IBD Unit, Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBER-EHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBER-EHD), Barcelona, Spain; IBD Unit, Radiology Department, Hospital Clinic of Barcelona, Barcelona, Spain.
Gastroenterology. 2019 Aug;157(2):432-439.e1. doi: 10.1053/j.gastro.2019.03.051. Epub 2019 Apr 3.
BACKGROUND & AIMS: The magnetic resonance index of activity (MARIA) for Crohn's disease (CD) is used to assess the activity of luminal CD. However, it has a number of practical limitations. We aimed to develop and validate a simplified MARIA to more easily and quickly assess CD activity and response to therapy.
We performed a retrospective analysis of magnetic resonance imaging data from 98 participants in 2 studies. We used logistic regression analysis to identify magnetic resonance imaging parameters independently associated with CD endoscopic index of severity (CDEIS) scores (the reference standard). We validated the responsiveness and reliability of the simplified MARIA in an independent cohort of 37 patients who underwent magnetic resonance imaging and endoscopy before and after a therapeutic intervention.
Logistic regression analysis showed that dichotomous qualitative assessment of wall thickening (>3 mm), presence of mural edema, perienteric fat stranding, and ulcers were independently associated with CDEIS scores; we used these factors to create a simplified MARIA. Simplified MARIA scores greater than 1 identified segments with active CD with 90% sensitivity and 81% specificity (area under the curve 0.91; 95% confidence interval 0.88-0.94). Simplified MARIA scores of 2 or more detected severe lesions (ulcers) with 85% sensitivity and 92% specificity (area under the curve 0.94; 95% confidence interval 0.91-0.96). For each patient, there was a high level of correlation between simplified MARIA scores and CDEIS scores (r = 0.83) and simplified MARIA scores and original MARIA scores (and r = 0.93) (P < .001). The simplified MARIA score accurately detected changes in lesion severity in response to therapy and was as reliable as endoscopy for the assessment of mucosal healing.
We developed and validated a simplified MARIA for easier and faster assessment of CD activity and severity. This index identifies patients with a response to therapy with a high level of accuracy. These findings require confirmation in independent, multireader studies.
磁共振活动指数（MARIA）用于评估腔内腔克罗恩病（CD）的活动度，但它存在许多实际限制。我们旨在开发和验证一种简化的 MARIA，以便更轻松、更快速地评估 CD 活动度和对治疗的反应。
我们对两项研究中的 98 名参与者的磁共振成像数据进行了回顾性分析。我们使用逻辑回归分析来确定与 CD 内镜严重程度指数（CDEIS）评分（参考标准）独立相关的磁共振成像参数。我们在接受治疗干预前后进行磁共振成像和内镜检查的 37 名患者的独立队列中验证了简化 MARIA 的反应性和可靠性。
逻辑回归分析显示，壁增厚（>3 毫米）、壁水肿、周围脂肪纹理和溃疡的二分定性评估与 CDEIS 评分独立相关；我们使用这些因素创建了简化 MARIA。简化 MARIA 评分大于 1 可识别出 90%敏感性和 81%特异性的活动期 CD 节段（曲线下面积 0.91；95%置信区间 0.88-0.94）。简化 MARIA 评分 2 或更高可检测到 85%敏感性和 92%特异性的严重病变（溃疡）（曲线下面积 0.94；95%置信区间 0.91-0.96）。对于每个患者，简化 MARIA 评分与 CDEIS 评分（r=0.83）和简化 MARIA 评分与原始 MARIA 评分（r=0.93）之间存在高度相关性（P<.001）。简化 MARIA 评分可准确检测到治疗反应中病变严重程度的变化，其评估黏膜愈合的可靠性与内镜相当。
我们开发并验证了一种简化的 MARIA，用于更轻松、更快速地评估 CD 活动度和严重程度。该指数以较高的准确性识别出对治疗有反应的患者。这些发现需要在独立的多读者研究中得到证实。
