MRI scoring system including dynamic motility evaluation in assessing the activity of Crohn's disease of the terminal ileum.
OBJECTIVE
We sought to investigate the value of a MRI scoring system including dynamic motility evaluation in the assessment of small bowel Crohn's disease activity.


METHODS
From March 2005 to December 2006, 52 patients with suspected Crohn's disease onset or relapse underwent MRI on a 1.5-T magnet. Bowel distention was achieved orally assuming a mean of 1.6 L of a polyethyleneglycol (PEG) preparation. Per-patient assessment of disease activity was based on a scoring system including evaluation of morphology and motility of the small bowel and perivisceral structures (true-FISP, cine-true-FISP, and HASTE T2W sequences) and dynamic assessment of parietal contrast enhancement (FLASH T1W sequence). Patients were included in three categories, using endoscopic biopsy as the standard reference: no activity/quiescent disease, mild activity, or moderate-to-severe activity. Patients without terminal ileum involvement were excluded from data analysis.


RESULTS
MRI allowed a detailed and panoramic evaluation of the small bowel in all subjects examined. MRI properly assessed 14 of 16 (87.5%) cases of no activity/quiescent disease, 12 of 14 (85.7%) cases of mild activity, and 15 of 15 (100%) cases of severe activity. Overall, activity score led to a per-patient misdiagnosis of disease activity in a nonsignificant proportion of subjects (4 of 45; 8.8%) (P > .05), determining two false-positive and two false-negative results of mild disease activity. Sensitivity, specificity, PPV, NPV, and overall accuracy in assessing disease activity were 93.1%, 87.5%, 93.1%, 87.5%, and 91.1%, respectively.


CONCLUSIONS
Accurate assessment of Crohn's disease activity is achieved by using an activity score providing an overall interpretation of MRI findings.
Girometti
Rossano
R
Institute of Radiology, University of Udine, via Colugna n. 50, 33100 Udine, Italy. rgirometti@sirm.org
Zuiani
Chiara
C
Toso
Francesco
F
Brondani
Giovanni
G
Sorrentino
Dario
D
Avellini
Claudio
C
Bazzocchi
Massimo
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D003287:Contrast Media; D003424:Crohn Disease / Q000503:physiopathology*; D005260:Female; D019786:Gadolinium DTPA; D005769:Gastrointestinal Motility / Q000502:physiology*; D006801:Humans; D007082:Ileum / Q000503:physiopathology*; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
D003287:Contrast Media; D011092:Polyethylene Glycols; D019786:Gadolinium DTPA