Department of Hepatogastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy.
Central Department of Radiology, Nancy University Hospital, Vandoeuvre-lès-Nancy.
Clin Gastroenterol Hepatol. 2022 May;20(5):e1040-e1049. doi: 10.1016/j.cgh.2021.06.035. Epub 2021 Jun 30.
BACKGROUND & AIMS: We developed and validated a magnetic resonance imaging-based index to predict Crohn's disease (CD) postoperative recurrence (POR).
Patients with CD who underwent a postoperative evaluation for recurrence (with colonoscopy and MRI no longer than 105 days apart) were included between 2006 and 2016 in University Hospital of Nancy, France. MRI items with good levels of intra-rater and inter-rater agreement (Gwet's coefficient ≥0.5) were selected. The MRI in Crohn's Disease to Predict Postoperative Recurrence (MONITOR) index's performance was assessed in terms of the area under the receiver operating characteristic curve (AUROC) and accuracy, by considering the Rutgeerts score as the gold standard. The MONITOR index was validated with a bootstrap method and an independent cohort.
Seventy-three MRI datasets were interpreted by 2 radiologists. Seven items (bowel wall thickness, contrast enhancement, T2 signal increase, diffusion-weighted signal increase, edema, ulcers, and the length of the diseased segment) had a Gwet's coefficient ≥0.5 and were significantly associated with the Rutgeerts score, leading to their inclusion in the MONITOR index. All the items had a weighting of 1, except the "ulcers" item weighting 2.5, reflecting the higher adjusted odds ratio. The AUROC [95% confidence interval] for the prediction of endoscopic POR (Rutgeerts score >i1) was 0.80 [0.70-0.90]. The optimal threshold was a MONITOR index ≥1, giving a sensitivity of 79%, a specificity of 55%, a predictive positive value of 68%, and a predictive negative value of 68%. The bootstrap validation gave an AUROC of 0.85 [0.73-0.97]. In the validation cohort, a MONITOR index ≥1 gave a sensitivity of 87%, a specificity of 75%, a predictive positive value of 84.6%, and a predictive negative value of 75%.
The MONITOR index is an efficient, reliable, easy-to-apply tool that can be used in clinical practice to predict the POR of CD.
我们开发并验证了一种基于磁共振成像的指数，用于预测克罗恩病（CD）术后复发（POR）。
纳入 2006 年至 2016 年期间在法国南锡大学医院接受术后复发评估（结肠镜检查和 MRI 检查时间不超过 105 天）的 CD 患者。选择具有良好的内部和外部观察者一致性（Gwet 系数≥0.5）的 MRI 项目。根据 Rutgeerts 评分作为金标准，评估磁共振成像克罗恩病术后复发预测（MONITOR）指数的表现，包括接收者操作特征曲线（AUROC）和准确性。通过 bootstrap 方法和独立队列对 MONITOR 指数进行验证。
两名放射科医生共解读了 73 份 MRI 数据集。7 项（肠壁厚度、对比增强、T2 信号增加、弥散加权信号增加、水肿、溃疡和病变段长度）具有 Gwet 系数≥0.5，与 Rutgeerts 评分显著相关，因此被纳入 MONITOR 指数。所有项目的权重均为 1，除了“溃疡”项目权重为 2.5，反映了更高的调整后比值比。内镜 POR（Rutgeerts 评分>i1）预测的 AUROC[95%置信区间]为 0.80[0.70-0.90]。最佳阈值为 MONITOR 指数≥1，灵敏度为 79%，特异性为 55%，阳性预测值为 68%，阴性预测值为 68%。bootstrap 验证的 AUROC 为 0.85[0.73-0.97]。在验证队列中，MONITOR 指数≥1 的灵敏度为 87%，特异性为 75%，阳性预测值为 84.6%，阴性预测值为 75%。
MONITOR 指数是一种高效、可靠、易于应用的工具，可用于临床实践中预测 CD 的 POR。
