TY - JOUR
T1 - Diagnostic Performance of Magnetic Resonance Enterography Disease Activity Indices Compared with a Histological Reference Standard for Adult Terminal Ileal Crohn’s Disease
T2 - Experience from the METRIC Trial
AU - Kumar, Shankar
AU - Parry, Thomas
AU - Mallett, Sue
AU - Bhatnagar, Gauraang
AU - Plumb, Andrew
AU - Walsh, Shaun
AU - Scott, Nigel
AU - Tandon, Ruchi
AU - Chong, Heung
AU - Du Parcq, John
AU - Martinez, Adrianna
AU - Moorghen, Morgan
AU - Rodriguez-Justo, Manuel
AU - Halligan, Steve
AU - Taylor, Stuart A.
AU - METRIC study investigators
AU - Baldwin-Cleland, Rachel
AU - Bloom, Stuart
AU - Gupta, Arun
AU - Hamlin, Peter J.
AU - Hart, Ailsa L.
AU - Higginson, Antony
AU - Jacobs, Ilan
AU - Mccartney, Sara
AU - Miles, Anne
AU - Murray, Charles D.
AU - Pollok, Richard C.
AU - Punwani, Shonit
AU - Quinn, Laura
AU - Shabir, Zainib
AU - Slater, Andrew
AU - Tolan, Damian
AU - Travis, Simon
AU - Windsor, Alastair
AU - Wylie, Peter
AU - Zealley, Ian
AU - Dyer, Jade
AU - Veeramalla, Pranitha
AU - Tebbs, Sue
AU - Hibbert, Steve
AU - Ellis, Richard
AU - Thursby-Pelham, Fergus
AU - Beable, Richard
AU - Gibbons, Nicola
AU - Ward, Claire
AU - O'connor, Anthony
AU - Lambie, Hannah
AU - Hyland, Rachel
AU - Lapham, Roger
AU - Quartey, Doris
AU - Scrimshaw, Deborah
N1 - Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press on behalf of European Crohn's and Colitis Organisation.
PY - 2022/10
Y1 - 2022/10
N2 - 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.
AB - 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.
KW - Crohn's disease
KW - imaging
KW - magnetic resonance enterography
UR - http://www.scopus.com/inward/record.url?scp=85135920431&partnerID=8YFLogxK
U2 - 10.1093/ecco-jcc/jjac062
DO - 10.1093/ecco-jcc/jjac062
M3 - Article
C2 - 35481898
AN - SCOPUS:85135920431
SN - 1873-9946
VL - 16
SP - 1531
EP - 1539
JO - Journal of Crohn's and Colitis
JF - Journal of Crohn's and Colitis
IS - 10
ER -