Magnetic resonance enterography to predict subsequent disabling Crohn's disease in newly diagnosed patients (METRIC-EF)-multivariable prediction model, multicentre diagnostic inception cohort

Stuart A Taylor^#¹, Shankar Kumar^#², Thomas Parry², Sue Mallett², Simon Travis³, Tim Raine⁴, Caroline Clarke⁵, Jing Yi Weng⁵, Gauraang Bhatnagar^{2

6}, Stuart Bloom⁷, Peter John Hamlin⁸, Ailsa Hart⁹, Roser Vega⁷, Maira Hameed², Anisha Bhagwanani⁶, Rebecca Greenhalgh¹⁰, Emma Helbren¹¹, James Stephenson^{2

12}, Ian Zealley¹³, Vivienne Eze¹⁴, Jamie Franklin¹⁵, Alison Corr¹⁰, Arun Gupta¹⁰, Damian Tolan¹⁶, William Hogg¹⁶, Antony Higginson¹⁷, Mohamed Ahmed⁴, Louise Lee¹², Richard Pollok^{18

19}, Jaymin Patel²⁰, Samantha Baillie¹⁹, Steve Halligan², Andrew Plumb²

Affiliations

¹ Centre for Medical Imaging, University College London (UCL), London, UK. stuart.taylor@ucl.ac.uk.
² Centre for Medical Imaging, University College London (UCL), London, UK.
³ Kennedy Institute and Translational Gastroenterology Unit, University of Oxford and Biomedical Research Centre, Oxford, UK.
⁴ Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁵ Research Department of Primary Care and Population Health, University College London (UCL), London, UK.
⁶ Department of Radiology, Frimley Park Hospital, Surrey, UK.
⁷ Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK.
⁸ Department of Gastroenterology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
⁹ Inflammatory Bowel Disease Unit, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK.
¹⁰ Department of Intestinal Imaging, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK.
¹¹ Department of Radiology, Hull University Teaching Hospitals NHS Trust, Hull, UK.
¹² Department of Radiology, University Hospitals of Leicester NHS Foundation Trust, Leicester, UK.
¹³ Department of Radiology, Ninewells Hospital and Medical School, Dundee, UK.
¹⁴ Department of Radiology, Maidstone and Tunbridge Wells NHS Foundation Trust, Kent, UK.
¹⁵ Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK.
¹⁶ Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
¹⁷ Department of Radiology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK.
¹⁸ Infection and Immunity Research Institute, St George's University of London, London, UK.
¹⁹ Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust London, London, UK.
²⁰ Department of Radiology, St George's University Hospitals NHS Foundation Trust London, London, UK.

^# Contributed equally.

PMID: 40369265
DOI: 10.1007/s00330-025-11636-8

Magnetic resonance enterography to predict subsequent disabling Crohn's disease in newly diagnosed patients (METRIC-EF)-multivariable prediction model, multicentre diagnostic inception cohort

Stuart A Taylor et al. Eur Radiol. 2025.

. 2025 May 14.

doi: 10.1007/s00330-025-11636-8. Online ahead of print.

Authors

Affiliations

¹ Centre for Medical Imaging, University College London (UCL), London, UK. stuart.taylor@ucl.ac.uk.
² Centre for Medical Imaging, University College London (UCL), London, UK.
³ Kennedy Institute and Translational Gastroenterology Unit, University of Oxford and Biomedical Research Centre, Oxford, UK.
⁴ Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁵ Research Department of Primary Care and Population Health, University College London (UCL), London, UK.
⁶ Department of Radiology, Frimley Park Hospital, Surrey, UK.
⁷ Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK.
⁸ Department of Gastroenterology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
⁹ Inflammatory Bowel Disease Unit, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK.
¹⁰ Department of Intestinal Imaging, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK.
¹¹ Department of Radiology, Hull University Teaching Hospitals NHS Trust, Hull, UK.
¹² Department of Radiology, University Hospitals of Leicester NHS Foundation Trust, Leicester, UK.
¹³ Department of Radiology, Ninewells Hospital and Medical School, Dundee, UK.
¹⁴ Department of Radiology, Maidstone and Tunbridge Wells NHS Foundation Trust, Kent, UK.
¹⁵ Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK.
¹⁶ Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
¹⁷ Department of Radiology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK.
¹⁸ Infection and Immunity Research Institute, St George's University of London, London, UK.
¹⁹ Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust London, London, UK.
²⁰ Department of Radiology, St George's University Hospitals NHS Foundation Trust London, London, UK.

^# Contributed equally.

PMID: 40369265
DOI: 10.1007/s00330-025-11636-8

Abstract

Objectives: Magnetic resonance enterography (MRE) is a first-line investigation to diagnose Crohn's disease (CD), but its role for prognostication is unknown. Accordingly, we assessed the predictive ability of prognostic models including MRE scores (MRE Global Score (MEGS), simplified MR Index of Activity (sMARIA), and Lémann index (LI)) against models using clinical predictors alone for the development of modified Beaugerie disabling CD (MBDD) within 5 years of diagnosis.

Methods: This was a multicentre, diagnostic inception cohort of patients with newly diagnosed CD across 9 UK hospitals, followed for 4 years or more. We censored development of MBDD ≤ 90 days from diagnosis, and used time-to-event models using Royston-Parmer flexible parametric models.

Results: We included 194 patients, median age 29, IQR 22-44 years, 52% female. Within 5 years of diagnosis, 42% (81/194) developed MBDD. In univariable analysis, initial steroid requirement was associated with increased risk of developing MBDD (HR 2.11 (95% CI 1.36, 3.26). The baseline clinical model had 49% (39, 60) sensitivity and 66% (57, 74) specificity for predicting the top 40% of patients with the greatest risk of developing MBDD, and 86% (77, 92) sensitivity and 35% (27, 45) specificity for predicting the development of MBDD in patients with an absolute risk of ≥ 10%. There was no significant difference in sensitivity when the MEGS, sMARIA, or LI were added to the baseline clinical model.

Conclusions: Addition of MRE scores at diagnosis to a multivariable model comprising clinical predictors did not improve prediction of MBDD within 5 years of diagnosis.

Key points: Question Magnetic resonance enterography (MRE) is important for diagnosing and monitoring Crohn's disease (CD), but primary research evaluating its prognostic role is lacking. Findings Adding MRE findings at diagnosis to a multivariable model comprising clinical predictors did not improve the prediction of disabling CD within 5 years of diagnosis. Clinical relevance When tested in a prospective, multicentre trial, current MRE activity and damage scores at diagnosis did not reliably predict whether patients would subsequently develop disabling CD. Notwithstanding this finding, MRE remains an essential tool for diagnosis and monitoring.

Keywords: Crohn’s disease; Magnetic resonance imaging; Prognostic model.

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Conflict of interest statement

Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Stuart Taylor. Conflict of interest: The authors of this manuscript declare relationships with the following companies: S.A.T.—Grant support from the NIHR HTA for the present manuscript. Personal fees from Alimentiv, shareholding in Motilent and grants from the NIHR. Consultant for AstraZeneca. Board member EME programme committee. NIHR emeritus senior investigator. S.M.—Grant support from the NIHR HTA for the present manuscript. S.Tr.—Grants/Research Support: Grant support from the NIHR HTA for the present manuscript, AbbVie, Buhlmann, Celgene, ECCO, Helmsley Trust, IOIBD, Janssen, Lilly, Pfizer, Takeda, UCB, UKIERI, Vifor, and Norman Collisson Foundation. Consulting Fees: Abacus; AbbVie; Actial; ai4gi; Alcimed; Allergan; Amgen; Apexian; Aptel; Arena; Asahi; Aspen; Astellas; Atlantic; AstraZeneca; Barco; Biocare; Biogen; BLPharma; Boehringer-Ingelheim; BMS; Buhlmann; Calcico; Celgene; Cellerix; Cerimon; ChemoCentryx; Chiesi; CisBio; ComCast; Coronado; Cosmo; Ducentis; Dynavax; Elan; Enterome; EQrX; Equillium; Falk; Ferring; FPRT Bio; Galapagos; Genentech/Roche; Genzyme; Gilead; Glenmark; Grunenthal; GSK; GW Pharmaceuticals; Immunocore; Immunometabolism; Indigo; Janssen; Lexicon; Lilly; Medarex; Medtrix; Merck; Merrimack; Mestag; Millenium; Neovacs; Novartis; Novo Nordisk; NPS-Nycomed; Ocera; Optima; Origin; Otsuka; Palau; Pentax; Pfizer; Pharmaventure; Phesi; Phillips; P&G; Pronota; Protagonist; Proximagen; Resolute; Robarts; Sandoz; Santarus; Satisfai; Sensyne Health; Shire; SigmoidPharma; Sorriso; Souffinez; Syndermix; Synthon; Takeda; Theravance; Tigenix; Tillotts; Topivert; Trino Therapeutics with Wellcome Trust; TxCell; UCB Pharma; Vertex; VHsquared; Vifor; Warner Chilcott and Zeria Speaker fees: AbbVie, Amgen, Biogen, Falk; Ferring, Janssen, Pfizer, Shire, Takeda, UCB. No stocks or share options. T.R.—Grant: AbbVie. S.B.—Grant support from the NIHR HTA for the present manuscript. P.J.H.—Grant support from the NIHR HTA for the present manuscript. A.H.—Grant support from the NIHR HTA for the present manuscript. Personal Fees: Abbvie, Arena, Aslan, AstraZeneca, Boehringer-Ingelheim, BMS, Celgene, Ferring, Galapagos, Gilead, GSK, Heptares, LabGenius, Janssen, Mylan, MSD, Novartis, Pfizer, Roche, Sandoz, Takeda and UCB. S.H.—Grant support from the NIHR HTA for the present manuscript. NIHR emeritus senior investigator. AAP—NIHR HTA, including grant support for the conduct of this study, grants from NIHR. Member of the Scientific Editorial Board for European Radiology (section: Gastrointestinal-Abdominal). As such, they did not participate in the selection or review processes for this article. The remaining authors declare no conflicts of interest. Statistics and biometry: Several authors have significant statistical expertise has significant statistical expertise. Informed consent: Written informed consent was obtained from all subjects (patients) in this study. Ethical approval: Institutional Review Board approval was obtained. Study subjects or cohorts overlap: None. Methodology: Prospective Prognostic study Multicentre

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Magnetic resonance enterography to predict subsequent disabling Crohn's disease in newly diagnosed patients (METRIC-EF)-multivariable prediction model, multicentre diagnostic inception cohort

Affiliations

Magnetic resonance enterography to predict subsequent disabling Crohn's disease in newly diagnosed patients (METRIC-EF)-multivariable prediction model, multicentre diagnostic inception cohort

Authors

Affiliations

Abstract

Conflict of interest statement

References

Grants and funding

LinkOut - more resources

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