Diagnostic performance of magnetic resonance enterography disease activity indices compared with a histological reference standard for adult terminal ileal Crohn's disease: experience from the METRIC trial

, Shankar Kumar, Thomas Parry, Sue Mallett, Gauraang Bhatnagar, Andrew Plumb, Shaun Walsh, Nigel Scott, Ruchi Tandon, Heung Chong, John du Parcq, Adrianna Martinez, Morgan Moorghen, Manuel Rodriguez-Justo, Steve Halligan, Stuart Taylor (Lead / Corresponding author)

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9 Citations (Scopus)
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Abstract

BACKGROUND AND AIMS: The simplified magnetic resonance enterography [MRE] index of activity [sMARIA], London, and 'extended' London, scoring systems are widely used in Crohn's disease [CD] to assess disease activity, although validation studies have usually been single-centre, retrospective, and/or used few readers. Here, we evaluated these MRE indices within a prospective, multicentre, multireader, diagnostic accuracy trial. METHODS: A subset of participants [newly diagnosed or suspected of relapse] recruited to the METRIC trial with available terminal ileal [TI] biopsies was included. Using pre-specified thresholds, the sensitivity and specificity of sMARIA, London, and 'extended' London scores for active and severe [sMARIA] TI CD were calculated using different thresholds for the histological activity index [HAI]. RESULTS: We studied 111 patients [median age 29 years, interquartile range 21-41, 75 newly diagnosed, 36 suspected relapse] from seven centres, of whom 22 had no active TI CD [HAI = 0], 39 mild [HAI = 1], 13 moderate [HAI = 2], and 37 severe CD activity [HAI = 3]. In total, 26 radiologists prospectively scored MRE datasets as per their usual clinical practice. Sensitivity and specificity for active disease [HAI >0] were 83% [95% confidence interval 74% to 90%] and 41% [23% to 61%] for sMARIA, 76% [67% to 84%] and 64% [43% to 80%] for the London score, and 81% [72% to 88%] and 41% [23% to 61%] for the 'extended' London score, respectively. The sMARIA had 84% [69-92%] sensitivity and 53% [41-64%] specificity for severe CD. CONCLUSIONS: When tested at their proposed cut-offs in a real-world setting, sMARIA, London, and 'extended' London indices achieve high sensitivity for active TI disease against a histological reference standard, but specificity is low.

Original languageEnglish
Pages (from-to)1531-1539
Number of pages9
JournalJournal of Crohn's and Colitis
Volume16
Issue number10
Early online date8 Jun 2022
DOIs
Publication statusPublished - Oct 2022

Keywords

  • Crohn’s disease
  • imaging
  • magnetic resonance enterography

ASJC Scopus subject areas

  • Gastroenterology

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