Defining Magnetic Resonance Imaging Treatment Response and Remission in Crohn’s Disease: A Systematic Review

Background: Magnetic resonance imaging is increasingly used to assess treatment response in Crohn’s disease clinical trials. We aimed to describe the definition of MRI response and remission as assessed by magnetic resonance enterography [MRE] to evaluate treatment efficacy in these patients. Methods: Electronic databases were searched up to May 1, 2023. All published studies enrolling patients with inflammatory bowel disease and assessment of treatment efficacy with MRE were eligible for inclusion. Results: Eighteen studies were included. All studies were performed in patients with Crohn’s disease. The study period ranged from 2008 to 2023. The majority of studies used endoscopy as the reference standard [61.1%]. MRE response was defined in 11 studies [61.1%]. Five scores and nine different definitions were proposed for MRE response. MRE remission was defined in 12 studies [66.7%]. Three scores and nine different definitions for MRE remission were described. The MaRIA score was the most frequent index used to evaluate MRE response [63.6%] and remission [41.7%]. MRE response was defined as MaRIA score <11 in 63.6% of studies using this index. In 60% of studies using the MaRIA score, MRE remission was defined as MaRIA score <7. In addition, 11 different time points of assessment were reported, ranging from 6 weeks to years. Conclusion: In this systematic review, significant heterogeneity in the definition of MRE response and remission evaluated in patients with Crohn’s disease was observed. Harmonization of eligibility and outcome criteria for MRE in Crohn’s Disease clinical trials is needed.