three different models of intestinal inflammation, including lipopolysaccharides (LPS) induced endothelial activation, dextran sodium sulfate (DSS) induced colitis and trinitrobenzene sulfonic acid (TNBS) induced colitis(13), we demonstrated that this contrast agent allows detection of mucosal inflammation, quantification of disease activity and assessment of the mucosal response to anti-inflammatory treatments.

show abstract

Diagnostic accuracy of magnetic resonance enterography and small bowel ultrasound for the extent and activity of newly diagnosed and relapsed Crohn's disease (METRIC): a multicentre trial

Cited by 180 publications

References 41 publications

Observer agreement for small bowel ultrasound in Crohn’s disease: results from the METRIC trial

Observer agreement for small bowel ultrasound in Crohn’s disease: results from the METRIC trial

Comparison of small intestinal contrast ultrasound with magnetic resonance enterography in pediatric Crohn's disease

Ultrasensitive Molecular Imaging of Mucosal Inflammation Using Leucocyte-Mimicking Particles Targeted to MAdCAM-1

Contact Info

Product

Resources

About