Assessment of Disease Activity in Small Bowel Crohn's Disease: Comparison between Endoscopy and Magnetic Resonance Enterography Using MRIA and Modified MRIA Score.

Arnaldo Scardapane,Filomenamila Lorusso,Amato Antonio Stabile Ianora,Annalisa Ambrosi,Mariabeatrice Principi,Maria Elisabetta Mancini,Alfredo Di Leo,Emanuela Salinaro,Giuseppe Angelelli

doi:10.1155/2015/159641

Arnaldo Scardapane, Filomenamila Lorusso + Show 7 more

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https://doi.org/10.1155/2015/159641

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Abstract

Objectives. To retrospectively compare the results of the MRIA (magnetic resonance index of activity) with a modified MRIA (mMRIA), which was calculated excluding from MRIA formula the data of relative contrast enhancement (RCE). Materials and Methods. MR-E and corresponding endoscopic records of 100 patients were reviewed. MRIA, mMRIA, and SES endoscopic index were calculated for all the patients. Namely, MRIA was calculated as follows: (1.5 × wall thickening + 0.02 × RCE + 5 × intramural edema + 10 × ulcers), while mMRIA was calculated with the modified formula (1.5 × wall thickening + 5 × intramural edema + 10 × ulcers). Results. Mean MRIA and mMRIA values were 19.3 and 17.68, respectively (p < 0.0001). A significant correlation (p < 0.0001) was observed between MRIA and mMRIA scores and between both MR indexes and SES (p < 0.0001). Conclusions. mMRIA was comparable to MRIA in the evaluation of disease activity in Crohn's disease.

Highlights

Crohn’s disease (CD) is a chronic progressive inflammatory disorder of the entire alimentary tract, classically involving the terminal ileum: ileitis is observed in 90% of the patients with small-intestinal CD, who in turn constitute 30–40% of all CD patients [1].The disease is characterized by a relapsing and remitting course, posing the problem of repeated follow-ups over time for the assessment of disease activity.To assess the severity of clinical disease activity, composite scores such as Crohn’s Disease Activity Index (CDAI) or the Harvey-Bradshaw Index are used [2].Ileocolonoscopy has been recognized as the gold standard for the evaluation of lesions in the colon and terminal ileum
To retrospectively compare the results of the MR index of activity (MRIA) with a modified MRIA, which was calculated excluding from MRIA formula the data of relative contrast enhancement (RCE)
Number of patients 3 27 51 19 remission was diagnosed in 3/100 patients (3%), a mild disease activity in 27/100 (27%) cases, a moderate activity (7–15) in 51/100 (51%) patients, and a severe disease (>15) in the remaining 19/100 (19%) patients (Table 3). Both the readers demonstrated the involvement of the terminal ileum in 75/100 patients, while the terminal ileum was considered normal in 25/100 cases

Summary

Introduction

Crohn’s disease (CD) is a chronic progressive inflammatory disorder of the entire alimentary tract, classically involving the terminal ileum: ileitis is observed in 90% of the patients with small-intestinal CD, who in turn constitute 30–40% of all CD patients [1].The disease is characterized by a relapsing and remitting course (flare-ups followed by clinical remission), posing the problem of repeated follow-ups over time for the assessment of disease activity.To assess the severity of clinical disease activity, composite scores such as Crohn’s Disease Activity Index (CDAI) or the Harvey-Bradshaw Index are used [2].Ileocolonoscopy has been recognized as the gold standard for the evaluation of lesions in the colon and terminal ileum. Crohn’s disease (CD) is a chronic progressive inflammatory disorder of the entire alimentary tract, classically involving the terminal ileum: ileitis is observed in 90% of the patients with small-intestinal CD, who in turn constitute 30–40% of all CD patients [1]. To assess the severity of clinical disease activity, composite scores such as Crohn’s Disease Activity Index (CDAI) or the Harvey-Bradshaw Index are used [2]. Plays a vital role in diagnosing and phenotyping CD, thereafter assessing disease activity and complications [4]. MR enterography (MR-E) of the small bowel, thanks to the lack of ionizing radiation, along with very high soft-tissue contrast and multiplanar images has high diagnostic accuracy in the evaluation of luminal and extraluminal abnormalities [5]

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