Randomized Controlled Trial

. 2018 Aug;3(8):548-558.

doi: 10.1016/S2468-1253(18)30161-4. Epub 2018 Jun 18.

Diagnostic accuracy of magnetic resonance enterography and small bowel ultrasound for the extent and activity of newly diagnosed and relapsed Crohn's disease (METRIC): a multicentre trial

Stuart A Taylor¹, Susan Mallett², Gauraang Bhatnagar³, Rachel Baldwin-Cleland⁴, Stuart Bloom⁵, Arun Gupta⁴, Peter J Hamlin⁶, Ailsa L Hart⁷, Antony Higginson⁸, Ilan Jacobs⁹, Sara McCartney⁵, Anne Miles¹⁰, Charles D Murray¹¹, Andrew A Plumb³, Richard C Pollok¹², Shonit Punwani³, Laura Quinn², Manuel Rodriguez-Justo¹³, Zainib Shabir¹⁴, Andrew Slater¹⁵, Damian Tolan¹⁶, Simon Travis¹⁷, Alastair Windsor¹⁸, Peter Wylie¹⁹, Ian Zealley²⁰, Steve Halligan³; METRIC study investigators

Collaborators, Affiliations

Collaborators

METRIC study investigators:
Jade Dyer, Pranitha Veeramalla, Sue Tebbs, Steve Hibbert, Richard Ellis, Fergus Thursby-Pelham, Richard Beable, Nicola Gibbons, Claire Ward, Anthony O'Connor, Hannah Lambie, Rachel Hyland, Nigel Scott, Roger Lapham, Doris Quartey, Deborah Scrimshaw, Helen Bungay, Maggie Betts, Simona Fourie, Niall Power, Rajapandian Ilangovan, Uday Patel, Evgenia Mainta, Phillip Lung, Ian Johnston, Mani Naghibi, Morgan Moorghen, Adriana Martinez, Francois Porte, Christopher Alexakis, James Pilcher, Anisur Rahman, Jonny Vlahos, Rebecca Greenhalgh, Anita Wale, Teresita Beeston, Wivijin Piga, Joey Clemente, Farooq Rahman, Simona de Caro, Shameer Mehta, Roser Vega, Roman Jastrub, Harbir Sidhu, Hameed Rafiee, Mairead Tennent, Caron Innes, Craig Mowat, Gillian Duncan, Steve Morris

Affiliations

¹ Centre for Medical Imaging, University College London (UCL), London, UK. Electronic address: stuart.taylor1@nhs.net.
² Institute of Applied Health Research, National Institute of Health and Research Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
³ Centre for Medical Imaging, University College London (UCL), London, UK.
⁴ Intestinal Imaging Centre, St Mark's Hospital, London North West University Healthcare (LNWUH) National Health Service (NHS) Trust, Harrow, UK.
⁵ Department of Gastroenterology, University College Hospital, London, UK.
⁶ Department of Gastroenterology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
⁷ Inflammatory Bowel Disease Unit, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK.
⁸ Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK.
⁹ Centre for Medical Imaging, UCL, London, UK.
¹⁰ Department of Psychological Sciences, Birkbeck University of London, London, UK.
¹¹ Department of Gastroenterology and Endoscopy, Royal Free London NHS Foundation Trust, London, UK.
¹² Department of Gastroenterology, St George's Hospital, London, UK.
¹³ Department of Histopathology, University College Hospital, London, UK.
¹⁴ Comprehensive Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, Holborn, London, UK.
¹⁵ Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK.
¹⁶ Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
¹⁷ Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK.
¹⁸ Department of Surgery, University College Hospital, London, UK.
¹⁹ Department of Radiology, Royal Free London NHS Foundation Trust, London, UK.
²⁰ Department of Radiology, Ninewells Hospital, Dundee, UK.

PMID: 29914843
PMCID: PMC6278907
DOI: 10.1016/S2468-1253(18)30161-4

Randomized Controlled Trial

Diagnostic accuracy of magnetic resonance enterography and small bowel ultrasound for the extent and activity of newly diagnosed and relapsed Crohn's disease (METRIC): a multicentre trial

Stuart A Taylor et al. Lancet Gastroenterol Hepatol. 2018 Aug.

. 2018 Aug;3(8):548-558.

doi: 10.1016/S2468-1253(18)30161-4. Epub 2018 Jun 18.

Authors

Collaborators

METRIC study investigators:
Jade Dyer, Pranitha Veeramalla, Sue Tebbs, Steve Hibbert, Richard Ellis, Fergus Thursby-Pelham, Richard Beable, Nicola Gibbons, Claire Ward, Anthony O'Connor, Hannah Lambie, Rachel Hyland, Nigel Scott, Roger Lapham, Doris Quartey, Deborah Scrimshaw, Helen Bungay, Maggie Betts, Simona Fourie, Niall Power, Rajapandian Ilangovan, Uday Patel, Evgenia Mainta, Phillip Lung, Ian Johnston, Mani Naghibi, Morgan Moorghen, Adriana Martinez, Francois Porte, Christopher Alexakis, James Pilcher, Anisur Rahman, Jonny Vlahos, Rebecca Greenhalgh, Anita Wale, Teresita Beeston, Wivijin Piga, Joey Clemente, Farooq Rahman, Simona de Caro, Shameer Mehta, Roser Vega, Roman Jastrub, Harbir Sidhu, Hameed Rafiee, Mairead Tennent, Caron Innes, Craig Mowat, Gillian Duncan, Steve Morris

Affiliations

¹ Centre for Medical Imaging, University College London (UCL), London, UK. Electronic address: stuart.taylor1@nhs.net.
² Institute of Applied Health Research, National Institute of Health and Research Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
³ Centre for Medical Imaging, University College London (UCL), London, UK.
⁴ Intestinal Imaging Centre, St Mark's Hospital, London North West University Healthcare (LNWUH) National Health Service (NHS) Trust, Harrow, UK.
⁵ Department of Gastroenterology, University College Hospital, London, UK.
⁶ Department of Gastroenterology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
⁷ Inflammatory Bowel Disease Unit, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK.
⁸ Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK.
⁹ Centre for Medical Imaging, UCL, London, UK.
¹⁰ Department of Psychological Sciences, Birkbeck University of London, London, UK.
¹¹ Department of Gastroenterology and Endoscopy, Royal Free London NHS Foundation Trust, London, UK.
¹² Department of Gastroenterology, St George's Hospital, London, UK.
¹³ Department of Histopathology, University College Hospital, London, UK.
¹⁴ Comprehensive Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, Holborn, London, UK.
¹⁵ Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK.
¹⁶ Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
¹⁷ Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK.
¹⁸ Department of Surgery, University College Hospital, London, UK.
¹⁹ Department of Radiology, Royal Free London NHS Foundation Trust, London, UK.
²⁰ Department of Radiology, Ninewells Hospital, Dundee, UK.

PMID: 29914843
PMCID: PMC6278907
DOI: 10.1016/S2468-1253(18)30161-4

Abstract

Background: Magnetic resonance enterography (MRE) and ultrasound are used to image Crohn's disease, but their comparative accuracy for assessing disease extent and activity is not known with certainty. Therefore, we did a multicentre trial to address this issue.

Methods: We recruited patients from eight UK hospitals. Eligible patients were 16 years or older, with newly diagnosed Crohn's disease or with established disease and suspected relapse. Consecutive patients had MRE and ultrasound in addition to standard investigations. Discrepancy between MRE and ultrasound for the presence of small bowel disease triggered an additional investigation, if not already available. The primary outcome was difference in per-patient sensitivity for small bowel disease extent (correct identification and segmental localisation) against a construct reference standard (panel diagnosis). This trial is registered with the International Standard Randomised Controlled Trial, number ISRCTN03982913, and has been completed.

Findings: 284 patients completed the trial (133 in the newly diagnosed group, 151 in the relapse group). Based on the reference standard, 233 (82%) patients had small bowel Crohn's disease. The sensitivity of MRE for small bowel disease extent (80% [95% CI 72-86]) and presence (97% [91-99]) were significantly greater than that of ultrasound (70% [62-78] for disease extent, 92% [84-96] for disease presence); a 10% (95% CI 1-18; p=0·027) difference for extent, and 5% (1-9; p=0·025) difference for presence. The specificity of MRE for small bowel disease extent (95% [85-98]) was significantly greater than that of ultrasound (81% [64-91]); a difference of 14% (1-27; p=0·039). The specificity for small bowel disease presence was 96% (95% CI 86-99) with MRE and 84% (65-94) with ultrasound (difference 12% [0-25]; p=0·054). There were no serious adverse events.

Interpretation: Both MRE and ultrasound have high sensitivity for detecting small bowel disease presence and both are valid first-line investigations, and viable alternatives to ileocolonoscopy. However, in a national health service setting, MRE is generally the preferred radiological investigation when available because its sensitivity and specificity exceed ultrasound significantly.

Funding: National Institute of Health and Research Health Technology Assessment.

PubMed Disclaimer

Figures

**Figure 1**
Trial profile CRP=C-reactive protein. MRE=magnetic resonance enterography.

**Figure 2**
Sensitivity and specificity of MRE and ultrasound for the extent and presence of small bowel and colonic disease against the consensus reference standard FN=false negative. FP=false positive. MRE=magnetic resonance enterography. TN=true negative. TP=true positive. Error bars represent 95% CI.

See this image and copyright information in PMC

Comment in

An optimal METRIC for imaging in small bowel Crohn's disease.
De Kock I, Delrue L, Hindryckx P. De Kock I, et al. Lancet Gastroenterol Hepatol. 2018 Aug;3(8):521-523. doi: 10.1016/S2468-1253(18)30197-3. Epub 2018 Jun 18. Lancet Gastroenterol Hepatol. 2018. PMID: 29914844 No abstract available.
Diagnostic accuracy of MRE and ultrasound for Crohn's disease.
Novak K, Maaser C, Wilkens R, Maconi G, Kucharzik T; International Bowel Ultrasound Group. Novak K, et al. Lancet Gastroenterol Hepatol. 2019 Feb;4(2):95-96. doi: 10.1016/S2468-1253(18)30388-1. Lancet Gastroenterol Hepatol. 2019. PMID: 30647016 No abstract available.
Diagnostic accuracy of MRE and ultrasound for Crohn's disease - Authors' reply.
Taylor SA, Halligan S, Bhatnagar G, Gupta A, Higginson A, Slater A, Tolan D, Wylie P, Zealley I, Mallett S. Taylor SA, et al. Lancet Gastroenterol Hepatol. 2019 Feb;4(2):96. doi: 10.1016/S2468-1253(18)30389-3. Lancet Gastroenterol Hepatol. 2019. PMID: 30647017 No abstract available.
Watch-and-wait strategy in rectal cancer.
Bujko K, Michalski W. Bujko K, et al. Lancet Gastroenterol Hepatol. 2019 Feb;4(2):96-97. doi: 10.1016/S2468-1253(18)30416-3. Lancet Gastroenterol Hepatol. 2019. PMID: 30647018 No abstract available.
Watch-and-wait strategy in rectal cancer - Authors' reply.
Chadi SA, Beets GL, Perez RO, Renehan AG. Chadi SA, et al. Lancet Gastroenterol Hepatol. 2019 Feb;4(2):97. doi: 10.1016/S2468-1253(18)30418-7. Lancet Gastroenterol Hepatol. 2019. PMID: 30647019 No abstract available.

References

1. Peyrin-Biroulet L, Fiorino G, Buisson A, Danese S. First-line therapy in adult Crohn's disease: who should receive anti-TNF agents? Nat Rev Gastroenterol Hepatol. 2013;10:345–351. - PubMed
1. Bernstein CN, Boult IF, Greenberg HM, van der Putten W, Duffy G, Grahame GR. A prospective randomized comparison between small bowel enteroclysis and small bowel follow-through in Crohn's disease. Gastroenterology. 1997;113:390–398. - PubMed
1. Panes J, Bouhnik Y, Reinisch W. Imaging techniques for assessment of inflammatory bowel disease: joint ECCO and ESGAR evidence-based consensus guidelines. J Crohns Colitis. 2013;7:556–585. - PubMed
1. Chatu S, Subramanian V, Pollok RC. Meta-analysis: diagnostic medical radiation exposure in inflammatory bowel disease. Aliment Pharmacol Ther. 2012;35:529–539. - PubMed
1. Sonnenberg A, Erckenbrecht J, Peter P, Niederau C. Detection of Crohn's disease by ultrasound. Gastroenterology. 1982;83:430–434. - PubMed

Publication types

Actions
Actions
Actions
Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Diagnostic accuracy of magnetic resonance enterography and small bowel ultrasound for the extent and activity of newly diagnosed and relapsed Crohn's disease (METRIC): a multicentre trial

Collaborators

Affiliations

Diagnostic accuracy of magnetic resonance enterography and small bowel ultrasound for the extent and activity of newly diagnosed and relapsed Crohn's disease (METRIC): a multicentre trial

Authors

Collaborators

Affiliations

Abstract

Figures

Comment in

References

Publication types

MeSH terms

Associated data

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical