MedWire News: Positive study findings have led Spanish researchers to propose that magnetic resonance (MR) could be used as an alternative to endoscopy to assess the activity and severity of ileocolonic Crohn’s disease (CD).
Quantitative MR changes such as wall thickening, contrast signal intensity, and relative contrast enhancement closely paralleled the severity of endoscopic lesions, say J Panes (Hospital Clinic of Barcelona) and colleagues.
Edema, ulcers, enlarged lymph nodes, and pseudopolyps on MR was also more prevalent in intestinal segments with more severe endoscopic lesions.
A subsequently developed MR index of activity accurately detected disease activity and ulceration, and correlated with endoscopic disease severity.
The study included 35 patients with clinically active CD and 15 with inactive disease who underwent ileocolonoscopy and MR.
Endoscopic activity was assessed using the CD Index of Severity (CDIS) and endoscopic lesions classified as absent, mild - with inflammation but without ulcers - or severe - with ulceration.
There were progressive and significant increases in several MR parameters over the three endoscopic lesion classifications including: wall thickness, post-contrast wall signal intensity, relative contrast enhancement, presence of edema, ulcers, pseudopolyps, and lymph node enlargement.
Independent predictors for segment CDIS score were wall thickness, relative contrast enhancement, edema, and ulcers at MR.
A simplified MR Index of Activity had an area under the receiver operating characteristic curve of 0.89 for detecting disease activity, and 0.98 for detecting ulcerative lesions in the colon and terminal ileum.
Reporting in the journal Gut, the researchers say MR provided complete assessment of the ileocolonic region in all patients, compared with 72% of complete ileocolonoscopies in their series.
“The possibility of identifying inflammatory lesions in all locations of the gastrointestinal tract, and also extraluminal complications, in just one examination represents a clear advantage of MR over colonoscopy for evaluation of CD,” they say.
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