Diagnostic performance of magnetic resonance enterography disease activity indices compared with a histological reference standard for adult terminal ileal Crohn’s disease: experience from the METRIC trial

<p><strong>Background and Aims:</strong> The simplified magnetic resonance enterography [MRE] index of activity [sMARIA], London, and ‘extended’ London, scoring systems are widely used in Crohn’s disease [CD] to assess disease activity, although validation studies have usually been...

وصف كامل

التفاصيل البيبلوغرافية
المؤلفون الرئيسيون: Kumar, S, Parry, T, Mallett, S, Bhatnagar, G, Plumb, A, Walsh, S, Scott, N, Tandon, R, Chong, H, du Parcq, J, Martinez, A, Moorghen, M, Rodriguez-Justo, M, Halligan, S, Taylor, SA, Travis, S
مؤلفون آخرون: METRIC study investigators
التنسيق: Journal article
اللغة:English
منشور في: Oxford University Press 2022
الموضوعات:
الوصف
الملخص:<p><strong>Background and Aims:</strong> The simplified magnetic resonance enterography [MRE] index of activity [sMARIA], London, and ‘extended’ London, scoring systems are widely used in Crohn’s disease [CD] to assess disease activity, although validation studies have usually been single-centre, retrospective, and/or used few readers. Here, we evaluated these MRE indices within a prospective, multicentre, multireader, diagnostic accuracy trial.</p> <p><strong>Methods:</strong> A subset of participants [newly diagnosed or suspected of relapse] recruited to the METRIC trial with available terminal ileal [TI] biopsies was included. Using pre-specified thresholds, the sensitivity and specificity of sMARIA, London, and ‘extended’ London scores for active and severe [sMARIA] TI CD were calculated using different thresholds for the histological activity index [HAI].</p> <p><strong>Results:</strong> We studied 111 patients [median age 29 years, interquartile range 21-41, 75 newly diagnosed, 36 suspected relapse] from seven centres, of whom 22 had no active TI CD [HAI = 0], 39 mild [HAI = 1], 13 moderate [HAI = 2], and 37 severe CD activity [HAI = 3]. In total, 26 radiologists prospectively scored MRE datasets as per their usual clinical practice. Sensitivity and specificity for active disease [HAI >0] were 83% [95% confidence interval 74% to 90%] and 41% [23% to 61%] for sMARIA, 76% [67% to 84%] and 64% [43% to 80%] for the London score, and 81% [72% to 88%] and 41% [23% to 61%] for the ‘extended’ London score, respectively. The sMARIA had 84% [69-92%] sensitivity and 53% [41-64%] specificity for severe CD.</p> <p><strong>Conclusions:</strong> When tested at their proposed cut-offs in a real-world setting, sMARIA, London, and ‘extended’ London indices achieve high sensitivity for active TI disease against a histological reference standard, but specificity is low.</p>