Magnetic resonance enterography versus capsule endoscopy activity indices for quantification of small bowel inflammation in Crohn’s disease

Author:

Kopylov Uri1,Klang Eyal23,Yablecovitch Doron43,Lahat Adi43,Avidan Benjamin43,Neuman Sandra43,Levhar Nina43,Greener Tomer43,Rozendorn Noa23,Beytelman Arkadi23,Yanai Henit5,Dotan Iris5,Chowers Yehuda67,Weiss Batya83,Ben-Horin Shomron43,Amitai Marianne M.23,Eliakim Rami43,

Affiliation:

1. Department of Gastroenterology, Sheba Medical Center, Tel Hashomer 52621, Israel

2. Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel

3. Sackler Faculty of Medicine, Tel Aviv University, Israel

4. Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel

5. IBD Center, Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel

6. Rambam Health Care Campus, Haifa, Israel

7. Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel

8. Edmond and Lily Safra Children’s Hospital, Tel Hashomer, Israel

Abstract

Background: Video capsule endoscopy (VCE) and magnetic resonance enterography (MRE) are the prime modalities for the evaluation of small bowel (SB) Crohn’s disease (CD). Mucosal inflammation on VCE is quantified using the Lewis score (LS). Diffusion-weighted (DW) magnetic resonance imaging (MRI) allows for accurate assessment of SB inflammation without administration of intravenous contrast material. The Magnetic Resonance Index of Activity (MaRiA) and the Clermont index are quantitative activity indices validated for contrast-enhanced MRE and DW-MRE, respectively. The aim of this study was to compare the quantification of distal SB inflammation by VCE and MR-related activity indices. Methods: Patients with known quiescent SB CD were prospectively recruited and underwent MRE and VCE. LS, MaRIA and Clermont scores were calculated for the distal SB. Results: Both MRI-based indices significantly correlated with the LS and the Clermont index ( r = 0.50, p = 0.001 and r = 0.53, p = 0.001, respectively). Both MaRIA and Clermont scores were significantly lower in patients with mucosal healing (LS < 135). The area under the curve (AUC) with both MR scores was moderate for prediction of any mucosal inflammation (LS ⩾ 135) and excellent for prediction of moderate-to-severe inflammation (LS ⩾ 790) (0.71 and 0.74 versus 0.93 and 0.91 for MaRIA and Clermont score, respectively). Conclusions: Modest correlation between VCE- and MRE-based quantitative indices of inflammation in patients with quiescent SB CD was observed. Between-modality correlation was higher in patients with endoscopically severe disease. DW-MRE gauged by Clermont score was at least as accurate as contrast-enhanced MRE for quantification of SB inflammation.

Publisher

SAGE Publications

Subject

Gastroenterology

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