Abstract
Purpose
We evaluated the diagnostic accuracy of magnetic resonance enterography (MR-E) in assessing Crohn’s disease (CD) activity by differentiating acute, chronic and remission stages of disease through a quantitative MR-E assessment.
Materials and methods
One hundred patients with a histological diagnosis of CD were studied with MR-E. Intestinal distension was obtained by oral administration of approximately 2 L of a polyethylene glycol solution (PEG). In all cases, the ileum and large bowel were imaged with morphological sequences (heavily T2-weighted single-shot, dual fast-field echo, balanced fast-field echo) and a postcontrast dynamic sequence (T1-weighted high-resolution isotropic volume excitation). Disease activity was assessed according to a multiparameter score (0–8) based on lesion morphology, signal intensity and contrast enhancement. MR-E findings were compared with clinical-laboratory data and disease activity indices [Crohn’s Disease Activity Index (CDAI); Inflammatory Bowel Disease Questionnaire (IBDQ)]. Multiple regression analysis was performed by correlating MR-E score, CDAI and IBDQ. Frequencies were then compared using the χ 2 test.
Results
MR-E identified inactive disease in 9% of cases, chronic disease in 57% and active disease in the remaining 34%. The most frequently involved bowel segment was the terminal ileum (52%). A statistically significant correlation was found between MR-E score and CDAI (R=0.86; p<0.001) and between MR-E score and IBDQ (R=−0.83; p<0.001). The most suggestive parameter for disease activity was layered bowel-wall enhancement, a finding predominantly present in patients with increased CDAI (≥150) and/or local complications (χ 2=7.13; p<0.01).
Conclusions
MR-E is a noninvasive and diagnostic imaging modality for CD study and follow-up. The MR-E score proposed in this study proved to be useful in assessing disease severity and monitoring response to treatment.
Riassunto
Obiettivo
Scopo del nostro lavoro è stato valutare l’accuratezza diagnostica dell’enterografia con risonanza magnetica (E-RM) nella determinazione dell’attività del morbo di Crohn (MC) differenziando gli stati di malattia acuta, cronica e di remissione attraverso un indice quantitativo (E-RM score).
Materiali e metodi
Cento pazienti con diagnosi istologica di MC sono stati studiati con E-RM. La distensione intestinale è stata ottenuta somministrando per os circa 2 l di una soluzione di glicole polietilenico (PEG). In tutti i casi l’ileo e l’intestino crasso sono stati studiati utilizzando sequenze morfologiche (T2w single shotheavy weight, DUAL fast field echo, balanced fast field echo) ed una sequenza dinamica post-contrastografica (T1w high resolution isotropic volume excitation). L’attività di malattia è stata valutata mediante uno score multiparametrico (compreso tra 0 e 8) basato sulle caratteristiche morfologiche, di segnale e contrastografiche delle lesioni. I dati della E-RM sono stati confrontati con quelli clinico-laboratoristici e con gli indici di attività di malattia (Crohn Disease Activity Index,CDAI; Inflammatory Bowel Disease Questionnaire, IBDQ). Un’analisi statistica di regressione multipla è stata eseguita correlando le seguenti variabili: score E-RM, CDAI e IBDQ. Le frequenze sono state confrontate con il test del χ 2.
Risultati
La E-RM ha identificato nel 9% dei casi una fase di remissione di malattia, nel 57% una fase cronica e nel restante 34% una fase di malattia attiva. Il segmento intestinale maggiormente coinvolto dalla patologia è stato l’ileo terminale (52%). è stata osservata una correlazione statisticamente significativa tra score E-RM e CDAI (R=0,86; p<0,001) e tra score E-RM ed IBDQ (R=−0,83; p<0,001). Il parametro più indicativo di attività di malattia è stato il pattern di contrast enhancement (ce) parietale di tipo stratificato, reperto presente prevalentemente nei pazienti con valore di CDAI aumentato (≥150) e/o con complicanze locali (χ2=7,13; p<0,01).
Conclusioni
La E-RM rappresenta una metodica d’imaging non invasiva e diagnostica per lo studio ed il follow-up del MC. Lo score E-RM da noi proposto si è rivelato utile nella valutazione della severità di malattia e nel monitoraggio della risposta al trattamento.
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Macarini, L., Stoppino, L.P., Centola, A. et al. Assessment of activity of Crohn’s disease of the ileum and large bowel: proposal for a new multiparameter MR enterography score. Radiol med 118, 181–195 (2013). https://doi.org/10.1007/s11547-012-0841-7
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DOI: https://doi.org/10.1007/s11547-012-0841-7