Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2018; 24(21): 2279-2290
Published online Jun 7, 2018. doi: 10.3748/wjg.v24.i21.2279
Magnetic resonance imaging and Crohn’s disease endoscopic index of severity: Correlations and concordance
Nai-Yi Zhu, Xue-Song Zhao, Fei Miao
Nai-Yi Zhu, Xue-Song Zhao, Fei Miao, Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
Author contributions: Zhu NY substantial contributions to conception and design of the study, acquisition of data, drafting the article or making critical revisions related to important intellectual content of the manuscript; Zhao XS analysis and interpretation of data; Miao F final approval of the version of the article to be published.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Ruijin Hospital, Shanghai Jiao Tong University School of Medicine.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
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/
Correspondence to: Fei Miao, MD, Doctor, Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai 200025, China. mf11066@rjh.com.cn
Telephone: +86-21-64085875 Fax: +86-21-64085875
Received: January 19, 2018
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
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.