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Published on: April 17, 2019
MRI characteristics of proctitis in Crohn's disease on perianal MRI
Charlotte J Tutein Nolthenius1,2, Shandra Bipat3, Banafsche Mearadji3
1Department of Radiology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands. c.j.tuteinnolthenius@amc.uva.nl.
Purpose:
Multiple features have been described for assessing inflammation in Crohn's disease (CD) in MR enterography, but have not been validated in perianal magnetic resonance imaging (MRI). Retrospectively, we studied which MRI features are valuable in assessing proctitis.
Materials And Methods:
CD patients (≥18 years) who underwent colonoscopy (reference standard) and perianal fistula MRI within 8 weeks were included. Seventeen MRI features were blindly scored by three observers and correlated to endoscopy (regression analysis). Reproducibility (multirater kappa, intraclass correlation coefficient) was determined for all three observer pairs. MRI features were considered relevant when significantly correlated to endoscopy for ≥2 observers, and reproducibility was ≥0.40 for ≥2 observer pairs.
Results:
Perianal MRI of 58 CD patients were included. Wall thickness, rectal mural fat, creeping fat, and size of mesorectal lymph nodes showed a significant correlation with endoscopy for ≥2 observers (p = 0.000-0.023, p = 0.011-0.172, p = 0.007-0.011 and p = 0.000-0.005, respectively) with a kappa/intraclass correlation coefficient of ≥0.60 for ≥2 observer pairs. Perimural T2 signal and perimural enhancement significantly correlated to endoscopy (all p values ≤0.05) for all three observers and the reproducibility was ≥0.40 for ≥2 observer pairs. Mural T2 signal and degree and pattern of T1 enhancement showed significant correlation to endoscopy for two observers, but with poor to moderate reproducibility.
Conclusion:
Wall thickness, mural fat, and mesorectal features (perimural T2 signal, perimural enhancement, creeping fat, and size of mesorectal lymph nodes) had significant correlation to endoscopy and were reproducible in diagnosing proctitis. Some established luminal features in MRE were considered not useful.
Insights
Perianal MRI effectively assesses Crohn's disease proctitis. Key features like wall thickness and mesorectal characteristics show significant correlation with endoscopy, aiding diagnosis.
Area of Science:
- Radiology
- Gastroenterology
- Medical Imaging
Background:
- Crohn's disease (CD) assessment often uses MR enterography, but perianal MRI features for proctitis require validation.
- Standardized MRI features for perianal inflammation in CD are needed.
Purpose of the Study:
- To identify and validate MRI features in perianal magnetic resonance imaging (MRI) for assessing proctitis in Crohn's disease patients.
- To determine the correlation and reproducibility of specific MRI findings with endoscopic results.
Main Methods:
- Retrospective analysis of perianal MRI from 58 Crohn's disease patients.
- Seventeen MRI features were scored by three observers and correlated with colonoscopy findings using regression analysis.
- Reproducibility was assessed using multirater kappa and intraclass correlation coefficients.
Main Results:
- Wall thickness, rectal mural fat, creeping fat, and mesorectal lymph node size showed significant correlation with endoscopy (p ≤ 0.023) and good reproducibility (κ/ICC ≥ 0.60).
- Perimural T2 signal and enhancement also correlated significantly with endoscopy (p ≤ 0.05) with acceptable reproducibility (κ/ICC ≥ 0.40).
- Some luminal features used in MR enterography were found to be less useful for perianal assessment.
Conclusions:
- Perianal MRI features including wall thickness, mural fat, and mesorectal characteristics are valuable and reproducible for diagnosing proctitis in Crohn's disease.
- These validated MRI findings can improve the non-invasive assessment of perianal inflammation in CD.
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