Is the Mixed Use of Magnetic Resonance Enterography and Computed Tomography Enterography Adequate for Routine Periodic Follow-Up of Bowel Inflammation in Patients with Crohn's Disease?

Abstract

Objective Computed tomography enterography (CTE) and magnetic resonance enterography (MRE) are considered substitutes for each other for evaluating Crohn's disease (CD). However, the adequacy of mixing them for routine periodic follow-up for CD has not been established. This study aimed to compare MRE alone with the mixed use of CTE and MRE for the periodic follow-up of small bowel inflammation in patients with CD. Materials and Methods We retrospectively compared two non-randomized groups, each comprising 96 patients with CD. One group underwent CTE and MRE (MRE followed by CTE or vice versa) for the follow-up of CD (interval, 13–27 months [median, 22 months]), and the other group underwent MRE alone (interval, 15–26 months [median, 21 months]). However, these two groups were similar in clinical characteristics. Three independent readers from three different institutions determined whether inflammation had decreased, remained unchanged, or increased within the entire small bowel and the terminal ileum based on sequential enterography of the patients after appropriate blinding. We compared the two groups for inter-reader agreement and accuracy (terminal ileum only) using endoscopy as the reference standard for enterographic interpretation. Results The inter-reader agreement was greater in the MRE alone group for the entire small bowel (intraclass correlation coefficient [ICC]: 0.683 vs. 0.473; p = 0.005) and the terminal ileum (ICC: 0.656 vs. 0.490; p = 0.030). The interpretation accuracy was higher in the MRE alone group without statistical significance (70.9%–74.5% vs. 57.9%–64.9% in individual readers; adjusted odds ratio = 3.21; p = 0.077). Conclusion The mixed use of CTE and MRE was inferior to MRE alone in terms of inter-reader reliability and could probably be less accurate than MRE alone for routine monitoring of small bowel inflammation in patients with CD. Therefore, the consistent use of MRE is favored for this purpose.

A Novel Chronic Enteropathy Associated with SLCO2A1 Gene Mutation: Enterography Findings in a Multicenter Korean Registry

“…The imaging protocol included coronal T2-weighted half-Fourier sequences with and without fat suppression; axial T2-weighted half-Fourier sequence with fat suppression; coronal free-breathing diffusion-weighted imaging (DWI) with b factors of 0 and 900 s/mm 2 and apparent diffusion coefficient (ADC) map; coronal dynamic T1-weighted spoiled gradient-echo sequences with fat suppression (precontrast and enteric and portal phases after intravenous administration of 0.2 mL/kg of gadoterate meglumine at a rate of 2 mL/s); and axial delayed contrast-enhanced T1-weighted spoiled gradient-echo sequence with fat suppression. Further details can be found in previous studies [ 11 12 ].…”

“…Additional MRE-specific findings, including the signal intensities of the involved bowel segment on T2-weighted images and DWI/ADC, were also evaluated. Restricted diffusion was defined as high signal intensity on high b -value DWI images ( b = 900 s/mm 2 ) with a low value on the corresponding ADC maps [ 11 12 ].…”

How to Clearly and Accurately Report Odds Ratio and Hazard Ratio in Diagnostic Research Studies?

“…When 34 original research studies reporting OR published in the Korean Journal of Radiology in 2020–2021 [ 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 ] were evaluated against a rigorous standard (i.e., complete transparency in reporting), 91.2% (31/34) clearly mentioned how they defined the odds, 62.1% (18/29) unmistakably described the reference category for OR calculation for categorical variables, and 42.9% (9/21) specified the one-unit amount for OR for continuous variables. Therefore, there is room for improvement in reporting.…”

Using MR Enterography and CT Enterography for Routine Crohn’s Surveillance: How We Do It Now, and How We Hope to Do it in the Future

“…We read with interest the provocative article by Ha et al [ 1 ] comparing agreement between three gastrointestinal (GI) radiologists from different institutions in assessing response to therapy for small bowel CD. In this study 96 patients underwent 2 MRE exams, and 96 patients underwent CTE followed or preceded by MRE.…”

“…What are we to make of these findings, and how should they influence our behavior and recommendations? Firstly, it should be recognized that both arms in the study by Ha et al [ 1 ] had acceptable and moderate reproducibility for assessing response. Secondly, the symptomatic nature of Crohn’s flares and their propensity to involve bowel obstruction and penetrating complications, means that neither patients nor referring clinicians are able to completely control which imaging modality will be utilized: a late night trip to the emergency department (ED) almost always means a CT will be performed, but this imaging has been shown to be well justified because nearly one-third of CD patients in this setting will have perforation, obstruction or abscess [ 17 ].…”