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Assessment of activity of Crohn’s disease of the ileum and large bowel: proposal for a new multiparameter MR enterography score

Valutazione dell’attività di malattia del morbo di Crohn dell’ileo e dell’intestino crasso: proposta di un nuovo score E-RM multiparametrico

  • Abdominal Radiology / Radiologia Addominale
  • Published:
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Abstract

Purpose

We evaluated the diagnostic accuracy of magnetic resonance enterography (MR-E) in assessing Crohn’s disease (CD) activity by differentiating acute, chronic and remission stages of disease through a quantitative MR-E assessment.

Materials and methods

One hundred patients with a histological diagnosis of CD were studied with MR-E. Intestinal distension was obtained by oral administration of approximately 2 L of a polyethylene glycol solution (PEG). In all cases, the ileum and large bowel were imaged with morphological sequences (heavily T2-weighted single-shot, dual fast-field echo, balanced fast-field echo) and a postcontrast dynamic sequence (T1-weighted high-resolution isotropic volume excitation). Disease activity was assessed according to a multiparameter score (0–8) based on lesion morphology, signal intensity and contrast enhancement. MR-E findings were compared with clinical-laboratory data and disease activity indices [Crohn’s Disease Activity Index (CDAI); Inflammatory Bowel Disease Questionnaire (IBDQ)]. Multiple regression analysis was performed by correlating MR-E score, CDAI and IBDQ. Frequencies were then compared using the χ 2 test.

Results

MR-E identified inactive disease in 9% of cases, chronic disease in 57% and active disease in the remaining 34%. The most frequently involved bowel segment was the terminal ileum (52%). A statistically significant correlation was found between MR-E score and CDAI (R=0.86; p<0.001) and between MR-E score and IBDQ (R=−0.83; p<0.001). The most suggestive parameter for disease activity was layered bowel-wall enhancement, a finding predominantly present in patients with increased CDAI (≥150) and/or local complications (χ 2=7.13; p<0.01).

Conclusions

MR-E is a noninvasive and diagnostic imaging modality for CD study and follow-up. The MR-E score proposed in this study proved to be useful in assessing disease severity and monitoring response to treatment.

Riassunto

Obiettivo

Scopo del nostro lavoro è stato valutare l’accuratezza diagnostica dell’enterografia con risonanza magnetica (E-RM) nella determinazione dell’attività del morbo di Crohn (MC) differenziando gli stati di malattia acuta, cronica e di remissione attraverso un indice quantitativo (E-RM score).

Materiali e metodi

Cento pazienti con diagnosi istologica di MC sono stati studiati con E-RM. La distensione intestinale è stata ottenuta somministrando per os circa 2 l di una soluzione di glicole polietilenico (PEG). In tutti i casi l’ileo e l’intestino crasso sono stati studiati utilizzando sequenze morfologiche (T2w single shotheavy weight, DUAL fast field echo, balanced fast field echo) ed una sequenza dinamica post-contrastografica (T1w high resolution isotropic volume excitation). L’attività di malattia è stata valutata mediante uno score multiparametrico (compreso tra 0 e 8) basato sulle caratteristiche morfologiche, di segnale e contrastografiche delle lesioni. I dati della E-RM sono stati confrontati con quelli clinico-laboratoristici e con gli indici di attività di malattia (Crohn Disease Activity Index,CDAI; Inflammatory Bowel Disease Questionnaire, IBDQ). Un’analisi statistica di regressione multipla è stata eseguita correlando le seguenti variabili: score E-RM, CDAI e IBDQ. Le frequenze sono state confrontate con il test del χ 2.

Risultati

La E-RM ha identificato nel 9% dei casi una fase di remissione di malattia, nel 57% una fase cronica e nel restante 34% una fase di malattia attiva. Il segmento intestinale maggiormente coinvolto dalla patologia è stato l’ileo terminale (52%). è stata osservata una correlazione statisticamente significativa tra score E-RM e CDAI (R=0,86; p<0,001) e tra score E-RM ed IBDQ (R=−0,83; p<0,001). Il parametro più indicativo di attività di malattia è stato il pattern di contrast enhancement (ce) parietale di tipo stratificato, reperto presente prevalentemente nei pazienti con valore di CDAI aumentato (≥150) e/o con complicanze locali (χ2=7,13; p<0,01).

Conclusioni

La E-RM rappresenta una metodica d’imaging non invasiva e diagnostica per lo studio ed il follow-up del MC. Lo score E-RM da noi proposto si è rivelato utile nella valutazione della severità di malattia e nel monitoraggio della risposta al trattamento.

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Authors and Affiliations

  1. Department of Diagnostic Imaging, University of Foggia, Viale Luigi Pinto 1, 71100, Foggia, Italy

    L. Macarini, L. P. Stoppino, A. Centola, S. Muscarella, P. Milillo & R. Vinci

  2. Department of Medical Science — Section of Hygiene, University of Foggia, Viale Luigi Pinto 1, 71100, Foggia, Italy

    F. Fortunato

  3. Department of Diagnostic Imaging, University of Palermo, Via del Vespro 127, 91027, Palermo, Italy

    F. Coppolino

  4. Department of Gastroenterology, University of Foggia, Viale Luigi Pinto 1, 71100, Foggia, Italy

    N. Della Valle & V. Ierardi

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  1. L. Macarini
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Correspondence to L. P. Stoppino.

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Macarini, L., Stoppino, L.P., Centola, A. et al. Assessment of activity of Crohn’s disease of the ileum and large bowel: proposal for a new multiparameter MR enterography score. Radiol med 118, 181–195 (2013). https://doi.org/10.1007/s11547-012-0841-7

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  • DOI: https://doi.org/10.1007/s11547-012-0841-7

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