Effective communication of cross-sectional imaging findings in Crohn’s disease: comparing conventional EMR reporting to a published scoring system

  • Andrew Flint
  • Naueen A. Chaudhry
  • Michael Riverso
  • Angela Pham
  • Patricia P. Moser
  • Lazarus K. Mramba
  • Ellen M. Zimmermann
  • Joseph R. Grajo
Article

Abstract

Purpose

The purpose of the article is to compare information regarding small bowel lesions in Crohn’s disease (CD) patients communicated by a published scoring system and radiology reports from electronic medical record (EMR) of cross-sectional abdominal imaging.

Methods

Two gastrointestinal radiologists (reference readers) blinded to EMR reports scored cross-sectional imaging exams using a published scoring system. Investigators compared EMR and radiologist scores based on the mentioned findings and severity documentation of each variable. Statistical analysis involved means and difference in proportions and logistic regression modeling.

Results

Seventy-three CD patients, with average age 40.6 years (± SD 14.4), having 80 small bowel lesions on imaging were included. EMR reports reliably mentioned within the consensus score included thickness (79%, p = 0.000), enhancement (70%, p = 0.000), active inflammation (86%, p = 0.000), perienteric fluid (82%, p = 0.000), and presence of stricture (62%, p = 0.002). Minimal lumen diameter (19%, p = 0.000), comb sign (19%, p = 0.000), lesion length (57%, p = 0.06), and fistula (50%, p = 1.0) were reported less often. There was a strong association between the EMR and scoring scale in noting severity of active inflammation (88%, p = 0.000), perienteric fluid (76%, p = 0.000), and internal fistula (71%, p = 0.000). The proportion matching severity values of comb sign and minimal lumen were 24% and 21%, respectively (p = 0.000). Severity matches for stricture were less likely among the non-GI radiologists (odds ratio = 0.33, SE = 0.168, p = 0.029). The odds of reporting stricture and fistula severity were 3.6 and 5.7, respectively, on MRE.

Conclusions

Findings and severity of inflammation were communicated consistently. Stricture severity including minimal luminal diameter, was less reliably reported, though its prognostic significance impacts management.

Keywords

Crohn’s disease Bowel stricture Magnetic resonance enterography CT enterography Radiological scoring system Published scoring system 

Notes

Acknowledgement

This work was supported by the Gatorade Trust through funds distributed by the University of Florida, Department of Medicine.

Compliance with ethical standards

Funding

This study was not funded by a grant.

Conflict of interest

None of the authors have any conflict of interest to declare in the context of this study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

This was a retrospective study, using pre-existing data in medical records, and no patient interaction was necessary. Hence, the requirement of informed consent was waived by institutional IRB.

References

  1. 1.
    Grand DJ, Guglielmo FF, Al-Hawary MM (2015) MR enterography in Crohn’s disease: current consensus on optimal imaging technique and future advances from the SAR Crohn’s disease-focused panel. Abdom Imaging 40(5):953–964. doi: 10.1007/s00261-015-0361-8 CrossRefPubMedGoogle Scholar
  2. 2.
    Dillman JR, Trout AT, Smith EA (2016) MR enterography: how to deliver added value. Pediatr Radiol 46(6):829–837. doi: 10.1007/s00247-016-3555-5 CrossRefPubMedGoogle Scholar
  3. 3.
    Pazahr S, Blume I, Frei P, et al. (2013) Magnetization transfer for the assessment of bowel fibrosis in patients with Crohn’s disease: initial experience. MAGMA 26(3):291–301. doi: 10.1007/s10334-012-0355-2 CrossRefPubMedGoogle Scholar
  4. 4.
    Deepak P, Fletcher JG, Fidler JL, et al. (2016) Radiological response is associated with better long-term outcomes and is a potential treatment target in patients with small bowel Crohn’s disease. Am J Gastroenterol 111(7):997–1006. doi: 10.1038/ajg.2016.177 CrossRefPubMedGoogle Scholar
  5. 5.
    Rieder F, Zimmermann EM, Remzi FH, Sandborn WJ (2013) Crohn’s disease complicated by strictures: a systematic review. Gut 62(7):1072–1084. doi: 10.1136/gutjnl-2012-304353 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Adler J, Punglia DR, Dillman JR, et al. (2012) Computed tomography enterography findings correlate with tissue inflammation, not fibrosis in resected small bowel Crohn’s disease. Inflamm Bowel Dis 18(5):849–856. doi: 10.1002/ibd.21801 CrossRefPubMedGoogle Scholar
  7. 7.
    Gibson DJ, Murphy DJ, Smyth AE, et al. (2015) Magnetic resonance enterography findings as predictors of clinical outcome following antitumor necrosis factor treatment in small bowel Crohn’s disease. Eur J Gastroenterol Hepatol 27(8):956–962. doi: 10.1097/MEG.0000000000000399 CrossRefPubMedGoogle Scholar
  8. 8.
    Quencer KB, Nimkin K, Mino-Kenudson M, Gee MS (2013) Detecting active inflammation and fibrosis in pediatric Crohn’s disease: prospective evaluation of MR-E and CT-E. Abdom Imaging 38(4):705–713. doi: 10.1007/s00261-013-9981-z CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Higgins PD, Fletcher JG (2015) Characterization of inflammation and fibrosis in Crohn’s disease lesions by magnetic resonance imaging. Am J Gastroenterol 110(3):441–443. doi: 10.1038/ajg.2015.26 CrossRefPubMedGoogle Scholar
  10. 10.
    Deepak P, Fletcher JG, Fidler JL, Bruining DH (2016) Computed tomography and magnetic resonance enterography in Crohn’s disease: assessment of radiologic criteria and endpoints for clinical practice and trials. Inflamm Bowel Dis 22(9):2280–2288. doi: 10.1097/MIB.0000000000000845 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Chaudhry NA, Riverso M, Grajo JR, et al. (2017) A fixed stricture on routine cross-sectional imaging predicts disease-related complications and adverse outcomes in patients with Crohn’s disease. Inflamm Bowel Dis 23(4):641–649. doi: 10.1097/MIB.0000000000001054 CrossRefPubMedGoogle Scholar
  12. 12.
    Rimola J, Ordás I, Rodriguez S, et al. (2011) Magnetic resonance imaging for evaluation of Crohn’s disease: validation of parameters of severity and quantitative index of activity. Inflamm Bowel Dis 17(8):1759–1768. doi: 10.1002/ibd.21551 CrossRefPubMedGoogle Scholar
  13. 13.
    Hill NS, DiSantis DJ (2015) The comb sign. Abdom Imaging 40(5):1010. doi: 10.1007/s00261-014-0285-8 CrossRefPubMedGoogle Scholar
  14. 14.
    StataCorp (2015) Stata Statistical Software: Release 14. College Station, TX: StataCorp LPGoogle Scholar
  15. 15.
    Gale HI, Sharatz SM, Taphey M, et al. (2017) Comparison of CT enterography and MR enterography imaging features of active Crohn disease in children and adolescents. Pediatr Radiol . doi: 10.1007/s00247-017-3876-z Google Scholar
  16. 16.
    Amitai MM, Raviv-Zilka L, Hertz M, et al. (2015) Main imaging features of Crohn’s Disease: agreement between MR-enterography and CT-enterography. Isr Med Assoc J 17(5):293–297PubMedGoogle Scholar
  17. 17.
    Ippolito D, Invernizzi F, Galimberti S, Panelli MR, Sironi S (2010) MR enterography with polyethylene glycol as oral contrast medium in the follow-up of patients with Crohn disease: comparison with CT enterography. Abdom Imaging 35(5):563–570CrossRefPubMedGoogle Scholar
  18. 18.
    Qiu Y, Mao R, Chen BL, et al. (2014) Systematic review with meta-analysis: magnetic resonance enterography vs. computed tomography enterography for evaluating disease activity in small bowel Crohn’s disease. Aliment Pharmacol Ther 40(2):134–146. doi: 10.1111/apt.12815 CrossRefPubMedGoogle Scholar
  19. 19.
    Fiorino G, Bonifacio C, Peyrin-Biroulet L, et al. (2011) Prospective comparison of computed tomography enterography and magnetic resonance enterography for assessment of disease activity and complications in ileocolonic Crohn’s disease. Inflamm Bowel Dis 17(5):1073–1080. doi: 10.1002/ibd.21533 CrossRefPubMedGoogle Scholar
  20. 20.
    Desai D (2015) Disease behaviour in patients with Crohn’s Disease: a review. Gastroenterol Hepatol Open Access 3(2):00076. doi: 10.15406/ghoa.2015.03.00076 Google Scholar
  21. 21.
    Cosnes J, Cattan S, Blain A, et al. (2002) Long-term evolution of disease behavior of Crohn’s disease. Inflamm Bowel Dis 8(4):244–250CrossRefPubMedGoogle Scholar
  22. 22.
    Sauer CG, Middleton JP, McCracken C, et al. (2016) Magnetic resonance enterography healing and magnetic resonance enterography remission predicts improved outcome in pediatric Crohn disease. J Pediatr Gastroenterol Nutr 62(3):378–383. doi: 10.1097/MPG.0000000000000976 CrossRefPubMedGoogle Scholar
  23. 23.
    Mandel MD, Miheller P, Müllner K, Golovics PA, Lakatos PL (2014) Have biologics changed the natural history of Crohn’s disease? Dig Dis 32(4):351–359. doi: 10.1159/000358135 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Division of Gastroenterology and Hepatology, Department of MedicineUniversity of Florida College of MedicineGainesvilleUSA
  2. 2.Division of Abdominal Imaging, Department of RadiologyUniversity of Florida College of MedicineGainesvilleUSA

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