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Validation of the simplified magnetic resonance index of activity by using DWI without gadolinium enhancement to evaluate bowel inflammation in Crohn's disease

 Heejin Bae  ;  Nieun Seo  ;  Eun Ae Kang  ;  Jae Hee Cheon  ;  Joon Seok Lim  ;  Myeong-Jin Kim 
 EUROPEAN RADIOLOGY, Vol.33(5) : 3266-3275, 2023-05 
Journal Title
Issue Date
Contrast Media / pharmacology ; Crohn Disease* / pathology ; Diffusion Magnetic Resonance Imaging / methods ; Gadolinium / pharmacology ; Humans ; Inflammation ; Magnetic Resonance Imaging / methods ; Magnetic Resonance Spectroscopy ; Reproducibility of Results ; Retrospective Studies ; Ulcer
Crohn’s disease ; Diagnosis ; Diffusion-weighted imaging ; Magnetic resonance enterography
Objectives To validate the modified simplified magnetic resonance index of activity (sMARIA) score using DWI on noncontrast magnetic resonance enterography (MRE) to evaluate active inflammation in patients with Crohn’s disease (CD),
compared to the original sMARIA scoring system, with and without contrast enhancement.

Methods This retrospective study included 275 bowel segments from 55 CD patients who underwent ileocolonoscopy and MRE within a 2-week period. Two blinded radiologists evaluated original sMARIA on both conventional MRE (CEsMARIA) and non-contrast MRE (T2-sMARIA). Modified sMARIA was then evaluated using non-contrast MRE, replacing ulcerations with DWI grades. Three scoring systems were compared for diagnostic accuracy of active inflammation, correlation with simple endoscopic score (SES)-CD, and interobserver reproducibility.

Results The AUC of modified sMARIA for detecting active inflammation (0.863, 95% confidence interval [0.803–0.923]) was significantly higher than T2-sMARIA (0.827 [0.773–0.881], p = 0.017), and comparable to CE-sMARIA (0.908 [0.857–0.959], p = 0.122). CE-sMARIA, T2-sMARIA, and modified sMARIA all showed moderate correlation with SES-CD (r = 0.795, 0.722, and 0.777, respectively). Interobserver reproducibility of diffusion restriction (κ, 0.686 [0.602–0.770]) was significantly better than ulcers on conventional MRE (κ, 0.382 [0.212–0.552]; p = 0.001) and T2-weighted image (κ, 0.312 [0.034–0.590]; p = 0.012).

Conclusions Modified sMARIA using DWI can improve the diagnostic performance of sMARIA on non-contrast MRE, showing comparable performance to sMARIA using contrast-enhanced MRE.

Key Points • DWI can improve the diagnostic performance of non-contrast magnetic resonance enterography (MRE) for assessing active inflammation in patients with Crohn’s disease.

• Modified simplified magnetic resonance index of activity (sMARIA) using DWI grades in place of ulcers showed comparable diagnostic performance to sMARIA using conventional MRE with contrast-enhanced sequences.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kang, Eun Ae(강은애)
Kim, Myeong Jin(김명진) ORCID logo https://orcid.org/0000-0001-7949-5402
Bae, Heejin(배희진) ORCID logo https://orcid.org/0000-0002-1227-8646
Seo, Nieun(서니은) ORCID logo https://orcid.org/0000-0001-8745-6454
Lim, Joon Seok(임준석) ORCID logo https://orcid.org/0000-0002-0334-5042
Cheon, Jae Hee(천재희) ORCID logo https://orcid.org/0000-0002-2282-8904
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