TY - JOUR
T1 - Comparison of MRI Activity Scoring Systems and Features for the Terminal Ileum in Patients With Crohn Disease
AU - Puylaert, Carl A J
AU - Nolthenius, Charlotte J Tutein
AU - Tielbeek, Jeroen A W
AU - Makanyanga, Jesica C
AU - Rodriguez-Justo, Manuel
AU - Brosens, Lodewijk A A
AU - Nio, C Yung
AU - Pendsé, Douglas A
AU - Ponsioen, Cyriel Y
AU - Vos, Frans M
AU - Taylor, Stuart A
AU - Stoker, Jaap
PY - 2019/2
Y1 - 2019/2
N2 - OBJECTIVE: The purpose of this study was to evaluate four previously validated MRI activity scoring systems for diagnosis and grading of Crohn disease (CD) in the terminal ileum against an endoscopic and histopathologic reference standard.SUBJECTS AND METHODS: Ethics approval and written informed consent were obtained. Subjects with known or suspected CD were prospectively recruited between December 2011 and August 2014. Each patient underwent MRI and ileocolonoscopy with terminal ileum biopsies. Four MRI scoring systems (Magnetic Resonance Index of Activity [MaRIA], Clermont score, London score, and Crohn disease MRI Index) and component features were applied by two observers and correlated to the Crohn disease endoscopic index of severity (CDEIS, 0-44) and histopathologic endoscopic acute inflammation score (0-6). Interobserver agreement (weighted kappa and intraclass correlation coefficient [ICC]) and diagnostic accuracy for active and ulcerating endoscopic or histopathologic disease were evaluated.RESULTS: Ninety-eight patients (median age, 32 years old; 55 women, 43 men) were included. All four scoring systems showed good interobserver agreement (ICC = 0.70-0.78), moderate-to-strong correlation to CDEIS (r = 0.57-0.67) and weak-to-moderate correlation to endoscopic acute inflammation score (r = 0.38-0.49). Scoring systems' diagnostic accuracy for active and ulcerating endoscopic disease ranged from 73% to 78% and 71% to 76%, respectively, whereas for active histopathologic disease accuracy ranged from 65% to 72%. Between the scoring systems, no significant differences were found for both observers regarding interobserver agreement, correlation coefficients, and diagnostic accuracy.CONCLUSION: All scoring systems were comparable in terms of interobserver agreement, correlation to the endoscopic and histopathologic reference standard, and diagnostic accuracy. The London score, MaRIA, and Clermont score have the additional benefit of having validated cutoff values for both active and ulcerating endoscopic disease.
AB - OBJECTIVE: The purpose of this study was to evaluate four previously validated MRI activity scoring systems for diagnosis and grading of Crohn disease (CD) in the terminal ileum against an endoscopic and histopathologic reference standard.SUBJECTS AND METHODS: Ethics approval and written informed consent were obtained. Subjects with known or suspected CD were prospectively recruited between December 2011 and August 2014. Each patient underwent MRI and ileocolonoscopy with terminal ileum biopsies. Four MRI scoring systems (Magnetic Resonance Index of Activity [MaRIA], Clermont score, London score, and Crohn disease MRI Index) and component features were applied by two observers and correlated to the Crohn disease endoscopic index of severity (CDEIS, 0-44) and histopathologic endoscopic acute inflammation score (0-6). Interobserver agreement (weighted kappa and intraclass correlation coefficient [ICC]) and diagnostic accuracy for active and ulcerating endoscopic or histopathologic disease were evaluated.RESULTS: Ninety-eight patients (median age, 32 years old; 55 women, 43 men) were included. All four scoring systems showed good interobserver agreement (ICC = 0.70-0.78), moderate-to-strong correlation to CDEIS (r = 0.57-0.67) and weak-to-moderate correlation to endoscopic acute inflammation score (r = 0.38-0.49). Scoring systems' diagnostic accuracy for active and ulcerating endoscopic disease ranged from 73% to 78% and 71% to 76%, respectively, whereas for active histopathologic disease accuracy ranged from 65% to 72%. Between the scoring systems, no significant differences were found for both observers regarding interobserver agreement, correlation coefficients, and diagnostic accuracy.CONCLUSION: All scoring systems were comparable in terms of interobserver agreement, correlation to the endoscopic and histopathologic reference standard, and diagnostic accuracy. The London score, MaRIA, and Clermont score have the additional benefit of having validated cutoff values for both active and ulcerating endoscopic disease.
KW - Adult
KW - Crohn Disease/diagnostic imaging
KW - Endoscopy, Gastrointestinal
KW - Female
KW - Humans
KW - Ileum/diagnostic imaging
KW - Magnetic Resonance Imaging
KW - Male
KW - Middle Aged
KW - Prospective Studies
KW - Severity of Illness Index
KW - Young Adult
U2 - https://doi.org/10.2214/AJR.18.19876
DO - https://doi.org/10.2214/AJR.18.19876
M3 - Article
C2 - 30540212
SN - 0361-803X
VL - 212
SP - W25-W31
JO - AJR. American journal of roentgenology
JF - AJR. American journal of roentgenology
IS - 2
ER -