title: Accuracy of magnetic resonance enterography in assessing response to therapy and mucosal healing in patients with Crohn's disease.
abstract: OBJECTIVE
  We assessed the accuracy of magnetic resonance enterography (MRE) in monitoring response to therapy in patients with Crohn's disease (CD) using ileocolonoscopy as a reference standard.
  
  
  METHODS
  We performed a prospective multicenter study of 48 patients with active CD and ulcers in at least one ileocolonic segment. All patients underwent ileocolonoscopy and MRE at baseline and 12 weeks after completing treatment with corticosteroids (CS) or anti-tumor necrosis factor agents. Disease activity was quantified using Crohn's Disease Endoscopic Index of Severity (CDEIS) and Magnetic Resonance Index of Activity (MaRIA). The primary analysis was to determine the accuracy of MRE in identification of healing, defined as the disappearance of ulcers in endoscopy examination. Additional analyses established the accuracy of MRE in determining endoscopic remission (a CDEIS score <3.5) and change in severity based on consideration of all segments.
  
  
  RESULTS
  MRE determined ulcer healing with 90% accuracy and endoscopic remission with 83% accuracy. The mean CDEIS and MaRIA scores significantly changed at week 12 in segments with ulcer healing, based on endoscopic examination (CDEIS: 21.28 ± 9.10 at baseline vs 2.73 ± 4.12 at 12 weeks; P < .001 and MaRIA: 18.86 ± 9.50 at baseline vs 8.73 ± 5.88 at 12 weeks; P < .001). The MaRIA score accurately detected changes in lesion severity (Guyatt score: 1.2 and standardized effect size: 1.07). MRE was as reliable as endoscopy in assessing healing; no significant changes in CDEIS or MaRIA scores were observed in segments with persistent ulcers, based on endoscopic examination (CDEIS: 26.43 ± 9.06 at baseline vs 20.77 ± 9.13 at 12 weeks; P = .18 and MaRIA: 22.13 ± 8.42 at baseline vs 20.77 ± 9.17 at 12 weeks; P = .42). The magnitude of change in CDEIS scores correlated with those in MaRIA scores (r = 0.51; P < .001).
  
  
  CONCLUSIONS
  MRE evaluates ulcer healing with a high level of accuracy when ileocolonoscopy is used as the reference standard. The MaRIA is a valid, responsive, and reliable index assessing response to therapy in patients with CD.
authors.affiliation: Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Ordás
authors.affiliation: Department of Radiology, Hospital Clinic of Barcelona, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rimola
authors.affiliation: Department of Radiology, Hospital Clinic of Barcelona, Barcelona, Spain.
authors.forename: Sonia
authors.initials: S
authors.lastname: Rodríguez
authors.affiliation: Department of Gastroenterology, Hospital Dr Peset, Valencia, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Paredes
authors.affiliation: Department of Radiology, Hospital Dr Peset, Valencia, Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: Martínez-Pérez
authors.affiliation: Department of Radiology, Hospital Dr Peset, Valencia, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Blanc
authors.affiliation: Department of Gastroenterology, Hospital Osakidetza, Galdakao, Spain.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Arévalo
authors.affiliation: Department of Radiology, Hospital Osakidetza, Galdakao, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Aduna
authors.affiliation: Department of Gastroenterology, Hospital del Mar, Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Andreu
authors.affiliation: Department of Radiology, Hospital del Mar, Barcelona, Spain.
authors.forename: Alexander
authors.initials: A
authors.lastname: Radosevic
authors.affiliation: Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Ramírez-Morros
authors.affiliation: Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Pinó
authors.affiliation: Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Gallego
authors.affiliation: Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
authors.forename: Aranzazu
authors.initials: A
authors.lastname: Jauregui-Amezaga
authors.affiliation: Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Ricart
authors.affiliation: Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain. Electronic address: jpanes@clinic.ub.es.
authors.forename: Julián
authors.initials: J
authors.lastname: Panés
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D003106:Colon / Q000473:pathology*; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy*; D004334:Drug Administration Schedule; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007082:Ileum / Q000473:pathology*; D060828:Induction Chemotherapy; D007413:Intestinal Mucosa / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D061067:Antibodies, Monoclonal, Humanized; D000068879:Adalimumab
keywords: C-reactive protein; CD; CDAI; CDEIS; CRP; CS; Crohn’s Disease Activity Index; Crohn’s Disease Endoscopic Index of Severity; Crohn’s disease; Inflammatory Bowel Diseases; MH; MRE; MaRIA; Magnetic Resonance Index of Activity; Measurement; Patient Management; TNF; corticosteroids; magnetic resonance enterography; mucosal healing; tumor necrosis factor