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.
Similar content being viewed by others
References
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
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
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
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
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
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
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
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
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
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
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
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
Hill NS, DiSantis DJ (2015) The comb sign. Abdom Imaging 40(5):1010. doi:10.1007/s00261-014-0285-8
StataCorp (2015) Stata Statistical Software: Release 14. College Station, TX: StataCorp LP
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
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):293–297
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):563–570
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
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
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
Cosnes J, Cattan S, Blain A, et al. (2002) Long-term evolution of disease behavior of Crohn’s disease. Inflamm Bowel Dis 8(4):244–250
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
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
Acknowledgement
This work was supported by the Gatorade Trust through funds distributed by the University of Florida, Department of Medicine.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Additional information
Andrew Flint and Naueen A. Chaudhry are co-first authors.
Rights and permissions
About this article
Cite this article
Flint, A., Chaudhry, N.A., Riverso, M. et al. Effective communication of cross-sectional imaging findings in Crohn’s disease: comparing conventional EMR reporting to a published scoring system. Abdom Radiol 43, 1798–1806 (2018). https://doi.org/10.1007/s00261-017-1368-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-017-1368-0