Published online Jun 7, 2018. doi: 10.3748/wjg.v24.i21.2279
Peer-review started: January 19, 2018
First decision: February 3, 2018
Revised: March 28, 2018
Accepted: April 26, 2018
Article in press: April 26, 2018
Published online: June 7, 2018
Crohn’s disease (CD) is an inflammatory bowel disease that may involve the entire gastrointestinal tract. CD easily recurs, and accurate and comprehensive evaluation and follow-up are essential to design an individualized treatment program. Crohn’s Disease Endoscopic Index of Severity (CDEIS) is generally used to assess CD activity. However, it is currently uncertain whether MRI abnormalities are concordant with changes in CDEIS. In addition, whether MRI is only a supplementary/accessory assessment method to endoscopy or could substitute endoscopy during follow-up remains unclear.
The clinical symptoms of CD may be unrelated to endoscopy and imaging findings. Endoscopy and histopathology are the first methods of choice for the diagnosis of CD. Nevertheless, these approaches are invasive and ill-suited for regular monitoring and follow-up. Therefore, MRI is probably one of the most appropriate methods for long-term evaluation and monitoring of CD.
We hypothesized that CDEIS changes correlated with MaRIA scores as well as individual MRI parameters before and after CD treatment. The present study aimed to help us to understand the pathological changes of CD and provide non-invasive modalities for examining therapeutic effects.
One hundred and four patients with CD were analyzed retrospectively. Among them, 61 and 43 patients were considered to have active CD (CDEIS > 6) and inactive CD (CDEIS ≤ 6), respectively. MaRIA scores as well as individual MRI parameters, including total relative contrast enhancement (tRCE), arterial RCE (aRCE), portal RCE (pRCE), delay phase RCE (dRCE), and apparent diffusion coefficient (ADC), were evaluated. Correlation and concordance between multiple MRI findings and CDEIS were examined.
In the present study, we found that CDEIS had correlations with MaRIAs at baseline in all patients, including tRCE, aRCE, pRCE, dRCE (all MaRIAs, P < 0.001), followed by single MRI indexes. Among the 61 active CD patients, 44 cases were remitted to inactive CD after treatment. In the 44 patients who achieved remission, correlations between CDEIS and all MaRIAs remained after treatment. However, the values of the correlation coefficient (r) were decreased. The most significant correlations were found between MaRIAs for aRCE and CDEIS.
MRI indicators had correlations with CDEIS in patients with active CD before treatment. However the correlations were decreased in patients with active CD that became inactive after treatment. The assessment was not completely concordant between CDEIS and MRI in patient with CD before and after treatment. The MaRIA score of aRCE seemed to be an important indicator. For dynamic assessment of therapeutic effects, MaRIA scores were better than single MRI indicators.
Endoscopic results were not completely consistent with MR data among CD patients. The most sensitive indicators in evaluating efficacy by MR were relevant indicators during the MR enhanced arterial phase. The most appropriate timing for performing MR evaluation and monitoring disease conditions after treatment of CD should be explored in the future.