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Validation of the simplified magnetic resonance index of activity by using DWI without gadolinium enhancement to evaluate bowel inflammation in Crohn’s disease

  • Magnetic Resonance
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Abstract

Objectives

To validate the modified simplified magnetic resonance index of activity (sMARIA) score using DWI on non-contrast magnetic resonance enterography (MRE) to evaluate active inflammation in patients with Crohn’s disease (CD), compared to the original sMARIA scoring system, with and without contrast enhancement.

Methods

This retrospective study included 275 bowel segments from 55 CD patients who underwent ileocolonoscopy and MRE within a 2-week period. Two blinded radiologists evaluated original sMARIA on both conventional MRE (CE-sMARIA) and non-contrast MRE (T2-sMARIA). Modified sMARIA was then evaluated using non-contrast MRE, replacing ulcerations with DWI grades. Three scoring systems were compared for diagnostic accuracy of active inflammation, correlation with simple endoscopic score (SES)-CD, and interobserver reproducibility.

Results

The AUC of modified sMARIA for detecting active inflammation (0.863, 95% confidence interval [0.803–0.923]) was significantly higher than T2-sMARIA (0.827 [0.773–0.881], p = 0.017), and comparable to CE-sMARIA (0.908 [0.857–0.959], p = 0.122). CE-sMARIA, T2-sMARIA, and modified sMARIA all showed moderate correlation with SES-CD (r = 0.795, 0.722, and 0.777, respectively). Interobserver reproducibility of diffusion restriction (κ, 0.686 [0.602–0.770]) was significantly better than ulcers on conventional MRE (κ, 0.382 [0.212–0.552]; p = 0.001) and T2-weighted image (κ, 0.312 [0.034–0.590]; p = 0.012).

Conclusions

Modified sMARIA using DWI can improve the diagnostic performance of sMARIA on non-contrast MRE, showing comparable performance to sMARIA using contrast-enhanced MRE.

Key Points

• DWI can improve the diagnostic performance of non-contrast magnetic resonance enterography (MRE) for assessing active inflammation in patients with Crohn’s disease.

• Modified simplified magnetic resonance index of activity (sMARIA) using DWI grades in place of ulcers showed comparable diagnostic performance to sMARIA using conventional MRE with contrast-enhanced sequences.

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Abbreviations

CD:

Crohn’s disease

CE:

Contrast-enhanced

CI:

Confidence interval

ICC:

Intraclass correlation coefficient

MARIA:

Magnetic resonance index of activity

MRE:

Magnetic resonance enterography

SD:

Standard deviation

SES:

Simple endoscopic score

sMARIA:

Simplified magnetic resonance index of activity

T1WI:

T1-weighted imaging

T2WI:

T2-weighted imaging

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Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) [grant number NRF-2018R1C1B6002747], a faculty research grant from Yonsei University College of Medicine [grant number 6-2021-0061], and Bracco diagnostics.

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, Republic of Korea, 03722

    Heejin Bae, Nieun Seo, Joon Seok Lim & Myeong-Jin Kim

  2. Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea

    Eun Ae Kang & Jae Hee Cheon

Authors
  1. Heejin Bae
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Correspondence to Nieun Seo.

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The scientific guarantor of this publication is Dr. Nieun Seo.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Hye Jung Shin (from the Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine) kindly provided statistical advice for this manuscript.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval from Severance Hospital was obtained.

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Bae, H., Seo, N., Kang, E.A. et al. Validation of the simplified magnetic resonance index of activity by using DWI without gadolinium enhancement to evaluate bowel inflammation in Crohn’s disease. Eur Radiol 33, 3266–3275 (2023). https://doi.org/10.1007/s00330-023-09501-7

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  • DOI: https://doi.org/10.1007/s00330-023-09501-7

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