1 Department of Diagnostic Radiology, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
2 Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan.
AJR Am J Roentgenol. 2019 Jan;212(1):67-76. doi: 10.2214/AJR.17.18897. Epub 2018 Nov 13.
The objectives of our study were to establish the efficacy of a 5-point MR enterocolonography classification for assessing Crohn disease (CD) activity, compare this classification with a validated MRI score (i.e., the MR index of activity [MaRIA]), and compare both with endoscopic findings, which were assessed using the Crohn disease endoscopic index of severity (CDEIS).
Seventy (derivation cohort) and 50 (validation cohort) patients with CD were retrospectively enrolled in this study. We developed a 5-point MR enterocolonography classification that consists of visual assessments alone. MR enterocolonography results were evaluated for each bowel segment (rectum; sigmoid, descending, transverse, and ascending colon; terminal and proximal ileum; and jejunum) by one observer in the derivation phase and independently by three observers in the validation phase using the 5-point MR enterocolonography classification lexicon and MaRIA. Areas under the ROC curves (AUCs) in discriminating endoscopic deep ulcers were compared between the MR enterocolonography classification and MaRIA. Interobserver reproducibility was assessed using weighted kappa coefficients.
The AUCs of the MR enterocolonography classification were 89.0% in the derivation phase and 88.5%, 81.0%, and 77.3% for the three observers in the validation phase. The AUCs of the MR enterocolonography classification were statistically noninferior to those of MaRIA (p < 0.001). The cross-validation accuracy was 81.9% in the derivation phase and 81.5% in the validation phase. The MR enterocolonography classification showed good reproducibility.
The 5-point MR enterocolonography classification was shown to be effective for evaluating CD activity in the large and small bowel.
本研究旨在建立一种 5 分法磁共振肠造影分类方法，以评估克罗恩病（CD）的活动度，并将其与一种经过验证的 MRI 评分（即活动指数磁共振评分[MaRIA]）进行比较，同时与内镜检查结果进行比较，内镜检查结果采用克罗恩病内镜严重程度指数（CDEIS）进行评估。
本研究回顾性纳入 70 例（推导队列）和 50 例（验证队列）CD 患者。我们开发了一种 5 分法磁共振肠造影分类方法，仅包含视觉评估。在推导阶段，由一名观察者对每个肠段（直肠、乙状结肠、降结肠、横结肠和升结肠、末端回肠和近端回肠、空肠）进行磁共振肠造影评估，在验证阶段，由三名观察者独立使用 5 分法磁共振肠造影分类词汇和 MaRIA 进行评估。比较磁共振肠造影分类和 MaRIA 在区分内镜下深溃疡方面的受试者工作特征曲线下面积（AUC）。采用加权 Kappa 系数评估观察者间的可重复性。
磁共振肠造影分类的 AUC 在推导阶段为 89.0%，在验证阶段，三名观察者的 AUC 分别为 88.5%、81.0%和 77.3%。磁共振肠造影分类的 AUC 在统计学上不劣于 MaRIA（p<0.001）。推导阶段的交叉验证准确率为 81.9%，验证阶段为 81.5%。磁共振肠造影分类具有良好的可重复性。
5 分法磁共振肠造影分类可有效评估小肠和大肠 CD 的活动度。
