Gastroenterology

Gastroenterology

Volume 157, Issue 2, August 2019, Pages 432-439.e1
Gastroenterology

Original Research
Full Report: Clinical—Alimentary Tract
Development and Validation of a Simplified Magnetic Resonance Index of Activity for Crohn’s Disease

https://doi.org/10.1053/j.gastro.2019.03.051Get rights and content

Background & Aims

The magnetic resonance index of activity (MARIA) for Crohn’s disease (CD) is used to assess the activity of luminal CD. However, it has a number of practical limitations. We aimed to develop and validate a simplified MARIA to more easily and quickly assess CD activity and response to therapy.

Patients and methods

We performed a retrospective analysis of magnetic resonance imaging data from 98 participants in 2 studies. We used logistic regression analysis to identify magnetic resonance imaging parameters independently associated with CD endoscopic index of severity (CDEIS) scores (the reference standard). We validated the responsiveness and reliability of the simplified MARIA in an independent cohort of 37 patients who underwent magnetic resonance imaging and endoscopy before and after a therapeutic intervention.

Results

Logistic regression analysis showed that dichotomous qualitative assessment of wall thickening (>3 mm), presence of mural edema, perienteric fat stranding, and ulcers were independently associated with CDEIS scores; we used these factors to create a simplified MARIA. Simplified MARIA scores greater than 1 identified segments with active CD with 90% sensitivity and 81% specificity (area under the curve 0.91; 95% confidence interval 0.88–0.94). Simplified MARIA scores of 2 or more detected severe lesions (ulcers) with 85% sensitivity and 92% specificity (area under the curve 0.94; 95% confidence interval 0.91–0.96). For each patient, there was a high level of correlation between simplified MARIA scores and CDEIS scores (r = 0.83) and simplified MARIA scores and original MARIA scores (and r = 0.93) (P < .001). The simplified MARIA score accurately detected changes in lesion severity in response to therapy and was as reliable as endoscopy for the assessment of mucosal healing.

Conclusion

We developed and validated a simplified MARIA for easier and faster assessment of CD activity and severity. This index identifies patients with a response to therapy with a high level of accuracy. These findings require confirmation in independent, multireader studies.

Section snippets

Patients and Examinations

MR data from 98 patients with an established diagnosis of CD, with or without clinical symptoms of activity, from 2 prospective studies were reanalyzed. Endoscopic and MR examinations of these 2 series were used to develop the MARIAs using endoscopy (CD endoscopic index of severity [CDEIS]) as reference standard.7, 11 All patients underwent both examinations within 2 days. Further analysis of responsiveness and reliability of the resulting simplified index was performed using an independent

Derivation of the MARIAs

For derivation of the MARIAs, data from 98 MRs of patients with CD were analyzed, representing a total of 588 segments, of which 495 were evaluated by both MR and endoscopy (terminal ileum n = 96, colonic segments = 399). Of these, 210 segments were categorized as having active disease by endoscopy (42.3%), of which 65 had mild-moderate activity (13.1%) and 145 (29.1%) had severe lesions (ulcers).

Prevalence of segmental qualitative MR findings according to endoscopic severity of lesions is

Discussion

The MARIA is one of the best characterized MR-based indices for assessing disease activity and grading severity in patients with CD and has been proposed as a tool for monitoring disease activity in clinical practice and clinical trials. The index has proven to have a substantial intra- and interrater reliability,23 but calculation of the index requires training, and measuring some components is time-consuming, in particular RCE, which requires measurements in 3 regions of interest in each

Acknowledgments

Author contributions: Ingrid Ordás: study design and study coordination, acquisition of endoscopic data, statistical analysis and interpretation of data, manuscript writing, critical revision and approval of the final draft submitted; Jordi Rimola: acquisition of data, interpretation of magnetic resonance imaging procedures, revision of the manuscript, and approval of the final draft submitted; Ignacio Alfaro: acquisition of data and approval of the final draft submitted; Sonia Rodríguez:

References (34)

  • H.A. Siddiki et al.

    Prospective comparison of state-of-the-art MR enterography and CT enterography in small-bowel Crohn's disease

    AJR Am J Roentgenol

    (2009)
  • J. Rimola et al.

    Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn's disease

    Gut

    (2009)
  • G. Fiorino et al.

    Prospective comparison of computed tomography enterography and magnetic resonance enterography for assessment of disease activity and complications in ileocolonic Crohn's disease

    Inflamm Bowel Dis

    (2011)
  • J. Rimola et al.

    Magnetic resonance imaging for evaluation of Crohn's disease: validation of parameters of severity and quantitative index of activity

    Inflamm Bowel Dis

    (2011)
  • A.J. Coimbra et al.

    Magnetic resonance enterography is feasible and reliable in multicenter clinical trials in patients with Crohn's disease, and may help select subjects with active inflammation

    Aliment Pharmacol Ther

    (2016)
  • A. Buisson et al.

    Diffusion-weighted magnetic resonance imaging for detecting and assessing ileal inflammation in Crohn's disease

    Aliment Pharmacol Ther

    (2013)
  • C. Hordonneau et al.

    Diffusion-weighted magnetic resonance imaging in ileocolonic Crohn's disease: validation of quantitative index of activity

    Am J Gastroenterol

    (2014)
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    Conflicts of interest The authors disclose the following: I.O. has received consulting fees from AbbVie, unrestricted research grants from Faes Pharma and AbbVie; J.R. has received consulting fees from Robarts Clinical Trials, TiGenix, and Takeda, unrestricted research grants from AbbVie and Genentech; E.R. has received consulting fees from AbbVie, MSD, Jansen, and Takeda; J.P. has received consulting fees from AbbVie, Arena, Boehringer Ingelheim, Celgene, GoodGut, GSK, Janssen, MSD, Nestlé, Oppilan, Pfizer, Takeda, Theravance, and TiGenix, and unrestricted research grants from AbbVie and MSD. The remaining authors disclose no conflicts.

    Funding This work was supported by unrestricted grants from Fondos de Investigación Sanitaria (FIS), Instituto de Salud Carlos III (PI07/90253 and PI10/01170), ECCO Grant 15/173, GETECCU Faes Farma, and AbbVie Laboratories.

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