title: Assessment of activity of Crohn's disease of the ileum and large bowel: proposal for a new multiparameter MR enterography score.
abstract: OBJECTIVE
  We evaluated the diagnostic accuracy of magnetic resonance enterography (MR-E) in assessing Crohn's disease (CD) activity by differentiating acute, chronic and remission stages of disease through a quantitative MR-E assessment.
  
  
  METHODS
  One hundred patients with a histological diagnosis of CD were studied with MR-E. Intestinal distension was obtained by oral administration of approximately 2 L of a polyethylene glycol solution (PEG). In all cases, the ileum and large bowel were imaged with morphological sequences (heavily T2-weighted single-shot, dual fast-field echo, balanced fast-field echo) and a postcontrast dynamic sequence (T1-weighted high-resolution isotropic volume excitation). Disease activity was assessed according to a multiparameter score (0-8) based on lesion morphology, signal intensity and contrast enhancement. MR-E findings were compared with clinical-laboratory data and disease activity indices [Crohn's Disease Activity Index (CDAI); Inflammatory Bowel Disease Questionnaire (IBDQ)]. Multiple regression analysis was performed by correlating MR-E score, CDAI and IBDQ. Frequencies were then compared using the χ (2) test.
  
  
  RESULTS
  MR-E identified inactive disease in 9% of cases, chronic disease in 57% and active disease in the remaining 34%. The most frequently involved bowel segment was the terminal ileum (52%). A statistically significant correlation was found between MR-E score and CDAI (R=0.86; p<0.001) and between MR-E score and IBDQ (R=-0.83; p<0.001). The most suggestive parameter for disease activity was layered bowel-wall enhancement, a finding predominantly present in patients with increased CDAI (≥ 150) and/or local complications (χ (2)=7.13; p<0.01).
  
  
  CONCLUSIONS
  MR-E is a noninvasive and diagnostic imaging modality for CD study and follow-up. The MR-E score proposed in this study proved to be useful in assessing disease severity and monitoring response to treatment.
authors: Department of Diagnostic Imaging, University of Foggia, Viale Luigi Pinto 1, 71100, Foggia, Italy.
authors: L
authors: L
authors: Macarini
authors: L P
authors: LP
authors: Stoppino
authors: A
authors: A
authors: Centola
authors: S
authors: S
authors: Muscarella
authors: F
authors: F
authors: Fortunato
authors: F
authors: F
authors: Coppolino
authors: N
authors: N
authors: Della Valle
authors: V
authors: V
authors: Ierardi
authors: P
authors: P
authors: Milillo
authors: R
authors: R
authors: Vinci
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003287:Contrast Media; D003424:Crohn Disease / Q000473:pathology*; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007077:Ileal Diseases / Q000473:pathology*; D007420:Intestine, Large / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA