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Magnetic resonance enterography has good inter-rater agreement and diagnostic accuracy for detecting inflammation in pediatric Crohn disease

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Abstract

Background

Magnetic resonance enterography (MRE) is increasingly relied upon for noninvasive assessment of intestinal inflammation in Crohn disease. However very few studies have examined the diagnostic accuracy of individual MRE signs in children.

Objective

We have created an MR-based multi-item measure of intestinal inflammation in children with Crohn disease — the Pediatric Inflammatory Crohn’s MRE Index (PICMI). To inform item selection for this instrument, we explored the inter-rater agreement and diagnostic accuracy of individual MRE signs of inflammation in pediatric Crohn disease and compared our findings with the reference standards of the weighted Pediatric Crohn’s Disease Activity Index (wPCDAI) and C-reactive protein (CRP).

Materials and methods

In this cross-sectional single-center study, MRE studies in 48 children with diagnosed Crohn disease (66% male, median age 15.5 years) were reviewed by two independent radiologists for the presence of 15 MRE signs of inflammation. Using kappa statistics we explored inter-rater agreement for each MRE sign across 10 anatomical segments of the gastrointestinal tract. We correlated MRE signs with the reference standards using correlation coefficients. Radiologists measured the length of inflamed bowel in each segment of the gastrointestinal tract. In each segment, MRE signs were scored as either binary (0-absent, 1-present), or ordinal (0-absent, 1-mild, 2-marked). These segmental scores were weighted by the length of involved bowel and were summed to produce a weighted score per patient for each MRE sign. Using a combination of wPCDAI≥12.5 and CRP≥5 to define active inflammation, we calculated area under the receiver operating characteristic curve (AUC) for each weighted MRE sign.

Results

Bowel wall enhancement, wall T2 hyperintensity, wall thickening and wall diffusion-weighted imaging (DWI) hyperintensity were most commonly identified. Inter-rater agreement was best for decreased motility and wall DWI hyperintensity (kappa≥0.64). Correlation between MRE signs and wPCDAI was higher than with CRP. AUC was highest (≥0.75) for ulcers, wall enhancement, wall thickening, wall T2 hyperintensity and wall DWI hyperintensity.

Conclusion

Some MRE signs had good inter-rater agreement and AUC for detection of inflammation in children with Crohn disease.

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Acknowledgements

The authors received funding for this study from an educational grant from the Canadian Association of Gastroenterology and Takeda Canada Inc. The authors are grateful to Karoline Fiedler for assisting in data extraction.

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology & Nutrition, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, 555 University Ave., Toronto, ON, Canada, M5G 1X8

    Peter C. Church, Anne M. Griffiths & Thomas D. Walters

  2. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Peter C. Church, Andrea S. Doria & Brian M. Feldman

  3. Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada

    Mary-Louise C. Greer, Ruth Cytter-Kuint & Andrea S. Doria

  4. SickKids Inflammatory Bowel Disease Center, The Hospital for Sick Children, Toronto, ON, Canada

    Anne M. Griffiths & Thomas D. Walters

  5. Shaare Zedek Medical Center, Jerusalem, Israel

    Dan Turner

  6. Division of Rheumatology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON, Canada

    Brian M. Feldman

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  1. Peter C. Church
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  2. Mary-Louise C. Greer
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Correspondence to Peter C. Church.

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The hospital and university research ethics boards approved this study and waived the requirement for informed consent.

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Church, P.C., Greer, ML.C., Cytter-Kuint, R. et al. Magnetic resonance enterography has good inter-rater agreement and diagnostic accuracy for detecting inflammation in pediatric Crohn disease. Pediatr Radiol 47, 565–575 (2017). https://doi.org/10.1007/s00247-017-3790-4

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  • DOI: https://doi.org/10.1007/s00247-017-3790-4

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