title: Evaluation of Crohn's disease activity: initial validation of a magnetic resonance enterography global score (MEGS) against faecal calprotectin.
abstract: OBJECTIVE
  To develop an MRI enterography global score (MEGS) of Crohn's disease (CD) activity compared with a reference standard of faecal calprotectin (fC), C-reactive protein (CRP) and Harvey-Bradshaw index (HBI).
  
  
  METHODS
  Calprotectin, CRP and HBI were prospectively recorded for 71 patients (median age 33, male 35) with known/suspected CD undergoing MRI enterography. Two observers in consensus scored activity for nine bowel segments, grading mural thickness, T2 signal, mesenteric oedema, T1 enhancement and pattern, and haustral loss. Segmental scores were multiplied according to disease length. Five points each were added for lymphadenopathy, comb sign, fistulae and abscesses to derive the MEGS. A previously validated MRI CD activity score (CDAS) was also calculated. MRI scores were correlated with clinical references using Spearman's rank. A logistic regression diagnostic model was built to discriminate active (fC > 100 μg/g) from inactive disease.
  
  
  RESULTS
  MEGS and CDAS were significantly correlated with fC (r = 0.46, P < 0.001) and (r = 0.39, P = 0.001) respectively. MEGS correlated with CRP (r = 0.39, P = 0.002). The model for discriminating active from inactive disease achieved an area under the receiver-operating curve of 0.75 and 0.66 after leave-one-out analysis.
  
  
  CONCLUSIONS
  A magnetic resonance enterography global score (MEGS) of CD activity correlated significantly with fC levels.
  
  
  CONCLUSIONS
  • Magnetic resonance imaging is now widely used to assess Crohn's disease. • Existing MRI activity scores depend on local segmental endoscopic/histological reference standards. • Scores including assessment of disease extent/complications better demonstrate full disease burden. • This new global Crohn's disease burden score correlates with calprotectin and CRP. • The MRI enterography score of disease activity can complement existing clinical markers.
authors.affiliation: Centre for Medical Imaging, University College London, London, UK.
authors.forename: Jesica C
authors.initials: JC
authors.lastname: Makanyanga
authors.forename: Doug
authors.initials: D
authors.lastname: Pendsé
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Dikaios
authors.forename: Stuart
authors.initials: S
authors.lastname: Bloom
authors.forename: Sara
authors.initials: S
authors.lastname: McCartney
authors.forename: Emma
authors.initials: E
authors.lastname: Helbren
authors.forename: Elaine
authors.initials: E
authors.lastname: Atkins
authors.forename: Terry
authors.initials: T
authors.lastname: Cuthbertson
authors.forename: Shonit
authors.initials: S
authors.lastname: Punwani
authors.forename: Alastair
authors.initials: A
authors.lastname: Forbes
authors.forename: Steve
authors.initials: S
authors.lastname: Halligan
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Taylor
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D003106:Colon / Q000473:pathology*; D003424:Crohn Disease / Q000175:diagnosis* / Q000378:metabolism; D005243:Feces / Q000737:chemistry; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000473:pathology*; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex
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