Abstract
Magnetic resonance enterography is increasingly utilized for assessment of luminal Crohn's disease activity. The Magnetic Resonance Index of Activity and the London Index are the most commonly used outcome measures in clinical trials. We assessed the reliability of these indices and several additional items. A consensus process clarified scoring conventions and identified additional items based on face validity. Four experienced radiologists evaluated 50 images in triplicate, in random order, at least 1 month apart, using a central image management system. Intra- and interrater reliability were assessed by calculating and comparing intraclass correlation coefficients. Intrarater intraclass correlation coefficients (95% confidence intervals) for the Magnetic Resonance Index of Activity, London, and London "extended" indices and a visual analogue scale were 0.89 (0.84 to 0.91), 0.87 (0.83 to 0.90), 0.89 (0.85 to 0.92), and 0.86 (0.81 to 0.90). Corresponding interrater intraclass correlation coefficients were 0.71 (0.61 to 0.77), 0.67 (0.55 to 0.75), 0.70 (0.61 to 0.76), and 0.71 (0.62 to 0.77). Reliability for each index was greatest in the terminal ileum and poorest in the rectum. All 3 indices were highly correlated with the visual analogue scale; 0.79 (0.71 to 0.85), 0.78 (0.71 to 0.84), and 0.79 (0.72 to 0.85) for the Magnetic Resonance Index of Activity, London, and the London "extended" indices, respectively. "Substantial" interrater reliability was observed for all 3 indices. Future studies should assess responsiveness to treatment in order to confirm their utility as evaluative indices in clinical trials and clinical practice.
Highlights
Crohn's disease is an inflammatory bowel disease, which can present throughout the gastrointestinal tract, affecting the small bowel and colon
Magnetic resonance imaging (MRI) features such as wall thickness and T1/T2 bowel wall signal have been validated as biomarkers of Crohn's disease activity, demonstrating good correlation with endoscopic and histopathologic grading of inflammation 2–4
Recent years have seen several MRI disease activity scores being developed and externally validated, combining multiple MRI features to predict overall disease activity 3–6. These scores are gradually disseminating into clinical practice, at present they are predominantly employed as research tools
Summary
Crohn's disease is an inflammatory bowel disease, which can present throughout the gastrointestinal tract, affecting the small bowel and colon. Recent years have seen several MRI disease activity scores being developed and externally validated, combining multiple MRI features to predict overall disease activity 3–6. These scores are gradually disseminating into clinical practice, at present they are predominantly employed as research tools. The MaRIA is based on quantitative measurement of relative bowel wall contrast enhancement (RCE) along with subjective evaluation of mural ulceration and abnormal T2 signal 3. Other indices, such as the London score and Crohn's Disease MRI Index (CDMI) rely on qualitative grading of various features by reporting radiologists 4,6. The current literature, reports variable reproducibility for many features used in MRI activity scores 6,7
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