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Evaluation of Crohn's disease activity by MR enterography: Derivation and histopathological comparison of an MR-based
Firdevs Ikbal Gücer1, Senem Senturk1, Seyma Özkanli1
1Istanbul Medeniyet University Göztepe Education and Research Hospital, Radiology Department, 34722, Istanbul, Turkey.
Aims:
To compose a qualitative magnetic resonance imaging (MRI) activity index showing Crohn disease (CD) activity, and to compare magnetic resonance enterography (MRE) findings with histopathology results.
Materials And Methods:
Twenty-six patients (11 male and 15 female; mean age 36.7) who had MRE and colonoscopic biopsy between October 2011 and August 2012 were included in the study. On MRE the following parameters were evaluated: bowel wall thickness, bowel wall T2 signal, bowel wall contrast enhancement pattern and degree, length and number of involved bowel segments, perimural T2 signal, mesenteric inflammation, mesenteric lymph nodes and complications of CD. Each parameter was scored to calculate MRI activity index. Biopsy specimens were retrospectively evaluated, histopathologic and endoscopic acute inflammmation scores (AIS, eAIS) were calculated. Each parameter and total MRI activity index were compared with the pathology scores (AIS, eAIS) by Mann-Whitney U test and Spearman correlation.
Results:
Statistically significant positive correlation was found between AIS and eAIS, mural thickness and eAIS. Moderate correlation was found between MRI activity index and eAIS, mural enhancement degree and eAIS; and poor correlation was found between mesenteric inflammation score and eAIS, MRI activity index and AIS, however they were not statistically significant.
Conclusions:
In CD, bowel wall thickness measured by MRE is best correlated with the histopathologic results which are accepted as the reference standard. In cases with high MRI activity index, eAIS is also generally high. MRI activity index which is measured simply and noninvasively can be used in the follow up of CD.
Insights
Magnetic resonance enterography (MRE) shows bowel wall thickness is the best indicator of Crohn disease (CD) activity compared to histopathology. A new MRI activity index can help monitor CD noninvasively.
Area of Science:
- Gastroenterology
- Radiology
- Medical Imaging
Background:
- Crohn disease (CD) diagnosis and monitoring require accurate assessment of disease activity.
- Histopathology is the gold standard but is invasive.
- Non-invasive imaging techniques like magnetic resonance enterography (MRE) are valuable for evaluating CD.
Purpose of the Study:
- To develop a qualitative MRI activity index for Crohn disease.
- To compare MRE findings with histopathology results in CD patients.
- To assess the utility of MRE in monitoring CD activity.
Main Methods:
- Twenty-six patients with CD underwent MRE and colonoscopic biopsy.
- MRE parameters included bowel wall thickness, signal intensity, enhancement, and signs of inflammation.
- An MRI activity index was calculated and compared with histopathologic scores (AIS, eAIS).
Main Results:
- Bowel wall thickness on MRE showed a significant positive correlation with endoscopic acute inflammation score (eAIS).
- The MRI activity index demonstrated a moderate correlation with eAIS.
- Mesenteric inflammation showed a poor, non-significant correlation with both AIS and eAIS.
Conclusions:
- MRE-measured bowel wall thickness is a reliable indicator of Crohn disease activity, correlating well with histopathology.
- The developed MRI activity index is a simple, non-invasive tool suitable for monitoring CD.
- MRE can aid in the non-invasive follow-up of Crohn disease activity.
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