Magnetic resonance enterography compared with ultrasonography in newly diagnosed and relapsing Crohn's disease patients: the METRIC diagnostic accuracy study

Stuart A. Taylor (Lead / Corresponding author), Sue Mallett, Gauraang Bhatnagar, Stephen Morris, Laura Quinn, Florian Tomini, Anne Miles, Rachel Baldwin-Cleland, Stuart Bloom, Arun Gupta, Peter John Hamlin, Ailsa L. Hart, Antony Higginson, Ilan Jacobs, Sara McCartney, Charles D. Murray, Andrew A. O. Plumb, Richard C. Pollok, Manuel Rodriguez-Justo, Zainib ShabirAndrew Slater, Damian Tolan, Simon Travis, Alastair Windsor, Peter Wylie, Ian Zealley, Steve Halligan

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)
89 Downloads (Pure)

Abstract

Background: Magnetic resonance enterography and enteric ultrasonography are used to image Crohn’s disease patients. Their diagnostic accuracy for presence, extent and activity of enteric Crohn’s disease was compared. Objective: To compare diagnostic accuracy, observer variability, acceptability, diagnostic impact and cost-effectiveness of magnetic resonance enterography and ultrasonography in newly diagnosed or relapsing Crohn’s disease. Design: Prospective multicentre cohort study. Setting: Eight NHS hospitals. Participants: Consecutive participants aged ≥ 16 years, newly diagnosed with Crohn’s disease or with established Crohn’s disease and suspected relapse. Interventions: Magnetic resonance enterography and ultrasonography. Main outcome measures: The primary outcome was per-participant sensitivity difference between magnetic resonance enterography and ultrasonography for small bowel Crohn’s disease extent. Secondary outcomes included sensitivity and specificity for small bowel Crohn’s disease and colonic Crohn’s disease extent, and sensitivity and specificity for small bowel Crohn’s disease and colonic Crohn’s disease presence; identification of active disease; interobserver variation; participant acceptability; diagnostic impact; and cost-effectiveness. Results: Out of the 518 participants assessed, 335 entered the trial, with 51 excluded, giving a final cohort of 284 (133 and 151 in new diagnosis and suspected relapse cohorts, respectively). Across the whole cohort, for small bowel Crohn’s disease extent, magnetic resonance enterography sensitivity [80%, 95% confidence interval (CI) 72% to 86%] was significantly greater than ultrasonography sensitivity (70%, 95% CI 62% to 78%), with a 10% difference (95% CI 1% to 18%; p = 0.027). For small bowel Crohn’s disease extent, magnetic resonance enterography specificity (95%, 95% CI 85% to 98%) was significantly greater than ultrasonography specificity (81%, 95% CI 64% to 91%), with a 14% difference (95% CI 1% to 27%). For small bowel Crohn’s disease presence, magnetic resonance enterography sensitivity (97%, 95% CI 91% to 99%) was significantly greater than ultrasonography sensitivity (92%, 95% CI 84% to 96%), with a 5% difference (95% CI 1% to 9%). For small bowel Crohn’s disease presence, magnetic resonance enterography specificity was 96% (95% CI 86% to 99%) and ultrasonography specificity was 84% (95% CI 65% to 94%), with a 12% difference (95% CI 0% to 25%). Test sensitivities for small bowel Crohn’s disease presence and extent were similar in the two cohorts. For colonic Crohn’s disease presence in newly diagnosed participants, ultrasonography sensitivity (67%, 95% CI 49% to 81%) was significantly greater than magnetic resonance enterography sensitivity (47%, 95% CI 31% to 64%), with a 20% difference (95% CI 1% to 39%). For active small bowel Crohn’s disease, magnetic resonance enterography sensitivity (96%, 95% CI 92% to 99%) was significantly greater than ultrasonography sensitivity (90%, 95% CI 82% to 95%), with a 6% difference (95% CI 2% to 11%). There was some disagreement between readers for both tests. A total of 88% of participants rated magnetic resonance enterography as very or fairly acceptable, which is significantly lower than the percentage (99%) of participants who did so for ultrasonography. Therapeutic decisions based on magnetic resonance enterography alone and ultrasonography alone agreed with the final decision in 122 out of 158 (77%) cases and 124 out of 158 (78%) cases, respectively. There were no differences in costs or quality-adjusted life-years between tests. Limitations: Magnetic resonance enterography and ultrasonography scans were interpreted by practitioners blinded to clinical data (but not participant cohort), which does not reflect use in clinical practice. Conclusions: Magnetic resonance enterography has higher accuracy for detecting the presence, extent and activity of small bowel Crohn’s disease than ultrasonography does. Both tests have variable interobserver agreement and are broadly acceptable to participants, although ultrasonography produces less participant burden. Diagnostic impact and cost-effectiveness are similar. Recommendations for future work include investigation of the comparative utility of magnetic resonance enterography and ultrasonography for treatment response assessment and investigation of non-specific abdominal symptoms to confirm or refute Crohn’s disease.

Original languageEnglish
Pages (from-to)vii-161
Number of pages162
JournalHealth Technology Assessment
Volume23
Issue number42
DOIs
Publication statusPublished - Aug 2019

Keywords

  • BIOMEDICAL
  • COLONIC DISEASES
  • COST–BENEFIT ANALYSIS
  • CROHN DISEASE
  • INTESTINE, SMALL
  • MAGNETIC RESONANCE IMAGING
  • OBSERVER VARIATION
  • PROSPECTIVE STUDIES
  • SENSITIVITY AND SPECIFICITY
  • TECHNOLOGY ASSESSMENT
  • ULTRASONOGRAPHY

Fingerprint Dive into the research topics of 'Magnetic resonance enterography compared with ultrasonography in newly diagnosed and relapsing Crohn's disease patients: the METRIC diagnostic accuracy study'. Together they form a unique fingerprint.

Cite this