Abdominal Imaging

, Volume 37, Issue 6, pp 958–966

Imaging indexes of activity and severity for Crohn’s disease: current status and future trends

  • Jordi Rimola
  • Ingrid Ordás
  • Sonia Rodríguez
  • Elena Ricart
  • Julián Panés
Article

Abstract

Background

Cross-sectional imaging techniques, including ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) are increasingly used for evaluation of Crohn’s disease (CD).

Aim

To review the accuracy of cross-sectional imaging indexes for measurement of disease activity and severity in patients with CD, and to evaluate its applicability on daily clinical practice and research.

Methods

Relevant publications were identified by literature search, and selected based on predefined quality parameters, including a sample size and reference standard. Nineteen publications were chosen.

Results

The US-based indexes of activity showed high correlation with reference standard indexes. There is a good or very good agreement between the MR-based indexes and the reference standard when the comparison is limited to small segments of intestine. Significant discrepancies have been found between indexes that evaluate the colon. Only one CT-based index was included. The main strengths and weaknesses of the indexes, according to its design, are discussed.

Conclusion

Standardization of image acquisition protocols and patient preparation should be procured, especially for MRI. In daily practice, a simple, semi-quantitative index providing relevant information on disease activity and severity is preferable. For research purposes, a precise and reproducible index should be mandatory.

Keywords

Crohn’s disease Disease activity Disease severity Magnetic resonance Ultrasonography Computed tomography 

References

  1. 1.
    Best WR, Becktel JM, Singleton JW, Kern F Jr (1976) Development of a Crohn’s disease activity index: national cooperative Crohn’s disease study. Gastroenterology 70:439–444PubMedGoogle Scholar
  2. 2.
    Colombel JF, Sandborn WJ, Reinisch W, et al. (2010) Infliximab, azathioprine, or combination therapy for Crohn’s disease. N Engl J Med 362(15):1383–1395. doi:10.1056/NEJMoa0904492 PubMedCrossRefGoogle Scholar
  3. 3.
    Hanauer SB, Feagan BG, Lichtenstein GR, et al. (2002) Maintenance infliximab for Crohn’s disease: the ACCENT I randomised trial. Lancet 359:1541–1549PubMedCrossRefGoogle Scholar
  4. 4.
    Lemann M, Mary JY, Colombel JF, et al. (2005) A randomized, double-blind, controlled withdrawal trial in Crohn’s disease patients in long-term remission on azathioprine. Gastroenterology 128(7):1812–1818PubMedCrossRefGoogle Scholar
  5. 5.
    Allez M, Lemann M, Bonnet J, et al. (2002) Long term outcome of patients with active Crohn’s disease exhibiting extensive and deep ulcerations at colonoscopy. Am J Gastroenterol 97(4):947–953PubMedGoogle Scholar
  6. 6.
    Solberg IC, Vatn MH, Hoie O, et al. (2007) Clinical course in Crohn’s disease: results of a Norwegian population-based ten-year follow-up study. Clin Gastroenterol Hepatol 5(12):1430–1438PubMedCrossRefGoogle Scholar
  7. 7.
    Landi B, Anh TN, Cortot A, et al. (1992) Endoscopic monitoring of Crohn’s disease treatment: a prospective, randomized clinical trial. The Groupe d’Etudes Therapeutiques des Affections Inflammatoires Digestives. Gastroenterology 102(5):1647–1653PubMedGoogle Scholar
  8. 8.
    Panes J, Bouzas R, Chaparro M, et al. (2011) Systematic review: the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn’s disease. Aliment Pharmacol Ther 34(2):125–145. doi:10.1111/j.1365-2036.2011.04710.x PubMedCrossRefGoogle Scholar
  9. 9.
    Rimola J, Rodriguez S, Garcia BO, et al. (2009) Magnetic resonance for assessment of disease activity and severity in Crohn disease. Gut 58(8):1113–1120. doi:10.1136/gut.2008.167957 PubMedCrossRefGoogle Scholar
  10. 10.
    Florie J, Horsthuis K, Hommes DW, et al. (2005) Magnetic resonance imaging compared with ileocolonoscopy in evaluating disease severity in Crohn’s disease. Clin Gastroenterol Hepatol 3(12):1221–1228PubMedCrossRefGoogle Scholar
  11. 11.
    Girometti R, Zuiani C, Toso F, et al. (2008) MRI scoring system including dynamic motility evaluation in assessing the activity of Crohn’s disease of the terminal ileum. Acad Radiol 15(2):153–164PubMedCrossRefGoogle Scholar
  12. 12.
    Laghi A, Borrelli O, Paolantonio P, et al. (2003) Contrast enhanced magnetic resonance imaging of the terminal ileum in children with Crohn’s disease. Gut 52(3):393–397PubMedCrossRefGoogle Scholar
  13. 13.
    Oussalah A, Laurent V, Bruot O, et al. (2010) Diffusion-weighted magnetic resonance without bowel preparation for detecting colonic inflammation in inflammatory bowel disease. Gut 59(8):1056–1065. doi:10.1136/gut.2009.197665 PubMedCrossRefGoogle Scholar
  14. 14.
    Pascu M, Roznowski AB, Muller HP, et al. (2004) Clinical relevance of transabdominal ultrasonography and magnetic resonance imaging in patients with inflammatory bowel disease of the terminal ileum and large bowel. Inflamm Bowel Dis 10(4):373–382PubMedCrossRefGoogle Scholar
  15. 15.
    Sailer J, Peloschek P, Reinisch W, et al. (2008) Anastomotic recurrence of Crohn’s disease after ileocolic resection: comparison of MR enteroclysis with endoscopy. Eur Radiol 18(11):2512–2521PubMedCrossRefGoogle Scholar
  16. 16.
    Schreyer AG, Golder S, Scheibl K, et al. (2005) Dark lumen magnetic resonance enteroclysis in combination with MRI colonography for whole bowel assessment in patients with Crohn’s disease: first clinical experience. Inflamm Bowel Dis 11(4):388–394PubMedCrossRefGoogle Scholar
  17. 17.
    Schreyer AG, Rath HC, Kikinis R, et al. (2005) Comparison of magnetic resonance imaging colonography with conventional colonoscopy for the assessment of intestinal inflammation in patients with inflammatory bowel disease: a feasibility study. Gut 54(2):250–256PubMedCrossRefGoogle Scholar
  18. 18.
    Seiderer J, Herrmann K, Diepolder H, et al. (2007) Double-balloon enteroscopy versus magnetic resonance enteroclysis in diagnosing suspected small-bowel Crohn’s disease: results of a pilot study. Scand J Gastroenterol 42(11):1376–1385PubMedCrossRefGoogle Scholar
  19. 19.
    Tillack C, Seiderer J, Brand S, et al. (2008) Correlation of magnetic resonance enteroclysis (MRE) and wireless capsule endoscopy (CE) in the diagnosis of small bowel lesions in Crohn’s disease. Inflamm Bowel Dis 14(9):1219–1228PubMedCrossRefGoogle Scholar
  20. 20.
    van Gemert-Horsthuis K, Florie J, Hommes DW, et al. (2006) Feasibility of evaluating Crohn’s disease activity at 3.0 Tesla. J Magn Reson Imaging 24(2):340–348PubMedCrossRefGoogle Scholar
  21. 21.
    Horsthuis K, de Ridder L, Smets AM, et al. (2010) Magnetic resonance enterography for suspected inflammatory bowel disease in a pediatric population. J Pediatr Gastroenterol Nutr 51(5):603–609. doi:10.1097/MPG.0b013e3181dee5bd PubMedCrossRefGoogle Scholar
  22. 22.
    Hyun SB, Kitazume Y, Nagahori M, et al. (2011) Magnetic resonance enterocolonography is useful for simultaneous evaluation of small and large intestinal lesions in Crohn’s disease. Inflamm Bowel Dis 17(5):1063–1072. doi:10.1002/ibd.21510 PubMedCrossRefGoogle Scholar
  23. 23.
    Drews BH, Barth TF, Hanle MM, et al. (2009) Comparison of sonographically measured bowel wall vascularity, histology, and disease activity in Crohn’s disease. Eur Radiol 19(6):1379–1386PubMedCrossRefGoogle Scholar
  24. 24.
    Futagami Y, Haruma K, Hata J, et al. (1999) Development and validation of an ultrasonographic activity index of Crohn’s disease. Eur J Gastroenterol Hepatol 11(9):1007–1012PubMedCrossRefGoogle Scholar
  25. 25.
    Neye H, Voderholzer W, Rickes S, et al. (2004) Evaluation of criteria for the activity of Crohn’s disease by power Doppler sonography. Dig Dis 22(1):67–72PubMedCrossRefGoogle Scholar
  26. 26.
    Chiorean MV, Sandrasegaran K, Saxena R, et al. (2007) Correlation of CT enteroclysis with surgical pathology in Crohn’s disease. Am J Gastroenterol 102(11):2541–2550PubMedCrossRefGoogle Scholar
  27. 27.
    Rimola J, Ordas I, Rodriguez S, et al. (2011) Magnetic resonance imaging for evaluation of Crohn’s disease: validation of parameters of severity and quantitative index of activity. Inflamm Bowel Dis 17(8):1759–1768. doi:10.1002/ibd.21551 PubMedCrossRefGoogle Scholar
  28. 28.
    Limberg B (1999) Diagnosis of chronic inflammatory bowel disease by ultrasonography. Z Gastroenterol 37(6):495–508PubMedGoogle Scholar
  29. 29.
    Steyerberg EW, Eijkemans MJ, Harrell FE Jr, Habbema JD (2000) Prognostic modelling with logistic regression analysis: a comparison of selection and estimation methods in small data sets. Stat Med 19(8):1059–1079PubMedCrossRefGoogle Scholar
  30. 30.
    Justice AC, Covinsky KE, Berlin JA (1999) Assessing the generalizability of prognostic information. Ann Intern Med 130(6):515–524PubMedGoogle Scholar
  31. 31.
    Modigliani R, Mary JY, Simon JF, et al. (1990) Clinical, biological, and endoscopic picture of attacks of Crohn’s disease. Evolution on prednisolone. Groupe d’Etude Therapeutique des Affections Inflammatoires Digestives. Gastroenterology 98(4):811–818PubMedCrossRefGoogle Scholar
  32. 32.
    Punwani S, Rodriguez-Justo M, Bainbridge A, et al. (2009) Mural inflammation in Crohn disease: location-matched histologic validation of MR imaging features. Radiology 252(3):712–720. doi:10.1148/radiol.2523082167 PubMedCrossRefGoogle Scholar
  33. 33.
    Soyer P, Boudiaf M, Sirol M, et al. (2010) Suspected anastomotic recurrence of Crohn disease after ileocolic resection: evaluation with CT enteroclysis. Radiology 254(3):755–764. doi:10.1148/radiol.09091165 PubMedCrossRefGoogle Scholar
  34. 34.
    Rimola J, Ordas I, Rodriguez S, Panes J (2010) Colonic Crohn’s disease: value of magnetic resonance colonography for detection and quantification of disease activity. Abdom Imaging 35(4):422–427. doi:10.1007/s00261-009-9545-4 PubMedCrossRefGoogle Scholar
  35. 35.
    Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH (1990) Acute pancreatitis: value of CT in establishing prognosis. Radiology 174(2):331–336PubMedGoogle Scholar
  36. 36.
    Froslie KF, Jahnsen J, Moum BA, Vatn MH (2007) Mucosal healing in inflammatory bowel disease: results from a Norwegian population-based cohort. Gastroenterology 133(2):412–422. doi:10.1053/j.gastro.2007.05.051 PubMedCrossRefGoogle Scholar
  37. 37.
    Schnitzler F, Fidder H, Ferrante M, et al. (2009) Mucosal healing predicts long-term outcome of maintenance therapy with infliximab in Crohn’s disease. Inflamm Bowel Dis 15(9):1295–1301. doi:10.1002/ibd.20927 PubMedCrossRefGoogle Scholar
  38. 38.
    Parente F, Molteni M, Marino B (2010) Are colonoscopy and bowel ultrasound useful for assessing response to short-term therapy and predicting disease outcome of moderate-to-severe forms of ulcerative colitis?: a prospective study. Am J Gastroenterol 105(5):1150–1157. doi:10.1038/ajg.2009.672 PubMedCrossRefGoogle Scholar
  39. 39.
    Ordás I, Rimola J, Ripollés T, et al. (2011) Accuracy of MRI to assess therapeutic responses and mucosal healing in Crohn’s disease. Gastroenterology 140:S-73Google Scholar
  40. 40.
    Higgins PD, Caoili E, Zimmermann M (2007) Computed tomographic enterography adds information to clinical management in small bowel Crohn’s disease. Inflamm Bowel Dis 13(3):262–268. doi:10.1002/ibd.20013 PubMedCrossRefGoogle Scholar
  41. 41.
    Pariente B, Cosnes J, Danese S, et al. (2011) Development of the Crohn’s disease digestive damage score, the Lemann score. Inflamm Bowel Dis 17(6):1415–1422. doi:10.1002/ibd.21506 PubMedCrossRefGoogle Scholar
  42. 42.
    D’Agostino RB Sr (2009) The delayed-start study design. N Engl J Med 361(13):1304–1306. doi:10.1056/NEJMsm0904209 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Jordi Rimola
    • 1
  • Ingrid Ordás
    • 2
  • Sonia Rodríguez
    • 1
  • Elena Ricart
    • 2
  • Julián Panés
    • 2
  1. 1.Department of Radiology, Centro de Investigaciones Biomédicas en Red, enfermedades hepáticas y digestivas (CIBER-ehd), IDIBAPSHospital Clínic of BarcelonaBarcelonaSpain
  2. 2.Department of Gastroenterology, Centro de Investigaciones Biomédicas en Red, enfermedades hepáticas y digestivas (CIBER-ehd), IDIBAPSHospital Clínic of BarcelonaBarcelonaSpain

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