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European Radiology

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Open Access 01-11-2015 | Gastrointestinal

Grading of Crohn’s disease activity using CT, MRI, US and scintigraphy: a meta-analysis

Authors: C. A. J. Puylaert, J. A. W. Tielbeek, S. Bipat, J. Stoker

Published in: European Radiology | Issue 11/2015

Abstract

Purpose

To assess the grading of Crohn’s disease activity using CT, MRI, US and scintigraphy.

Materials and methods

MEDLINE, EMBASE and Cochrane databases were searched (January 1983–March 2014) for studies evaluating CT, MRI, US and scintigraphy in grading Crohn’s disease activity compared to endoscopy, biopsies or intraoperative findings. Two independent reviewers assessed the data. Three-by-three tables (none, mild, frank disease) were constructed for all studies, and estimates of accurate, over- and under-grading were calculated/summarized by fixed or random effects models.

Results

Our search yielded 9356 articles, 19 of which were included. Per-patient data showed accurate grading values for CT, MRI, US and scintigraphy of 86 % (95 % CI: 75–93 %), 84 % (95 % CI: 67–93 %), 44 % (95 % CI: 28–61 %) and 40 % (95 % CI: 16–70 %), respectively. In the per-patient analysis, CT and MRI showed similar accurate grading estimates (P = 0.8). Per-segment data showed accurate grading values for CT and scintigraphy of 87 % (95 % CI: 77–93 %) and 86 % (95 % CI: 80–91 %), respectively. MRI and US showed grading accuracies of 67–82 % and 56–75 %, respectively.

Conclusions

CT and MRI showed comparable high accurate grading estimates in the per-patient analysis. Results for US and scintigraphy were inconsistent, and limited data were available.

Key Points

• CT and MRI have comparable high accuracy in grading Crohn’s disease.

• Data on US and scintigraphy is inconsistent and limited.

• MRI is preferable over CT as it lacks ionizing radiation exposure.

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Horsthuis K, Bipat S, Bennink RJ, Stoker J (2008) Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta-analysis of prospective studies. Radiology 247:64–79CrossRefPubMed

Panes J, Bouzas R, Chaparro M et al (2011) Systematic review: the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn’s disease. Aliment Pharmacol Ther 34:125–145CrossRefPubMed

Travis SP, Stange EF, Lemann M et al (2006) European evidence based consensus on the diagnosis and management of Crohn’s disease: current management. Gut 55:i16–i35PubMedCentralCrossRefPubMed

Hommes DW, van Deventer SJ (2004) Endoscopy in inflammatory bowel diseases. Gastroenterology 126:1561–1573CrossRefPubMed

Fletcher JG, Fidler JL, Bruining DH, Huprich JE (2011) New concepts in intestinal imaging for inflammatory bowel diseases. Gastroenterology 140:1795–1806CrossRefPubMed

Rimola J, Ordas I, Rodriguez S, Ricart E, Panes J (2012) Imaging indexes of activity and severity for Crohn’s disease: current status and future trends. Abdom Imaging 37:958–966CrossRefPubMed

Horsthuis K, Bipat S, Stokkers PC, Stoker J (2009) Magnetic resonance imaging for evaluation of disease activity in Crohn’s disease: a systematic review. Eur Radiol 19:1450–1460CrossRefPubMed

Moher D, Liberati A, Tetzlaff J, Altman DG, The PG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6, e1000097PubMedCentralCrossRefPubMed

Whiting PF, Rutjes AW, Westwood ME et al (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155:529–536CrossRefPubMed

10.

Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J (2003) The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 3:25PubMedCentralCrossRefPubMed

11.

Deeks JJ, Macaskill P, Irwig L (2005) The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol 58:882–893CrossRefPubMed

12.

Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560PubMedCentralCrossRefPubMed

13.

Akaike H (1974) A new look at the statistical model identification. IEEE Trans Autom Control 19:716–723CrossRef

14.

Bipat S, Zwinderman AH, Bossuyt PM, Stoker J (2007) Multivariate random-effects approach: for meta-analysis of cancer staging studies. Acad Radiol 14:974–984CrossRefPubMed

15.

Glas AS, Lijmer JG, Prins MH, Bonsel GJ, Bossuyt PMM (2003) The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol 56:1129–1135CrossRefPubMed

16.

Mohamed AM, Amin SK, El-Shinnawy MA, Elfouly A, Baki AH (2012) Role of CT enterography in assessment of Crohn’s disease activity: correlation with histopathologic diagnosis. Egypt J Radiol Nucl Med 43:353–359CrossRef

17.

Mao R, Gao X, Zhu ZH et al (2013) CT enterography in evaluating postoperative recurrence of Crohn’s disease after ileocolic resection: complementary role to endoscopy. Inflamm Bowel Dis 19:977–982CrossRefPubMed

18.

Kolkman JJ, Falke TH, Roos JC et al (1996) Computed tomography and granulocyte scintigraphy in active inflammatory bowel disease. Comparison with endoscopy and operative findings. Dig Dis Sci 41:641–650CrossRefPubMed

19.

Shoenut JP, Semelka RC, Silverman R, Yaffe CS, Micflikier AB (1993) Magnetic resonance imaging in inflammatory bowel disease. J Clin Gastroenterol 17:73–78CrossRefPubMed

20.

Shoenut JP, Semelka RC, Magro CM, Silverman R, Yaffe CS, Micflikier AB (1994) Comparison of magnetic resonance imaging and endoscopy in distinguishing the type and severity of inflammatory bowel disease. J Clin Gastroenterol 19:31–35CrossRefPubMed

21.

Florie J, Horsthuis K, Hommes DW et al (2005) Magnetic resonance imaging compared with ileocolonoscopy in evaluating disease severity in Crohn’s disease. Clin Gastroenterol Hepatol 3:1221–1228CrossRefPubMed

22.

Schreyer AG, Golder S, Scheibl K et al (2005) Dark lumen magnetic resonance enteroclysis in combination with MRI colonography for whole bowel assessment in patients with Crohn’s disease: first clinical experience. Inflamm Bowel Dis 11:388–394CrossRefPubMed

23.

Schreyer AG, Rath HC, Kikinis R et al (2005) Comparison of magnetic resonance imaging colonography with conventional colonoscopy for the assessment of intestinal inflammation in patients with inflammatory bowel disease: a feasibility study. Gut 54:250–256PubMedCentralCrossRefPubMed

24.

van Gemert-Horsthuis K, Florie J, Hommes DW et al (2006) Feasibility of evaluating Crohn’s disease activity at 3.0 Tesla. J Magn Reson Imaging 24:340–348CrossRefPubMed

25.

Girometti R, Zuiani C, Toso F et al (2008) MRI scoring system including dynamic motility evaluation in assessing the activity of Crohn’s disease of the terminal ileum. Acad Radiol 15:153–164CrossRefPubMed

26.

Horsthuis K, de Ridder L, Smets AM et al (2010) Magnetic resonance enterography for suspected inflammatory bowel disease in a pediatric population. J Pediatr Gastroenterol Nutr 51:603–609CrossRefPubMed

27.

Koilakou S, Sailer J, Peloschek P et al (2010) Endoscopy and MR enteroclysis: equivalent tools in predicting clinical recurrence in patients with Crohn’s disease after ileocolic resection. Inflamm Bowel Dis 16:198–203CrossRefPubMed

28.

Gallego JC, Echarri AI, Porta A, Ollero V (2011) Ileal Crohn’s disease: MRI with endoscopic correlation. Eur J Radiol 80:e8–e12CrossRefPubMed

29.

Schill G, Iesalnieks I, Haimerl M et al (2013) Assessment of disease behavior in patients with Crohn’s disease by MR enterography. Inflamm Bowel Dis 19:983–990CrossRefPubMed

30.

Bozkurt T, Rommel T, Stabenow-Lohbauer U, Langer M, Schmiegelow P, Lux G (1996) Sonographic bowel wall morphology correlates with clinical and endoscopic activity in Crohn’s disease and ulcerative colitis. Eur J Ultrasound 4:27–33CrossRef

31.

Neye H, Voderholzer W, Rickes S, Weber J, Wermke W, Lochs H (2004) Evaluation of criteria for the activity of Crohn’s disease by power Doppler sonography. Dig Dis 22:67–72CrossRefPubMed

32.

Drews BH, Barth TF, Hanle MM et al (2009) Comparison of sonographically measured bowel wall vascularity, histology, and disease activity in Crohn’s disease. Eur Radiol 19:1379–1386CrossRefPubMed

33.

Sciarretta G, Furno A, Mazzoni M, Basile C, Malaguti P (1993) Technetium-99 m hexamethyl propylene amine oxime granulocyte scintigraphy in Crohn’s disease: diagnostic and clinical relevance. Gut 34:1364–1369PubMedCentralCrossRefPubMed

34.

Biancone L, Scopinaro F, Ierardi M et al (1997) 99mTc-HMPAO granulocyte scintigraphy in the early detection of postoperative asymptomatic recurrence in Crohn’s disease. Dig Dis Sci 42:1549–1556CrossRefPubMed

35.

Panes J, Bouhnik Y, Reinisch W et al (2013) Imaging techniques for assessment of inflammatory bowel disease: joint ECCO and ESGAR evidence-based consensus guidelines. J Crohns Colitis 7:556–585CrossRefPubMed

36.

Masselli G, Gualdi G (2013) CT and MR enterography in evaluating small bowel diseases: when to use which modality? Abdom Imaging 38:249–259CrossRefPubMed

37.

Grand DJ, Harris A, Loftus EV Jr (2012) Imaging for luminal disease and complications: CT enterography, MR enterography, small-bowel follow-through, and ultrasound. Gastroenterol Clin N Am 41:497–512CrossRef

38.

Siddiki HA, Fidler JL, Fletcher JG et al (2009) Prospective comparison of state-of-the-art MR enterography and CT enterography in small-bowel Crohn’s disease. AJR Am J Roentgenol 193:113–121CrossRefPubMed

39.

Lee SS, Kim AY, Yang SK et al (2009) Crohn disease of the small bowel: comparison of CT enterography, MR enterography, and small-bowel follow-through as diagnostic techniques. Radiology 251:751–761CrossRefPubMed

40.

Jensen MD, Nathan T, Rafaelsen SR, Kjeldsen J (2011) Diagnostic accuracy of capsule endoscopy for small bowel Crohn’s disease is superior to that of MR enterography or CT enterography. Clin Gastroenterol Hepatol 9:124–129CrossRefPubMed

41.

Jensen MD, Kjeldsen J, Rafaelsen SR, Nathan T (2011) Diagnostic accuracies of MR enterography and CT enterography in symptomatic Crohn’s disease. Scand J Gastroenterol 46:1449–1457CrossRefPubMed

42.

Rimola J, Rodriguez S, Garcia-Bosch O et al (2009) Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn’s disease. Gut 58:1113–1120CrossRefPubMed

43.

Vermeire S, Ferrante M, Rutgeerts P (2013) Recent advances: personalised use of current Crohn’s disease therapeutic options. Gut 62:1511–1515CrossRefPubMed

44.

Peloquin JM, Pardi DS, Sandborn WJ et al (2008) Diagnostic ionizing radiation exposure in a population-based cohort of patients with inflammatory bowel disease. Am J Gastroenterol 103:2015–2022PubMedCentralCrossRefPubMed

45.

Steward MJ, Punwani S, Proctor I et al (2012) Non-perforating small bowel Crohn’s disease assessed by MRI enterography: derivation and histopathological validation of an MR-based activity index. Eur J Radiol 81:2080–2088CrossRefPubMed

Title: Grading of Crohn’s disease activity using CT, MRI, US and scintigraphy: a meta-analysis
Authors: C. A. J. Puylaert
J. A. W. Tielbeek
S. Bipat
J. Stoker
Publication date: 01-11-2015
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 11/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-015-3737-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Grading of Crohn’s disease activity using CT, MRI, US and scintigraphy: a meta-analysis

Abstract

Purpose

Materials and methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusions

Key Points

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