Connecticut Children's Medical Center, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Hartford; University of Connecticut School of Medicine, Department of Pediatrics, Farmington.
Connecticut Children's Medical Center, Division of Pediatric Radiology.
J Pediatr Gastroenterol Nutr. 2022 May 1;74(5):610-616. doi: 10.1097/MPG.0000000000003412.
Ileocolonoscopy (IC) detects mucosal inflammation and magnetic resonance enterography (MRE) detects transmural inflammation in Crohn disease (CD). We aimed to evaluate the relationship between the simplified magnetic resonance index of activity (MARIAs) and measures of inflammation by IC in children with newly diagnosed CD.
Retrospective review of 140 patients 6-18 years of age with CD who had baseline IC and MRE within 5 weeks of diagnosis. MARIAs was calculated for each intestinal segment (terminal ileum [TI], ascending colon, transverse colon, descending colon, sigmoid colon, rectum), defined as (1 × thickness > 3 mm) + (1 × edema) + (1 × fat stranding) + (2 × ulcers). Sensitivity and specificity were derived using receiver operating characteristic (ROC) curves to compare MARIAs to IC findings.
Using IC as the reference standard, the cutoff MARIAs ≥1 identified TI segments with active inflammation with 84% sensitivity, 73% specificity, 85% positive predictive value (PPV), 70% negative predictive value (NPV), and area under the curve (AUC) 0.782 (95% confidence interval [CI] 0.689-0.876). The cutoff MARIAs ≥2 identified TI segments with severe lesions with 87% sensitivity, 76% specificity, 87% PPV, 76% NPV, and AUC 0.814 (95% CI 0.712-0.916). There was poor sensitivity for all colonic segments.
The MARIAs is feasible and accurate in reflecting disease activity in the TI, but not in the colon, in children with newly diagnosed CD. Although the MARIAs may be useful for monitoring TI disease activity over time, full assessment continues to require both IC and MRE.
回肠结肠镜检查（IC）可检测黏膜炎症，磁共振肠造影术（MRE）可检测克罗恩病（CD）的肠壁炎症。我们旨在评估新诊断为 CD 的儿童中简化的磁共振活动指数（MARIAs）与 IC 炎症指标之间的关系。
回顾性分析了 140 名 6-18 岁的 CD 患者，这些患者在确诊后 5 周内进行了基线 IC 和 MRE。MARIAs 为每个肠段（末端回肠 [TI]、升结肠、横结肠、降结肠、乙状结肠、直肠）计算，定义为（1×厚度>3mm）+（1×水肿）+（1×脂肪纹理）+（2×溃疡）。使用受试者工作特征（ROC）曲线比较 MARIAs 与 IC 结果，得出敏感性和特异性。
以 IC 为参考标准，MARIAs≥1 可识别出 TI 段有活动性炎症，其敏感性为 84%，特异性为 73%，阳性预测值（PPV）为 85%，阴性预测值（NPV）为 70%，曲线下面积（AUC）为 0.782（95%置信区间 [CI] 0.689-0.876）。MARIAs≥2 可识别出 TI 段有严重病变，其敏感性为 87%，特异性为 76%，PPV 为 87%，NPV 为 76%，AUC 为 0.814（95%CI 0.712-0.916）。所有结肠段的敏感性均较低。
MARIAs 可用于反映新诊断为 CD 的儿童 TI 段的疾病活动度，但其在结肠段的应用效果不佳。尽管 MARIAs 可能有助于监测 TI 疾病活动度随时间的变化，但仍需要同时进行 IC 和 MRE 检查。
