title: Grading of Crohn's disease activity using CT, MRI, US and scintigraphy: a meta-analysis.
abstract: OBJECTIVE
  To assess the grading of Crohn's disease activity using CT, MRI, US and scintigraphy.
  
  
  METHODS
  MEDLINE, EMBASE and Cochrane databases were searched (January 1983-March 2014) for studies evaluating CT, MRI, US and scintigraphy in grading Crohn's disease activity compared to endoscopy, biopsies or intraoperative findings. Two independent reviewers assessed the data. Three-by-three tables (none, mild, frank disease) were constructed for all studies, and estimates of accurate, over- and under-grading were calculated/summarized by fixed or random effects models.
  
  
  RESULTS
  Our search yielded 9356 articles, 19 of which were included. Per-patient data showed accurate grading values for CT, MRI, US and scintigraphy of 86% (95% CI: 75-93%), 84% (95% CI: 67-93%), 44% (95% CI: 28-61%) and 40% (95% CI: 16-70%), respectively. In the per-patient analysis, CT and MRI showed similar accurate grading estimates (P = 0.8). Per-segment data showed accurate grading values for CT and scintigraphy of 87% (95% CI: 77-93%) and 86% (95% CI: 80-91%), respectively. MRI and US showed grading accuracies of 67-82% and 56-75%, respectively.
  
  
  CONCLUSIONS
  CT and MRI showed comparable high accurate grading estimates in the per-patient analysis. Results for US and scintigraphy were inconsistent, and limited data were available.
  
  
  CONCLUSIONS
  • CT and MRI have comparable high accuracy in grading Crohn's disease. • Data on US and scintigraphy is inconsistent and limited. • MRI is preferable over CT as it lacks ionizing radiation exposure.
authors.affiliation: Academic Medical Center, Department of Radiology, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, The Netherlands. c.a.puylaert@amc.uva.nl.
authors.forename: C A J
authors.initials: CA
authors.lastname: Puylaert
authors.affiliation: Academic Medical Center, Department of Radiology, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, The Netherlands.
authors.forename: J A W
authors.initials: JA
authors.lastname: Tielbeek
authors.affiliation: Academic Medical Center, Department of Radiology, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Bipat
authors.affiliation: Academic Medical Center, Department of Radiology, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Stoker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003424:Crohn Disease / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D012015:Reference Standards; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D055815:Young Adult
keywords: Crohn’s disease; Magnetic resonance imaging; Radionuclide imaging; Ultrasound; X-ray computed tomography