Diagnostic Performance of Magnetic Resonance Enterography Disease Activity Indices Compared with a Histological Reference Standard for Adult Terminal Ileal Crohn’s Disease: Experience from the METRIC Trial

Shankar Kumar, Thomas Parry, Sue Mallett, Gauraang Bhatnagar, Andrew Plumb, Shaun Walsh, Nigel Scott, Ruchi Tandon, Heung Chong, John Du Parcq, Adrianna Martinez, Morgan Moorghen, Manuel Rodriguez-Justo, Steve Halligan, Stuart A. Taylor*, METRIC study investigators, Laura Quinn

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)
35 Downloads (Pure)

Abstract

Background and Aims: The simplified magnetic resonance enterography [MRE] index of activity [sMARIA], London, and 'extended' London, scoring systems are widely used in Crohn's disease [CD] to assess disease activity, although validation studies have usually been single-centre, retrospective, and/or used few readers. Here, we evaluated these MRE indices within a prospective, multicentre, multireader, diagnostic accuracy trial. Methods: A subset of participants [newly diagnosed or suspected of relapse] recruited to the METRIC trial with available terminal ileal [TI] biopsies was included. Using pre-specified thresholds, the sensitivity and specificity of sMARIA, London, and 'extended' London scores for active and severe [sMARIA] TI CD were calculated using different thresholds for the histological activity index [HAI]. Results: We studied 111 patients [median age 29 years, interquartile range 21-41, 75 newly diagnosed, 36 suspected relapse] from seven centres, of whom 22 had no active TI CD [HAI = 0], 39 mild [HAI = 1], 13 moderate [HAI = 2], and 37 severe CD activity [HAI = 3]. In total, 26 radiologists prospectively scored MRE datasets as per their usual clinical practice. Sensitivity and specificity for active disease [HAI >0] were 83% [95% confidence interval 74% to 90%] and 41% [23% to 61%] for sMARIA, 76% [67% to 84%] and 64% [43% to 80%] for the London score, and 81% [72% to 88%] and 41% [23% to 61%] for the 'extended' London score, respectively. The sMARIA had 84% [69-92%] sensitivity and 53% [41-64%] specificity for severe CD. Conclusions: When tested at their proposed cut-offs in a real-world setting, sMARIA, London, and 'extended' London indices achieve high sensitivity for active TI disease against a histological reference standard, but specificity is low.

Original languageEnglish
Pages (from-to)1531-1539
Number of pages9
JournalJournal of Crohn's and Colitis
Volume16
Issue number10
Early online date8 Jun 2022
DOIs
Publication statusPublished - Oct 2022

Bibliographical note

Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press on behalf of European Crohn's and Colitis Organisation.

Keywords

  • Crohn's disease
  • imaging
  • magnetic resonance enterography

ASJC Scopus subject areas

  • General Medicine

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