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Review
. 2015 Nov;25(11):3295-313.
doi: 10.1007/s00330-015-3737-9. Epub 2015 Jun 17.

Grading of Crohn's disease activity using CT, MRI, US and scintigraphy: a meta-analysis

C A J Puylaert  1 , J A W Tielbeek  2 , S Bipat  2 , J Stoker  2
Affiliations
Review

Grading of Crohn's disease activity using CT, MRI, US and scintigraphy: a meta-analysis

C A J Puylaert et al. Eur Radiol. 2015 Nov.

Abstract

Purpose: To assess the grading of Crohn's disease activity using CT, MRI, US and scintigraphy.

Materials and methods: MEDLINE, EMBASE and Cochrane databases were searched (January 1983-March 2014) for studies evaluating CT, MRI, US and scintigraphy in grading Crohn's disease activity compared to endoscopy, biopsies or intraoperative findings. Two independent reviewers assessed the data. Three-by-three tables (none, mild, frank disease) were constructed for all studies, and estimates of accurate, over- and under-grading were calculated/summarized by fixed or random effects models.

Results: Our search yielded 9356 articles, 19 of which were included. Per-patient data showed accurate grading values for CT, MRI, US and scintigraphy of 86% (95% CI: 75-93%), 84% (95% CI: 67-93%), 44% (95% CI: 28-61%) and 40% (95% CI: 16-70%), respectively. In the per-patient analysis, CT and MRI showed similar accurate grading estimates (P = 0.8). Per-segment data showed accurate grading values for CT and scintigraphy of 87% (95% CI: 77-93%) and 86% (95% CI: 80-91%), respectively. MRI and US showed grading accuracies of 67-82% and 56-75%, respectively.

Conclusions: CT and MRI showed comparable high accurate grading estimates in the per-patient analysis. Results for US and scintigraphy were inconsistent, and limited data were available.

Key points: • CT and MRI have comparable high accuracy in grading Crohn's disease. • Data on US and scintigraphy is inconsistent and limited. • MRI is preferable over CT as it lacks ionizing radiation exposure.

Keywords: Crohn’s disease; Magnetic resonance imaging; Radionuclide imaging; Ultrasound; X-ray computed tomography.

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Figures

Fig. 1
Fig. 1
Flow diagram showing study selection
Fig. 2
Fig. 2
QUADAS signalling questions (Table 1) per domain (from up to down: patient selection, index test, reference test and patient flow). The last column shows whether studies included patients prospectively.
Fig. 3
Fig. 3
QUADAS risk of bias per domain and concerns regarding applicability for domains of patient selection, index test and reference test
Fig. 4
Fig. 4
Accurate grading, over- and under-grading per study on a per-patient and per-segment basis
See this image and copyright information in PMC

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