Magnetic resonance enterography versus capsule endoscopy activity indices for quantification of small bowel inflammation in Crohn’s disease

Abstract

Background: Video capsule endoscopy (VCE) and magnetic resonance enterography (MRE) are the prime modalities for the evaluation of small bowel (SB) Crohn's disease (CD). Mucosal inflammation on VCE is quantified using the Lewis score (LS). Diffusion-weighted (DW) magnetic resonance imaging (MRI) allows for accurate assessment of SB inflammation without administration of intravenous contrast material. The Magnetic Resonance Index of Activity (MaRiA) and the Clermont index are quantitative activity indices validated for contrast-enhanced MRE and DW-MRE, respectively. The aim of this study was to compare the quantification of distal SB inflammation by VCE and MR-related activity indices. Methods: Patients with known quiescent SB CD were prospectively recruited and underwent MRE and VCE. LS, MaRIA and Clermont scores were calculated for the distal SB. Results: Both MRI-based indices significantly correlated with the LS and the Clermont index (r = 0.50, p = 0.001 and r = 0.53, p = 0.001, respectively). Both MaRIA and Clermont scores were significantly lower in patients with mucosal healing (LS < 135). The area under the curve (AUC) with both MR scores was moderate for prediction of any mucosal inflammation (LS ⩾ 135) and excellent for prediction of moderate-to-severe inflammation (LS ⩾ 790) (0.71 and 0.74 versus 0.93 and 0.91 for MaRIA and Clermont score, respectively). Conclusions: Modest correlation between VCE-and MRE-based quantitative indices of inflammation in patients with quiescent SB CD was observed. Between-modality correlation was higher in patients with endoscopically severe disease. DW-MRE gauged by Clermont score was at least as accurate as contrast-enhanced MRE for quantification of SB inflammation.

Assessment of Crohn’s Disease Activity: Magnetic Resonance Enterography in Comparison with Clinical and Endoscopic Evaluations

“…The main characteristics of each of the studies [32,[52][53][54][55][56][57][58][59][60] evaluating the ability of the MaRIA score to diagnose active bowel disease in CD are summarized in Table III. Recently, Erden et al [60] have evaluated the MaRIA score in patients with entero-enteric fistulas and found no significant difference between patients with fistulas from those without fistulas. A potential limitation of the MaRIA is that it does not take into account the overall length of inflamed segments, even in the small bowel where extensive disease can occur.…”

“…In patients with active CD the intestinal wall shows diffusion restriction and a low ADC with high signal intensity on DWI using low and high b-values. Several studies have evaluated the efficacy of DWI in detecting active CD in comparison with ileocolonoscopy [58,63], videocapsule endoscopy [56], laboratory tests or other modalities of assessment [58,67]. DWI has been shown to have a high sensitivity for the detection of small bowel inflammatory disease, although the majority of the studies included small numbers of patients.…”

Development and Validation of a Simplified Magnetic Resonance Index of Activity for Crohn’s Disease

“…7,11 Since its first description, the MARIA has been increasingly used in observational studies as an objective measure of disease activity in patients with CD. [12][13][14][15][16][17][18][19][20][21] Furthermore, the MARIA has demonstrated to be a valid, responsive, and reliable index assessing response to therapy and endoscopic mucosal healing (MH). 22 Besides diagnostic accuracy and responsiveness, reproducibility is a critical property of an evaluative instrument, especially when serial measurements are required.…”

A review of magnetic resonance enterography-based indices for quantification of Crohn’s disease inflammation

“…Kopylov and colleagues 75 examined the relationship between the Lewis score, a capsule endoscopy-based index, MaRIA and Clermont in the distal small bowel. Both MaRIA and Clermont were significantly correlated with Lewis score ( r = 0.50, p = 0.001 and r = 0.53, p = 0.001, respectively), and the AUC of both scores was moderate for prediction of mucosal inflammation in general (Lewis score > 135) and excellent for prediction of moderate-to-severe inflammation (Lewis score > 790; 0.71 and 0.74 versus 0.93 and 0.91 for MaRIA and Clermont, respectively).…”