TY - JOUR
T1 - Diagnostic performance of magnetic resonance enterography disease activity indices compared with a histological reference standard for adult terminal ileal Crohn's disease
T2 - experience from the METRIC trial
AU - Kumar, Shankar
AU - Parry, Thomas
AU - Mallett, Sue
AU - Bhatnagar, Gauraang
AU - Plumb, Andrew
AU - Walsh, Shaun
AU - Scott, Nigel
AU - Tandon, Ruchi
AU - Chong, Heung
AU - du Parcq, John
AU - Martinez, Adrianna
AU - Moorghen, Morgan
AU - Rodriguez-Justo, Manuel
AU - Halligan, Steve
AU - Taylor, Stuart
AU - METRIC study investigators
A2 - Mowat, Craig
N1 - Funding Information:
This work was supported by the National Institute of Health Research health technology assessment (NIHR HTA) programme (project number 10/68/01) published in full in Health Technology Assessment, 2019 Aug;23(42):1–162. 10.3310/hta23420. PubMed PMID: 31432777. The project is supported by researchers at the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre. The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, NIHR, NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC), HTA programme, or the Department of Health.
Copyright:
© The Author(s) 2022. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For permissions, please email: [email protected].
PY - 2022/10
Y1 - 2022/10
N2 - 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.
AB - 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.
KW - Crohn’s disease
KW - imaging
KW - magnetic resonance enterography
UR - http://www.scopus.com/inward/record.url?scp=85135920431&partnerID=8YFLogxK
U2 - 10.1093/ecco-jcc/jjac062
DO - 10.1093/ecco-jcc/jjac062
M3 - Article
C2 - 35481898
SN - 1873-9946
VL - 16
SP - 1531
EP - 1539
JO - Journal of Crohn's and Colitis
JF - Journal of Crohn's and Colitis
IS - 10
ER -