Department of Radiology, Hospital Clínic de Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
Inflamm Bowel Dis. 2011 Aug;17(8):1759-68. doi: 10.1002/ibd.21551. Epub 2010 Nov 8.
The use of magnetic resonance imaging (MRI) for assessment of Crohn's disease (CD) is expanding. The aim of this study is to define and provide an external validation of the MRI predictors of active CD, severe CD, and a quantitative Magnetic Resonance Index of Activity (MaRIA).
In all, 48 patients with clinically active (n = 29) or inactive (n = 19) CD underwent ileocolonoscopy (reference standard) and MRI. T2-weighted and pre- and postcontrast-enhanced T1-weighted sequences were acquired. Endoscopic activity was evaluated by the Crohn's Disease Endoscopic Index of Severity (CDEIS), and also classified as absent, mild (inflammation without ulcers), or severe (presence of ulceration).
In complete agreement with a previous derivation study, independent predictors of disease severity using CDEIS as a reference were wall thickness, relative contrast enhancement (RCE), presence of edema, and ulcers on MRI. Estimation of activity in each segment using this regression model, or another with simplified coefficients (MaRIA(S) = 1.5wall thickness + 0.02RCE + 5edema + 10ulceration) correlated with CDEIS (r = 0.798, P< 0.001; r = 0.80 P < 0.001, respectively). In the validation cohort both indexes had a high and equal accuracy for diagnosis of active disease: receiver operator characteristic (ROC) area 0.93, sensitivity 0.87, specificity 0.87 using a cutoff point ≥ 7, and for diagnosis of severe disease: ROC area 0.96, sensitivity 0.92, specificity 0.92 using a cutoff point ≥ 11. The total of segment values (MaRIA(T)) correlated with global CDEIS (r = 0.83, P< 0.001).
The MRI variables that should be evaluated in clinical practice to diagnose active CD and severe CD are validated, as well as the quantitative index of activity for use in research studies.
磁共振成像（MRI）在评估克罗恩病（CD）中的应用正在不断扩展。本研究旨在定义并验证 MRI 预测 CD 活动性、重度 CD 以及定量磁共振活动指数（MaRIA）的方法。
共 48 例活动性（n = 29）或非活动性（n = 19）CD 患者接受了回结肠镜检查（参考标准）和 MRI 检查。采集 T2 加权和对比增强前后 T1 加权序列。通过克罗恩病内镜严重指数（CDEIS）评估内镜活动度，并分为无活动（无溃疡炎症）、轻度（存在炎症无溃疡）或重度（存在溃疡）。
与先前的推导研究完全一致，使用 CDEIS 作为参考，MRI 预测疾病严重程度的独立预测因子为壁厚度、相对对比增强（RCE）、水肿和溃疡的存在。使用该回归模型或简化系数的另一种模型（MaRIA(S) = 1.5wall thickness + 0.02RCE + 5edema + 10ulceration）估计每个节段的活动度与 CDEIS 相关（r = 0.798，P<0.001；r = 0.80，P<0.001）。在验证队列中，两种指数对于诊断活动性疾病均具有较高且相等的准确性：接受者操作特征（ROC）曲线下面积 0.93，敏感性 0.87，特异性 0.87，截断点≥7，对于诊断重度疾病：ROC 曲线下面积 0.96，敏感性 0.92，特异性 0.92，截断点≥11。节段总值（MaRIA(T)）与全球 CDEIS 相关（r = 0.83，P<0.001）。
用于诊断活动性 CD 和重度 CD 的 MRI 变量以及用于研究的定量活动指数已得到验证。
