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Correlation between magnetic resonance enterography and ileo-colonoscopy for assessment of disease activity in terminal ileal Crohn’s disease

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Abstract

Background

Magnetic resonance enterography (MRE) has emerged as a novel tool for the assessment of disease activity in Crohn’s disease (CD). Real world data from Indian subcontinent on performance of MRE in terminal ileal CD are lacking.

Methods

Retrospective analysis of patients with terminal ileal CD who underwent both ileo-colonoscopy and MRE was performed. Ileo-colonoscopy was considered the gold standard for assessment of disease activity. On ileo-colonoscopy, a simple endoscopic score for Crohn’s disease (SES-CD) ≥2 was considered active disease; presence of ulcers indicated severe disease. MRE scoring of the disease activity was performed using magnetic resonance index of activity (MARIA) and simplified MARIA (MARIAs). The measure of agreement between ileo-colonoscopy and MRE and comparison of MARIA and MARIAs for assessment of disease activity and sensitivity of MRE to detect mucosal ulcerations were calculated.

Results

Seventy patients with terminal ileal CD (mean age 40.74±15.56 years; 71.4% males [n=50]) were evaluated. The sensitivities of MARIA and MARIAs scores to detect active disease were 0.76 and 0.84, respectively. The area under the receiver operating characteristic curve (AUROC) for detecting severe disease was 0.836 (p<0.0001) for MARIA and 0.861 (p<0.0001) for MARIAs. For mild active disease, there was no agreement between SES-CD and MARIA or MARIAs; however, for severe disease, the agreement was fair and moderate for MARIA and MARIAs, respectively. MARIA and MARIAs were comparable for identification of active and severe disease (κ 0.759, p<0.0001 and κ 0.840, p<0.0001, respectively). MRE was 68.18% sensitive to detect mucosal ulcers.

Conclusion

MRE is a reliable and sensitive tool for detection of endoscopically severe, but not mild, terminal ileal CD.

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Author notes

  1. Chandan Kakkar and Arshdeep Singh contributed equally and share the first authorship.

Authors and Affiliations

  1. Department of Radiology and Radiodiagnosis, Dayanand Medical College, Ludhiana, 141 001, India

    Chandan Kakkar, Kamini Gupta & Kavita Saggar

  2. Department of Gastroenterology, Dayanand Medical College, Ludhiana, 141 001, India

    Arshdeep Singh, Ramit Mahajan, Dharmatma Singh & Ajit Sood

  3. Department of Internal Medicine, Dayanand Medical College, Ludhiana, 141 001, India

    Vandana Midha

  4. Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA

    Shriya Goyal

  5. Department of Pathology, Dayanand Medical College, Ludhiana, 141 001, India

    Vikram Narang

  6. Research and Development Center, Dayanand Medical College, Ludhiana, 141 001, India

    Namita Bansal

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  1. Chandan Kakkar
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Correspondence to Ajit Sood.

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CK, AS, RM, VM, SG, VN, KG, DS, NB, KS, and AS declare no competing interests.

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The study was performed conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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Kakkar, C., Singh, A., Mahajan, R. et al. Correlation between magnetic resonance enterography and ileo-colonoscopy for assessment of disease activity in terminal ileal Crohn’s disease. Indian J Gastroenterol 41, 465–474 (2022). https://doi.org/10.1007/s12664-022-01242-7

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