Development and Validation of a Simplified Magnetic Resonance Index of Activity for Crohn's Disease
Development and Validation of a Simplified Magnetic Resonance Index of Activity for Crohn's Disease
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DOI：
10.1053/j.gastro.2019.03.051
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发表时间：
2019-08-01
期刊：
影响因子：
29.4
通讯作者：
Panes, Julian
中科院分区：
文献类型：
--
作者：
Ordas, Ingrid;Rimola, Jordi;Panes, Julian
背景与目的：磁共振活动指数（MARIA）用于评估克罗恩病（CD）管腔CD的活动性。然而，它有一些实际限制。我们的目标是开发和验证简化的MARIA，以更容易和快速地评估CD活性和对治疗的反应。患者和方法：我们对2项研究中98名参与者的磁共振成像数据进行了回顾性分析。我们使用逻辑回归分析来确定与CD内镜严重指数（CDEIS）评分（参考标准）独立相关的磁共振成像参数。我们在一个由37名患者组成的独立队列中验证了简化MARIA的反应性和可靠性，这些患者在治疗干预前后接受了磁共振成像和内窥镜检查。研究结果：Logistic回归分析显示，肠壁增厚（>3 mm）、存在肠壁水肿、肠周脂肪搁浅和溃疡的二分定性评估与CDEIS评分独立相关;我们使用这些因素创建简化的MARIA。简化的MARIA评分大于1可识别活动性CD节段，灵敏度为90%，特异性为81%（曲线下面积0.91; 95%置信区间0.88-0.94）。简化的MARIA评分为2分或2分以上，检测到严重病变（溃疡），灵敏度为85%，特异性为92%（曲线下面积为0.94; 95%置信区间为0.91-0.96）。对于每例患者，简化的MARIA评分与CDEIS评分（r = 0.83）和简化的MARIA评分与原始MARIA评分（r = 0.93）之间存在高度相关性（P <0.001）。简化的MARIA评分准确地检测了治疗后病变严重程度的变化，并且在评估粘膜愈合方面与内镜检查一样可靠。结论：我们开发并验证了一种简化的MARIA，用于更容易和更快地评估CD活动和严重程度。该指数以高水平的准确性识别对治疗有反应的患者。这些发现需要在独立的多读者研究中得到证实。
BACKGROUND & AIMS: The magnetic resonance index of activity (MARIA) for Crohn's disease (CD) is used to assess the activity of luminal CD. However, it has a number of practical limitations. We aimed to develop and validate a simplified MARIA to more easily and quickly assess CD activity and response to therapy. PATIENTS AND METHODS: We performed a retrospective analysis of magnetic resonance imaging data from 98 participants in 2 studies. We used logistic regression analysis to identify magnetic resonance imaging parameters independently associated with CD endoscopic index of severity (CDEIS) scores (the reference standard). We validated the responsiveness and reliability of the simplified MARIA in an independent cohort of 37 patients who underwent magnetic resonance imaging and endoscopy before and after a therapeutic intervention. RESULTS: Logistic regression analysis showed that dichotomous qualitative assessment of wall thickening (>3 mm), presence of mural edema, perienteric fat stranding, and ulcers were independently associated with CDEIS scores; we used these factors to create a simplified MARIA. Simplified MARIA scores greater than 1 identified segments with active CD with 90% sensitivity and 81% specificity (area under the curve 0.91; 95% confidence interval 0.88-0.94). Simplified MARIA scores of 2 or more detected severe lesions (ulcers) with 85% sensitivity and 92% specificity (area under the curve 0.94; 95% confidence interval 0.91-0.96). For each patient, there was a high level of correlation between simplified MARIA scores and CDEIS scores (r = 0.83) and simplified MARIA scores and original MARIA scores (and r = 0.93) (P < .001). The simplified MARIA score accurately detected changes in lesion severity in response to therapy and was as reliable as endoscopy for the assessment of mucosal healing. CONCLUSION: We developed and validated a simplified MARIA for easier and faster assessment of CD activity and severity. This index identifies patients with a response to therapy with a high level of accuracy. These findings require confirmation in independent, multireader studies.