Skip to main content
SpringerLink
Log in

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

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

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 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

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

References

  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 4:28–62

    Article  CAS  Google Scholar 

  2. Lichtenstein GR, Hanauer SB, Sandborn WJ (2009) Management of Crohn’s disease in adults. Am J Gastroenterol 104:465–483

    Article  PubMed  Google Scholar 

  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 6:1218–1224

    Article  PubMed  Google Scholar 

  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 103:162–169

    Article  PubMed  Google Scholar 

  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 34:50–54

    Article  PubMed  Google Scholar 

  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 105:162–169

    Article  PubMed  Google Scholar 

  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 28:1221–1229

    Article  CAS  PubMed  Google Scholar 

  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 14:40–46

    Article  PubMed  Google Scholar 

  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 81:2080–2088

    Article  PubMed  Google Scholar 

  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 17:984–993

    Article  PubMed  Google Scholar 

  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 58:1113–1120

    Article  CAS  PubMed  Google Scholar 

  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 55:11–19

    Google Scholar 

  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 189:1015–1022

    Article  PubMed  Google Scholar 

  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 103:2015–2022

    Article  PubMed Central  PubMed  Google Scholar 

  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 17:1759–1768

    Article  PubMed  Google Scholar 

  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 251:369–379

    Article  PubMed  Google Scholar 

  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–e305

    Article  Google Scholar 

  18. Harvey R, Bradshaw J (1980) A simple index of Crohn’s disease activity. Lancet 1:514

    Article  CAS  PubMed  Google Scholar 

  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):5–36

    Google Scholar 

  20. Lauenstein T, Schneemann H (2003) Optimization of oral contrast agents for MR imaging of the small bowel. Radiology 228:279–283

    Article  PubMed  Google Scholar 

  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 54:257–263

    Article  CAS  PubMed  Google Scholar 

  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 229:99–108

    Article  PubMed  Google Scholar 

  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 52:1738–1744

    Article  CAS  PubMed  Google Scholar 

  24. Tolan DJM, Greenhalgh R, Zealley IA, Halligan S, Taylor SA (2010) MR enterographic manifestations of small bowel Crohn disease. Radiographics 30:367–384

    Article  PubMed  Google Scholar 

  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–e472

    Article  CAS  PubMed  Google Scholar 

  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 47:528–537

    Article  Google Scholar 

  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 37:958–966

    Article  PubMed  Google Scholar 

  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 14:1392–1398

    Article  PubMed  Google Scholar 

  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 118:622–626

    CAS  PubMed  Google Scholar 

  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 20:615–621

    Article  CAS  PubMed  Google Scholar 

  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 46:420–427

    Article  PubMed  Google Scholar 

  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 4:144–152

    Article  Google Scholar 

  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 22:340–345

    Article  CAS  PubMed  Google Scholar 

  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 142:63–70

    Article  CAS  PubMed  Google Scholar 

  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 103:2007–2014

    Article  PubMed  Google Scholar 

  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 96:663–674

    Article  CAS  PubMed  Google Scholar 

  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 45:325–331

    Article  CAS  PubMed  Google Scholar 

  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 17:1415–1422

    Article  PubMed Central  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Centre for Medical Imaging, University College London, London, UK

    Jesica C. Makanyanga, Nikolaos Dikaios, Emma Helbren, Shonit Punwani, Steve Halligan & Stuart A. Taylor

  2. Department of Specialist Radiology, University College London Hospitals, Podium Level 2, 235 Euston Road, London, UK, NW1 2BU

    Doug Pendsé, Emma Helbren, Elaine Atkins, Terry Cuthbertson, Shonit Punwani, Steve Halligan & Stuart A. Taylor

  3. Department of Gastroenterology, University College London Hospitals, London, UK

    Stuart Bloom, Sara McCartney & Alastair Forbes

Authors
  1. Jesica C. Makanyanga
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Doug Pendsé
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nikolaos Dikaios
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stuart Bloom
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sara McCartney
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emma Helbren
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Elaine Atkins
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Terry Cuthbertson
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shonit Punwani
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Alastair Forbes
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Steve Halligan
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Stuart A. Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stuart A. Taylor.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Makanyanga, J.C., Pendsé, D., Dikaios, N. et al. Evaluation of Crohn’s disease activity: Initial validation of a magnetic resonance enterography global score (MEGS) against faecal calprotectin. Eur Radiol 24, 277–287 (2014). https://doi.org/10.1007/s00330-013-3010-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-013-3010-z

Key words

Search

Navigation