Advertisement

European Radiology

, Volume 24, Issue 2, pp 277–287 | Cite as

Evaluation of Crohn’s disease activity: Initial validation of a magnetic resonance enterography global score (MEGS) against faecal calprotectin

  • Jesica C. Makanyanga
  • Doug Pendsé
  • Nikolaos Dikaios
  • Stuart Bloom
  • Sara McCartney
  • Emma Helbren
  • Elaine Atkins
  • Terry Cuthbertson
  • Shonit Punwani
  • Alastair Forbes
  • Steve Halligan
  • Stuart A. TaylorEmail author
Gastrointestinal

Abstract

Objectives

To develop an MRI enterography global score (MEGS) of Crohn’s disease (CD) activity compared with a reference standard of faecal calprotectin (fC), C-reactive protein (CRP) and Harvey-Bradshaw index (HBI).

Methods

Calprotectin, CRP and HBI were prospectively recorded for 71 patients (median age 33, male 35) with known/suspected CD undergoing MRI enterography. Two observers in consensus scored activity for nine bowel segments, grading mural thickness, T2 signal, mesenteric oedema, T1 enhancement and pattern, and haustral loss. Segmental scores were multiplied according to disease length. Five points each were added for lymphadenopathy, comb sign, fistulae and abscesses to derive the MEGS. A previously validated MRI CD activity score (CDAS) was also calculated. MRI scores were correlated with clinical references using Spearman’s rank. A logistic regression diagnostic model was built to discriminate active (fC > 100 μg/g) from inactive disease.

Results

MEGS and CDAS were significantly correlated with fC (r = 0.46, P < 0.001) and (r = 0.39, P = 0.001) respectively. MEGS correlated with CRP (r = 0.39, P = 0.002). The model for discriminating active from inactive disease achieved an area under the receiver-operating curve of 0.75 and 0.66 after leave-one-out analysis.

Conclusion

A magnetic resonance enterography global score (MEGS) of CD activity correlated significantly with fC levels.

Key Points

Magnetic resonance imaging is now widely used to assess Crohns disease.

Existing MRI activity scores depend on local segmental endoscopic/histological reference standards.

Scores including assessment of disease extent/complications better demonstrate full disease burden.

This new global Crohns disease burden score correlates with calprotectin and CRP.

The MRI enterography score of disease activity can complement existing clinical markers.

Key words

Crohn’s disease Magnetic resonance imaging Calprotectin C-reactive protein Inflammatory bowel diseases 

Abbreviations

fC

Faecal calprotectin

CDAS

Crohn’s disease activity score

MEGS

MRI enterography global score

CRP

C-reactive protein

HBI

Harvey-bradshaw index

CDAI

Crohn’s disease activity index

MRE

Magnetic resonance enterography

ANOVA

Analysis of variance analysis

AUC

Area under the curve

ROC

Receiver-operating characteristic

Notes

Acknowledgments

This work was undertaken at the Comprehensive Biomedical Research Centre, University College Hospital London, which received a proportion of the funding from the National Institute for Health Research. The views expressed in this publication are those of the authors and not necessarily those of the UK Department of Health. The authors have received funding from the European Community’s Seventh Framework Programme (FP7/2007-2013) of the VIGOR++ Project under grant agreement no. 270379.

References

  1. 1.
    Dignass A, Van Assche G, Lindsay JO et al (2010) The second European evidence-based Consensus on the diagnosis and management of Crohn’s disease: current management. J Crohn’s Colitis 4:28–62CrossRefGoogle Scholar
  2. 2.
    Lichtenstein GR, Hanauer SB, Sandborn WJ (2009) Management of Crohn’s disease in adults. Am J Gastroenterol 104:465–483PubMedCrossRefGoogle Scholar
  3. 3.
    Jones J, Loftus EV, Panaccione R et al (2008) Relationships between disease activity and serum and fecal biomarkers in patients with Crohn’s disease. Clin Gastroenterol Hepatol 6:1218–1224PubMedCrossRefGoogle Scholar
  4. 4.
    Langhorst J, Elsenbruch S, Koelzer J, Rueffer A, Michalsen A, Dobos GJ (2008) Noninvasive markers in the assessment of intestinal inflammation in inflammatory bowel diseases: performance of fecal lactoferrin, calprotectin, and PMN-elastase, CRP, and clinical indices. Am J Gastroenterol 103:162–169PubMedCrossRefGoogle Scholar
  5. 5.
    Røseth AG, Schmidt PN, Fagerhol MK (1999) Correlation between faecal excretion of indium-111-labelled granulocytes and calprotectin, a granulocyte marker protein, in patients with inflammatory bowel disease. Scand J Gastroenterol 34:50–54PubMedCrossRefGoogle Scholar
  6. 6.
    Schoepfer AM, Beglinger C, Straumann A et al (2009) Fecal calprotectin correlates more closely with the Simple Endoscopic Score for Crohn’s disease (SES-CD) than CRP, blood leukocytes, and the CDAI. Am J Gastroenterol 105:162–169PubMedCrossRefGoogle Scholar
  7. 7.
    Sipponen T, Kärkkäinen P, Savilahti E et al (2008) Correlation of faecal calprotectin and lactoferrin with an endoscopic score for Crohn’s disease and histological findings. Aliment Pharmacol Ther 28:1221–1229PubMedCrossRefGoogle Scholar
  8. 8.
    Sipponen T, Savilahti E, Kolho K-L, Nuutinen H, Turunen U, Färkkilä M (2008) Crohn’s disease activity assessed by fecal calprotectin and lactoferrin: correlation with Crohn's disease activity index and endoscopic findings. Inflamm Bowel Dis 14:40–46PubMedCrossRefGoogle Scholar
  9. 9.
    Steward MJ, Punwani S, Proctor I et al (2012) Non-perforating small bowel Crohn’s disease assessed by MRI enterography: derivation and histopathological validation of an MR-based activity index. Eur J Radiol 81:2080–2088PubMedCrossRefGoogle Scholar
  10. 10.
    Zappa M, Stefanescu C, Cazals-Hatem D et al (2011) Which magnetic resonance imaging findings accurately evaluate inflammation in small bowel Crohn’s disease? A retrospective comparison with surgical pathologic analysis. Inflamm Bowel Dis 17:984–993PubMedCrossRefGoogle Scholar
  11. 11.
    Rimola J, Rodriguez S, García-Bosch O et al (2009) Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn’s disease. Gut 58:1113–1120PubMedCrossRefGoogle Scholar
  12. 12.
    Lasocki A, Pitman A, Williams R, Lui B, Kalade AV, Farish S (2011) Relative efficacy of different MRI signs in diagnosing active Crohn’s disease, compared against a histological gold standard. J Magn Reson Imaging 55:11–19Google Scholar
  13. 13.
    Jaffe TA, Gaca AM, Delaney S et al (2007) Radiation doses from small-bowel follow-through and abdominopelvic MDCT in Crohn’s disease. AJR Am J Roentgenol 189:1015–1022PubMedCrossRefGoogle Scholar
  14. 14.
    Peloquin J, Pardi D, Sandborn W et al (2008) Diagnostic ionizing radiation exposure in a population-based cohort of patients with inflammatory bowel disease. Am J Gastroenterol 103:2015–2022PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Rimola J, Ordás 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 17:1759–1768PubMedCrossRefGoogle Scholar
  16. 16.
    Taylor SA, Punwani S, Rodriguez-Justo M et al (2009) Mural Crohn disease: correlation of dynamic contrast-enhanced MR imaging findings with angiogenesis and inflammation at histologic examination—Pilot study1. Radiology 251:369–379PubMedCrossRefGoogle Scholar
  17. 17.
    Ziech MLW, Bipat S, Roelofs J et al (2010) Retrospective comparison of magnetic resonance imaging features and histopathology in Crohn’s disease patients. Eur J Radiol 80:e299–e305CrossRefGoogle Scholar
  18. 18.
    Harvey R, Bradshaw J (1980) A simple index of Crohn’s disease activity. Lancet 1:514PubMedCrossRefGoogle Scholar
  19. 19.
    Silverberg MS, Satsangi J, Ahmad T et al (2005) Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: Report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol 19(Suppl A):5–36Google Scholar
  20. 20.
    Lauenstein T, Schneemann H (2003) Optimization of oral contrast agents for MR imaging of the small bowel. Radiology 228:279–283PubMedCrossRefGoogle Scholar
  21. 21.
    Ajaj WM, Lauenstein TC, Pelster G et al (2005) Magnetic resonance colonography for the detection of inflammatory diseases of the large bowel: quantifying the inflammatory activity. Gut 54:257–263PubMedCrossRefGoogle Scholar
  22. 22.
    Taylor SA, Halligan S, Goh V et al (2003) Optimizing colonic distention for multi-detector row CT colonography: effect of hyoscine butylbromide and rectal balloon catheter. Radiology 229:99–108PubMedCrossRefGoogle Scholar
  23. 23.
    Ajaj W, Pelster G, Treichel U, Vogt F (2003) Dark lumen magnetic resonance colonography: comparison with conventional colonoscopy for the detection of colorectal pathology. Gut 52:1738–1744PubMedCrossRefGoogle Scholar
  24. 24.
    Tolan DJM, Greenhalgh R, Zealley IA, Halligan S, Taylor SA (2010) MR enterographic manifestations of small bowel Crohn disease. Radiographics 30:367–384PubMedCrossRefGoogle Scholar
  25. 25.
    Ziech MLW, Bossuyt PMM, Laghi A, Lauenstein TC, Taylor SA, Stoker J (2012) Grading luminal Crohn’s disease: which MRI features are considered as important? Eur J Radiol 81:e467–e472PubMedCrossRefGoogle Scholar
  26. 26.
    Björkesten C-G, Nieminen U, Turunen U, Arkkila P, Sipponen T, Färkkilä M (2012) Surrogate markers and clinical indices, alone or combined, as indicators for endoscopic remission in anti-TNF-treated luminal Crohn’s disease. Scand J Gastroenterol 47:528–537CrossRefGoogle Scholar
  27. 27.
    Rimola J, Ordás I, Rodríguez S, Ricart E, Panés J (2012) Imaging indexes of activity and severity for Crohn’s disease: current status and future trends. Abdom Imaging 37:958–966PubMedCrossRefGoogle Scholar
  28. 28.
    Sipponen T, Savilahti E, Kärkkäinen P et al (2008) Fecal calprotectin, lactoferrin, and endoscopic disease activity in monitoring anti-TNF-alpha therapy for Crohn’s disease. Inflamm Bowel Dis 14:1392–1398PubMedCrossRefGoogle Scholar
  29. 29.
    Eder P, Stawczyk-Eder K, Krela-Kaźmierczak I, Linke K (2008) Clinical utility of the assessment of fecal calprotectin in Leśniowski-Crohn’s disease. Pol Arch Med Wewn 118:622–626PubMedGoogle Scholar
  30. 30.
    Dolwani S, Metzner M, Wassell JJ, Yong A, Hawthorne AB (2004) Diagnostic accuracy of faecal calprotectin estimation in prediction of abnormal small bowel radiology. Aliment Pharmacol Ther 20:615–621PubMedCrossRefGoogle Scholar
  31. 31.
    Lönnkvist MH, Theodorsson E, Holst M, Ljung T, Hellström PM (2011) Blood chemistry markers for evaluation of inflammatory activity in Crohn’s disease during infliximab therapy. Scand J Gastroenterol 46:420–427PubMedCrossRefGoogle Scholar
  32. 32.
    García-Sánchez V, Iglesias-Flores E, González R et al (2010) Does fecal calprotectin predict relapse in patients with Crohn’s disease and ulcerative colitis? J Crohn’s and Colitis 4:144–152CrossRefGoogle Scholar
  33. 33.
    Kallel L, Ayadi I, Matri S et al (2010) Fecal calprotectin is a predictive marker of relapse in Crohn’s disease involving the colon: a prospective study. Eur J Gastroenterol Hepatol 22:340–345PubMedCrossRefGoogle Scholar
  34. 34.
    Louis E, Mary J-Y, Vernier-Massouille G et al (2012) Maintenance of remission among patients with Crohn’s disease on antimetabolite therapy after infliximab therapy is stopped. Gastroenterology 142:63–70PubMedCrossRefGoogle Scholar
  35. 35.
    D’Incà R, Dal Pont E, Di Leo V et al (2008) Can calprotectin predict relapse risk in inflammatory bowel disease? Am J Gastroenterol 103:2007–2014PubMedCrossRefGoogle Scholar
  36. 36.
    Lamb CA, Mohiuddin MK, Gicquel J et al (2009) Faecal calprotectin or lactoferrin can identify postoperative recurrence in Crohn’s disease. Br J Surg 96:663–674PubMedCrossRefGoogle Scholar
  37. 37.
    Sipponen T, Björkesten C-GAF, Färkkilä M, Nuutinen H, Savilahti E, Kolho K-L (2010) Faecal calprotectin and lactoferrin are reliable surrogate markers of endoscopic response during Crohn’s disease treatment. Scand J Gastroenterol 45:325–331PubMedCrossRefGoogle Scholar
  38. 38.
    Pariente B, Cosnes J, Danese S et al (2011) Development of the Crohn’s disease digestive damage score, the Lémann score. Inflamm Bowel Dis 17:1415–1422PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Jesica C. Makanyanga
    • 1
  • Doug Pendsé
    • 2
  • Nikolaos Dikaios
    • 1
  • Stuart Bloom
    • 3
  • Sara McCartney
    • 3
  • Emma Helbren
    • 1
    • 2
  • Elaine Atkins
    • 2
  • Terry Cuthbertson
    • 2
  • Shonit Punwani
    • 1
    • 2
  • Alastair Forbes
    • 3
  • Steve Halligan
    • 1
    • 2
  • Stuart A. Taylor
    • 1
    • 2
    Email author
  1. 1.Centre for Medical ImagingUniversity College LondonLondonUK
  2. 2.Department of Specialist RadiologyUniversity College London HospitalsLondonUK
  3. 3.Department of GastroenterologyUniversity College London HospitalsLondonUK

Personalised recommendations