title: Comparison of Diagnostic Accuracy and Impact of Magnetic Resonance Imaging and Colonoscopy for the Management of Crohn's Disease.
abstract: OBJECTIVE
  The objective of the current study was to compare two patient assessment strategies using colonoscopy and MRI alternatively as first- and second-line examinations.
  
  
  METHODS
  Clinical data, endoscopy and magnetic resonance imaging (MRI) examinations of 100 patients diagnosed with ileocolonic Crohn's disease (CD) performed within 1 week were blindly reviewed by 4 clinical investigators. Two investigators evaluated MRI followed by colonoscopy for 50 cases and the same examinations in reverse order for another 50 cases; the other 2 investigators evaluated the same cases switching the order of examinations. The assessments included the likelihood of the presence of inflammation, stenosis, fistula and abscess, and therapeutic recommendations.
  
  
  RESULTS
  Information from the first examination was considered sufficient for management in 80% of cases for MRI and only 34% of cases for colonoscopy (p < 0.001). Adding MRI to the information from colonoscopy changed the clinicians' confidence grade in a higher proportion of patients than adding colonoscopy to information from MRI for the diagnosis of disease activity (10 vs 4%, p = 0.03), stenosis (25 vs 9%, p < 0.001), fistula (31 vs 0%, p < 0.001) and internal abscess (27 vs 0%, p < 0.001). Indications for anti-tumour necrosis factor (TNF) therapy (51 vs 37%, F = 0.006), and surgery (12 vs 5%, F = 0.019) were more frequent after MRI than after colonoscopy as first examination. As a second examination, MRI led to change in therapy in a higher proportion of patients than colonoscopy (28 vs 8%, p < 0.001).
  
  
  CONCLUSIONS
  In CD, information provided by MRI has a higher impact on patient management than colonoscopy and may be considered as a first-line examination for CD assessment.
authors.affiliation: Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain Department of Digestive Diseases, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain.
authors.forename: O
authors.initials: O
authors.lastname: García-Bosch
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: I
authors.initials: I
authors.lastname: Ordás
authors.affiliation: Department of Digestive Diseases, Hospital Universitari Mútua de Terrassa, Terrassa, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Aceituno
authors.affiliation: Department of Radiology, Hospital Clinic of Barcelona, Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Rodríguez
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: A M
authors.initials: AM
authors.lastname: Ramírez
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: M
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: E
authors.initials: E
authors.lastname: Ricart
authors.affiliation: Department of Radiology, Hospital Clinic of Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Rimola
authors.affiliation: Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain jpanes@clinic.ub.es.
authors.forename: J
authors.initials: J
authors.lastname: Panes
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000066491:Clinical Decision-Making; D003113:Colonoscopy; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D016037:Single-Blind Method
chemical_list: D000893:Anti-Inflammatory Agents
keywords: Crohn’s disease; disease management; magnetic resonance imaging