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Increasing efficiency of MRE for diagnosis of Crohn’s disease activity through proper sequence selection: a practical approach for clinical trials

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Abstract

Purpose

To derive the best magnetic resonance enterography (MRE) approach for detecting activity and severe lesions in Crohn’s disease (CD) to use for selecting patients and measuring response to treatment in clinical trials.

Methods

We compared the accuracies of MRE (T2-weighted sequences, DWI (b = 800 s/mm2) sequences, combined T2-weighted and DWI sequences, combined T2-weighted or DWI sequences, and MaRIA score based on T2-weighted and contrast-enhanced T1-weighted sequences) versus ileocolonoscopy (SES-CD) performed within 1 month. Bowel segments were classified as inactive (SES-CD < 2), active (SES-CD ≥ 2), or active with severe lesions (ulcers seen at endoscopy). McNemar’s test was used to compare the accuracies of the different approaches against endoscopy.

Results

224 segments in 43 patients were analyzed. For detecting active disease, the combination of findings from T2 and DWI sequences results in the highest specific and accurate sequence combination. Combined T2-weighted and DWI sequences had similar sensitivity to those of MaRIA (P = 0.25) but lower specificity (P = 0.007) and accuracy (P = 0.0013) than MaRIA score. For detecting severe lesions, T2-weighted sequences alone had greater accuracy [similar to MaRIA score (P > 0.999)] than other noncontrast approaches.

Conclusions

T2-weighted sequences should be used as a first screening step, and followed by contrast-enhanced T1-weighted sequences only when abnormal findings are identified; adding DWI does not improve the accuracy of MRE.

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Abbreviations

CD:

Crohn’s disease

DWI:

Diffusion-weighted imaging

MRE:

Magnetic resonance enterography

CI:

Confidence interval

SES-CD:

Simplified endoscopic score for Crohn disease

Anti-TNF:

Anti-tumor necrosis factor

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Authors and Affiliations

  1. Department of Radiology, Centre de Diagnòstic per la Imatge (CDI), Hospital Clínic Barcelona, University of Barcelona, C/Villarroel 170 Escala 3 Planta 1, Barcelona, 08036, Catalonia, Spain

    Jordi Rimola & Sonia Rodríguez

  2. Department of Radiology, Fundación Hospital de Jove, Gijón, Spain

    Almudena Alvarez-Cofiño

  3. Gastroenterology Department, Hospital San Borja Arriaran, Santiago, Chile

    Tamara Pérez-Jeldres

  4. Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain

    Ignacio Alfaro, Ingrid Ordás, Elena Ricart & Julián Panés

  5. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain

    Elena Ricart & Julián Panés

Authors
  1. Jordi Rimola
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  2. Almudena Alvarez-Cofiño
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  3. Tamara Pérez-Jeldres
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  4. Sonia Rodríguez
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  5. Ignacio Alfaro
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  6. Ingrid Ordás
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  7. Elena Ricart
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  8. Julián Panés
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Correspondence to Jordi Rimola.

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Rimola, J., Alvarez-Cofiño, A., Pérez-Jeldres, T. et al. Increasing efficiency of MRE for diagnosis of Crohn’s disease activity through proper sequence selection: a practical approach for clinical trials. Abdom Radiol 42, 2783–2791 (2017). https://doi.org/10.1007/s00261-017-1203-7

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  • DOI: https://doi.org/10.1007/s00261-017-1203-7

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