Magnetic resonance imaging compared with ileocolonoscopy in evaluating disease severity in Crohn's disease.
OBJECTIVE
Abdominal magnetic resonance imaging (MRI) has shown promising results in the detection of Crohn's disease (CD)-related lesions. The purpose of this study was to assess the value of MRI in measuring disease activity in CD patients in comparison with ileocolonoscopy.


METHODS
Thirty-one patients undergoing ileocolonoscopy because of suspicion of relapsing CD underwent MRI with water as intraluminal contrast medium. At endoscopy, disease severity was graded (4-point scale), and Crohn's Disease Endoscopic Index of Severity (CDEIS) was determined. Two radiologists independently interpreted the MRI scans. Radiologic grading (4-point scale) was compared with endoscopic grading of disease severity and CDEIS (overall, for all segments). Wall thickness and enhancement were compared with CDEIS. Patient experience and preference were determined.


RESULTS
In, respectively, 14 and 14 patients (radiologist 1) and 16 and 11 patients (radiologist 2) an exact match or 1 level of difference in grading was scored with the endoscopist. Correlation between severity rated at MRI and CDEIS was moderate to strong with r = 0.61 (P < .001) for observer 1 and r = 0.63 (P < .001) for observer 2. Per segment, best correlation was seen in the terminal ileum (r = 0.63; P < .001, for both observers). Wall thickness correlated moderately to strongly with CDEIS (r = 0.57, P < .001 and r = 0.50, P < .001 for observers 1 and 2), whereas enhancement correlated weakly to moderately (r = 0.45, P < .001 and r = 0.42, P < .001). Patients experienced more pain during endoscopy, and all patients except 2 preferred MRI to endoscopy.


CONCLUSIONS
MRI can correctly identify disease severity in patients with CD and is a patient-friendly alternative to ileocolonoscopy.
Florie
Jasper
J
Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands. j.florie@amc.uva.nl
Horsthuis
Karin
K
Hommes
Daniel W
DW
Nio
C Yung
CY
Reitsma
Johannes B
JB
van Deventer
Sander J
SJ
Stoker
Jaap
J
D000293:Adolescent; D000328:Adult; D003113:Colonoscopy / Q000379:methods*; D003424:Crohn Disease / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires