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Crohn's disease activity before and after medical therapy evaluated by MaRIA score and others parameters in MR
Laura Maria Minordi1, Luigi Larosa1, Gianfranco Belmonte2
1Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia Diagnostica e Interventistica Generale, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Largo Francesco Vito, 1, 00168 Roma, Italy.
Insights
MR Enterography (MRE) shows moderate agreement with clinical assessment for evaluating Crohn's disease (CD) treatment response. MRE findings correlate with clinical changes, aiding in therapy evaluation for CD patients.
Area of Science:
- Gastroenterology
- Radiology
- Medical Imaging
Background:
- Crohn's disease (CD) is a chronic inflammatory bowel disease requiring ongoing monitoring of treatment efficacy.
- Assessing treatment response in CD is crucial for optimizing patient management and preventing disease progression.
- Current clinical indices, like the Harvey Bradshaw Index (HBI), provide subjective measures of disease activity.
Purpose of the Study:
- To retrospectively evaluate the utility of MR Enterography (MRE) in assessing treatment response in Crohn's disease (CD) patients.
- To compare MRE findings with clinical assessments using the Harvey Bradshaw Index (HBI).
- To determine the concordance between radiological and clinical judgments of treatment response in CD.
Main Methods:
- A retrospective analysis of 46 CD patients who underwent serial MRE examinations after medical therapy.
- Evaluation of MRE parameters including the Magnetic Resonance Index of Activity (MaRIA), wall thickening, longitudinal extension, mural hyperenhancement, and extraintestinal signs.
- Clinical response was assessed using the HBI and categorized as improved, worsened, or stable.
- Statistical analysis using the Cohen Kappa test to determine agreement between MRE findings and clinical judgment.
Main Results:
- Among 46 patients, 72% showed agreement between MR judgment and clinical assessment (Kappa = 0.49, p < 0.01).
- Clinical improvement correlated significantly with reduced wall thickening, decreased longitudinal disease extension, and diminished engorged vasa recta (p < 0.05).
- Worsening disease correlated significantly with increased wall thickening (p = 0.05).
Conclusions:
- MR Enterography (MRE) is a valuable tool for evaluating treatment response in Crohn's disease (CD) patients.
- MRE findings provide objective radiological correlates to clinical assessments of disease activity.
- The study supports the integration of MRE into the routine monitoring of CD patients undergoing therapy.
Aim:
Aim of this retrospective study is to evaluate the response to therapy in Crohn's disease (CD) patients studied by MR Enterography (MRE) in comparison with Harvey Bradshaw Index (HBI).
Methods:
One hundred and sixty patients with histological proved CD have undergone MRE in the last years. Forty-six patients who repeated MRE after medical therapy within six months were selected for the study. Magnetic Resonance Index of Activity (MaRIA) was evaluated for each patient and used to define the MR judgment. In MRE we also evaluated wall thickening, longitudinal extension of wall thickening, presence of stratified mural hyperenhancement and extraintestinal signs. The clinical response to therapy was judged based on HBI and classified as improved, worsened or stable disease. Clinical judgment was correlated with MRE findings and the agreement was analysed using the Cohen Kappa test.
Results:
Among 46 enrolled patients, 18 (39%) improved clinically, 4 (10%) worsened, 24 (51%) remained stable. MR judgment was in agreement with clinical assessment in 33 patients (72%), showing moderate significant concordance (Kappa = 0.49; p < 0.01). No agreement was observed in 13 (28%) patients. Moreover, clinical improvement was significantly correlated to reduction of wall thickening, reduction of longitudinal extension of the disease and reduction of engorged vasa recta (p < 0.05). Worsening conditions were significantly correlated to increased wall thickening (p = 0.05).
Conclusions:
MRE is useful in evaluating the response to therapy in CD patients.
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