A simplified magnetic resonance enterography approach based on the most inflamed bowel segment performed comparably to a full multi-segment scoring system for assessing Crohn disease activity and predicting remission.
In a retrospective cohort study, researchers evaluated 252 patients with suspected or known Crohn disease who underwent magnetic resonance enterography (MRE). Using the simplified magnetic resonance index of activity (sMARIA), three radiologists scored six bowel segments per patient and identified the maximal segmental score as the highest segment-specific value. Among 77 patients who also underwent ileocolonoscopy within 4 weeks, disease activity was assessed using the simple endoscopic score for Crohn disease (SES-CD).
The maximal segmental score showed a very strong correlation with the global sMARIA score, suggesting that overall disease activity is largely driven by the most inflamed segment. In patients with endoscopic data, both scoring approaches showed similar, moderate correlations with SES-CD, with no statistically significant difference between them.
For predicting endoscopic remission, defined as a score less than three, performance was similar between methods, with area under the curve values of 0.84 vs 0.85 for the maximal segmental and global scores, respectively.
A secondary analysis found that combining the two most inflamed segments performed similarly to the global score.
The simplified score also tracked changes in disease activity, showing strong correlation with the global score on follow-up imaging. Interobserver agreement among radiologists was high for both approaches. In a subgroup of patients with inflammation in multiple bowel segments, correlations were lower but remained significant.
The study was limited by its retrospective design and potential selection bias. Endoscopic reference data were available for 31% of patients. The maximal segmental score was derived retrospectively rather than applied prospectively in clinical workflow, and some bowel segments may not have been fully evaluated because of imaging protocol constraints.
In their conclusion, Nieun Seo, MD, PhD, of Yonsei University College of Medicine, and colleagues wrote that “the Maximal Segmental Score based on the evaluation of the most inflamed bowel segment can be a simple practical MRE-based index to represent overall disease activity and predict endoscopic remission in CD.”
Disclosures: The study was supported by national and institutional research funding. The researchers reported no conflicts of interest.
Source: Medicine