Magnetic resonance enterography versus capsule endoscopy activity indices for quantification of small bowel inflammation in Crohn's disease

Uri Kopylov*, Eyal Klang, Doron Yablecovitch, Adi Lahat, Benjamin Avidan, Sandra Neuman, Nina Levhar, Tomer Greener, Noa Rozendorn, Arkadi Beytelman, Henit Yanai, Iris Dotan, Yehuda Chowers, Batya Weiss, Shomron Ben-Horin, Marianne M. Amitai, Rami Eliakim

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

40 Scopus citations

Abstract

Background: Video capsule endoscopy (VCE) and magnetic resonance enterography (MRE) are the prime modalities for the evaluation of small bowel (SB) Crohn's disease (CD). Mucosal inflammation on VCE is quantified using the Lewis score (LS). Diffusion-weighted (DW) magnetic resonance imaging (MRI) allows for accurate assessment of SB inflammation without administration of intravenous contrast material. The Magnetic Resonance Index of Activity (MaRiA) and the Clermont index are quantitative activity indices validated for contrast-enhanced MRE and DW-MRE, respectively. The aim of this study was to compare the quantification of distal SB inflammation by VCE and MR-related activity indices. Methods: Patients with known quiescent SB CD were prospectively recruited and underwent MRE and VCE. LS, MaRIA and Clermont scores were calculated for the distal SB. Results: Both MRI-based indices significantly correlated with the LS and the Clermont index (r = 0.50, p = 0.001 and r = 0.53, p = 0.001, respectively). Both MaRIA and Clermont scores were significantly lower in patients with mucosal healing (LS < 135). The area under the curve (AUC) with both MR scores was moderate for prediction of any mucosal inflammation (LS >3/4 135) and excellent for prediction of moderate-to-severe inflammation (LS >3/4 790) (0.71 and 0.74 versus 0.93 and 0.91 for MaRIA and Clermont score, respectively). Conclusions: Modest correlation between VCE- and MRE-based quantitative indices of inflammation in patients with quiescent SB CD was observed. Between-modality correlation was higher in patients with endoscopically severe disease. DW-MRE gauged by Clermont score was at least as accurate as contrast-enhanced MRE for quantification of SB inflammation.

Original languageEnglish
Pages (from-to)655-663
Number of pages9
JournalTherapeutic Advances in Gastroenterology
Volume9
Issue number5
DOIs
StatePublished - 1 Sep 2016

Keywords

  • Crohn's disease
  • diffusion-weighted MRI
  • magnetic resonance enterography
  • videocapsule endoscopy

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