Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, Republic of Korea, 03722.
Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea.
Eur Radiol. 2023 May;33(5):3266-3275. doi: 10.1007/s00330-023-09501-7. Epub 2023 Mar 11.
To validate the modified simplified magnetic resonance index of activity (sMARIA) score using DWI on non-contrast magnetic resonance enterography (MRE) to evaluate active inflammation in patients with Crohn's disease (CD), compared to the original sMARIA scoring system, with and without contrast enhancement.
This retrospective study included 275 bowel segments from 55 CD patients who underwent ileocolonoscopy and MRE within a 2-week period. Two blinded radiologists evaluated original sMARIA on both conventional MRE (CE-sMARIA) and non-contrast MRE (T2-sMARIA). Modified sMARIA was then evaluated using non-contrast MRE, replacing ulcerations with DWI grades. Three scoring systems were compared for diagnostic accuracy of active inflammation, correlation with simple endoscopic score (SES)-CD, and interobserver reproducibility.
The AUC of modified sMARIA for detecting active inflammation (0.863, 95% confidence interval [0.803-0.923]) was significantly higher than T2-sMARIA (0.827 [0.773-0.881], p = 0.017), and comparable to CE-sMARIA (0.908 [0.857-0.959], p = 0.122). CE-sMARIA, T2-sMARIA, and modified sMARIA all showed moderate correlation with SES-CD (r = 0.795, 0.722, and 0.777, respectively). Interobserver reproducibility of diffusion restriction (κ, 0.686 [0.602-0.770]) was significantly better than ulcers on conventional MRE (κ, 0.382 [0.212-0.552]; p = 0.001) and T2-weighted image (κ, 0.312 [0.034-0.590]; p = 0.012).
Modified sMARIA using DWI can improve the diagnostic performance of sMARIA on non-contrast MRE, showing comparable performance to sMARIA using contrast-enhanced MRE.
• DWI can improve the diagnostic performance of non-contrast magnetic resonance enterography (MRE) for assessing active inflammation in patients with Crohn's disease. • Modified simplified magnetic resonance index of activity (sMARIA) using DWI grades in place of ulcers showed comparable diagnostic performance to sMARIA using conventional MRE with contrast-enhanced sequences.
通过对比增强磁共振肠造影术（CE-MRE）和非对比增强磁共振肠造影术（非增强 MRE），使用 DWI 验证改良简化磁共振活动指数（sMARIA）评分，评估克罗恩病（CD）患者的活动性炎症，与原始 sMARIA 评分系统相比，包括增强和非增强两种情况。
本回顾性研究纳入了 55 例 CD 患者的 275 个肠段，这些患者在 2 周内接受了结肠镜检查和 MRE 检查。两名盲法放射科医生分别在常规 MRE（CE-sMARIA）和非增强 MRE（T2-sMARIA）上评估原始 sMARIA。然后，使用非增强 MRE 替代溃疡的 DWI 分级来评估改良 sMARIA。比较三种评分系统在评估活动性炎症的诊断准确性、与简单内镜评分-CD（SES-CD）的相关性以及观察者间的可重复性。
改良 sMARIA 检测活动性炎症的 AUC（0.863，95%置信区间[0.803-0.923]）显著高于 T2-sMARIA（0.827 [0.773-0.881]，p=0.017），与 CE-sMARIA（0.908 [0.857-0.959]，p=0.122）相当。CE-sMARIA、T2-sMARIA 和改良 sMARIA 均与 SES-CD 呈中度相关（r=0.795、0.722 和 0.777）。扩散受限的观察者间重复性（κ，0.686 [0.602-0.770]）明显优于常规 MRE 上的溃疡（κ，0.382 [0.212-0.552]；p=0.001）和 T2 加权图像（κ，0.312 [0.034-0.590]；p=0.012）。
使用 DWI 改良 sMARIA 可提高非增强 MRE 评估 CD 患者活动性炎症的诊断性能，其表现与使用对比增强 MRE 的 sMARIA 相当。
• DWI 可提高非增强磁共振肠造影术（MRE）评估克罗恩病患者活动性炎症的诊断性能。
• 使用 DWI 分级替代溃疡的改良简化磁共振活动指数（sMARIA）与使用增强序列的常规 MRE 相比，具有相当的诊断性能。
