Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2019; 25(31): 4555-4566
Published online Aug 21, 2019. doi: 10.3748/wjg.v25.i31.4555
Layered enhancement at magnetic resonance enterography in inflammatory bowel disease: A meta-analysis
Davide Bellini, Flaminia Rivosecchi, Nicola Panvini, Marco Rengo, Damiano Caruso, Iacopo Carbone, Riccardo Ferrari, Pasquale Paolantonio, Andrea Laghi
Davide Bellini, Flaminia Rivosecchi, Nicola Panvini, Marco Rengo, Iacopo Carbone, Department of Radiological Sciences, Oncology and Pathology, "Sapienza" University of Rome, I.C.O.T. Hospital, Latina 04100, Italy
Damiano Caruso, Andrea Laghi, Department of Surgical and Medical Sciences and Translational Medicine, “Sapienza”-University of Rome, Sant'Andrea University Hospital, AOU Sant’Andrea, Rome 00189, Italy
Riccardo Ferrari, Department of Emergency Radiology, San Camillo-Forlanini Hospital, Rome 00152, Italy
Pasquale Paolantonio, Department of Radiology, San Giovanni Hospital, Rome 00184, Italy
Author contributions: Bellini D conception and design of the study, acquisition of data, analysis and interpretation of data, drafting the article, critical revision, final approval; Rivosecchi F acquisition of data, analysis and interpretation of data, drafting the article, revising the article, final approval; Panvini N acquisition of data, analysis and interpretation of data, drafting the article, revising the article, final approval; Rengo M analysis and interpretation of data, revising the article, final approval; Caruso D analysis and interpretation of data, revising the article, final approval; Carbone I analysis and interpretation of data, revising the article, final approval; Ferrari R interpretation of data, revising the article, final approval; Paolantonio P interpretation of data, revising the article, final approval; Laghi A conception and design of the study, analysis and interpretation of data, critical revision, final approval.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Andrea Laghi, MD, Full Professor of Radiology, Department of Surgical and Medical Sciences and Translational Medicine, “Sapienza”-University of Rome, Sant'Andrea University Hospital, AOU Sant’Andrea, Via di Grottarossa, 1035-1039, Rome 00189, Italy. andrea.laghi@uniroma1.it
Telephone: +39-335-8100145 Fax: +39-06-33775610
Received: March 26, 2019
Peer-review started: March 28, 2019
First decision: June 6, 2019
Revised: June 25, 2019
Accepted: July 19, 2019
Article in press: July 19, 2019
Published online: August 21, 2019
ARTICLE HIGHLIGHTS
Research background

Cross-sectional imaging evaluation of the small bowel is recommended in Crohn’s Disease (CD) to determine the grade of disease activity and the extent of bowel involvement. Magnetic resonance enterography/enteroclysis (MRE) is often preferred over other cross-sectional imaging modalities due to its ability to demonstrate transmural involvement or extraenteric complications and the lack of radiation exposure.

Research motivation

Layered pattern (LP) of bowel walls’ contrast enhancement is commonly observed at MRE in patients with CD. Nevertheless, it remains uncertain whether LP has to be considered as a sign of active inflammation or rather correlates with chronic changes and the presence of coexisting fibrosis. A better characterization of the clinical significance of LP may further expand the role of MRE, helping clinicians to choose the best treatment option and to monitor response to therapies over the course of the disease.

Research objectives

We performed a systematic review and meta-analysis aiming to estimate the diagnostic performance of LP of bowel walls’ enhancement at MRE in detecting inflammatory activity in CD.

Research methods

Electronic search was performed to identify studies that investigated the diagnostic accuracy of LP for the recognition of active inflammation in patients with known or suspected CD using ileocolonoscopy with biopsy or surgical specimens’ histopathological analysis as reference standard. Quality Assessment for Diagnostic Accuracy Studies 2 (QUADAS-2) was employed to assess methodological quality of the included studies. Pooled data on diagnostic accuracy were estimated by means of bivariate random-effect model analysis.

Research results

After full-text review, five studies met the inclusion criteria for quantitative analysis. Cumulative data on LP diagnostic accuracy demonstrated by meta-analysis were as follows: pooled sensitivity, 49.3% (95%CI: 41.0%-57.8%); pooled specificity, 89.1% (95%CI: 81.3%-94.4%); pooled PLR, 3.3 (95%CI: 1.9-5.7); pooled NLR, 0.6 (95%CI: 0.5-0.9); and SDOR, 6.8 (95%CI: 2.6-17.6). Summary ROC curve returned an area under the curve (AUC) of 0.82 (SE 0.06). High risk of bias and applicability concerns were raised up in relation to patient selection in one of the included studies.

Research conclusions

LP of bowel walls’ enhancement at MRE yields high specificity for active inflammation in patients with CD.

Research perspectives

Our findings may further refine the role of MRE in characterizing inflammatory activity in CD, providing relevant information to ensure proper therapeutic management. Future prospective studies adopting a prespecified definition of LP are advisable to further support our findings.