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. 2022 Feb 5;4(1):otac004.
doi: 10.1093/crocol/otac004. eCollection 2022 Jan.

Development of a New Index to Assess Small Bowel Inflammation Severity in Crohn's Disease Using Magnetic Resonance Enterography

Yoram Bouhnik  1 , Catherine Le Berre  2 , Magaly Zappa  3 , Maïté Lewin  4 , Mourad Boudiaf  5 , Anne Marie Zagdanski  6 , Eric Frampas  7 , Ammar Oudjit  5 , Béatrice Scotto  8 , Muriel Tissier  9 , Laurence Annet  10 , Sophie Aufort  11 , Thierry Yzet  12 , Muriel Cuilleron  13 , Guillaume Baudin  14 , Vered Abitbol  15 , Jacques Cosnes  16 , Arnaud Bourreille  2 , Jean Yves Mary  17 ; GETAID CDMRIS Study Group
Collaborators, Affiliations

Development of a New Index to Assess Small Bowel Inflammation Severity in Crohn's Disease Using Magnetic Resonance Enterography

Yoram Bouhnik et al. Crohns Colitis 360. .

Abstract

Background: The severity of small bowel (SB) inflammation in Crohn's disease (CD) patients is a key component of the therapeutic choice. We aimed to develop a SB-CD Magnetic Resonance Enterography (MRE) index of Inflammation Severity (CDMRIS).

Methods: Each gastroenterologist/radiologist pair in 13 centers selected MREs from 6 patients with SB-CD stratified on their perceived MRE inflammation severity. The 78 blinded MREs were allocated through balanced incomplete block design per severity stratum to these 13 pairs for rating the presence/severity of 13 preselected items for each SB 20-cm diseased segment. Global inflammation severity was evaluated using a 100-cm visual analog scale. Reproducibility of recorded items was evaluated. The CDMRIS was determined through linear mixed modeling as a combination of the numbers of segments with lesions highly correlated to global inflammation severity.

Results: Four hundred and forty-two readings were available. Global inflammation severity mean ± SD was 21.0 ± 16.2. The independent predictors explaining 54% of the global inflammation severity variance were the numbers of segments with T1 mild-moderate and severe intensity of enhancement, deep ulceration without fistula, comb sign, fistula, and abscess. Unbiased correlation between CDMRIS and global inflammation severity was 0.76.

Conclusions: The CDMRIS is now available to evaluate the severity of SB-CD inflammation. External validation and sensitivity-to-change are mandatory next steps.

Keywords: CDMRIS; Crohn; MRE; small bowel.

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Figures

Figure 1.
Figure 1.
Flow diagram illustrating the study protocol.
Figure 2.
Figure 2.
Examples of intensity of enhancement (IE) in T1-weighted sequences when compared to normal bowel loops, as absent (A), mild–moderate (B), or severe (C).
Figure 3.
Figure 3.
Scatterplot of the CDMRIS index as a function of the investigator global inflammation severity measured on VAS. The area of each circle is related to the number of coincident data plotted there (varying between 1 and 41). Abbreviation: VAS, visual analog scale.
See this image and copyright information in PMC

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