Evaluation of Crohn’s disease activity: Initial validation of a magnetic resonance enterography global score (MEGS) against faecal calprotectin
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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).
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.
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.
A magnetic resonance enterography global score (MEGS) of CD activity correlated significantly with fC levels.
• Magnetic resonance imaging is now widely used to assess Crohn’s 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 Crohn’s disease burden score correlates with calprotectin and CRP.
• The MRI enterography score of disease activity can complement existing clinical markers.
Key wordsCrohn’s disease Magnetic resonance imaging Calprotectin C-reactive protein Inflammatory bowel diseases
Crohn’s disease activity score
MRI enterography global score
Crohn’s disease activity index
Magnetic resonance enterography
Analysis of variance analysis
Area under the curve
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.
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