Intest Res.  2024 Apr;22(2):152-161. 10.5217/ir.2023.00095.

Assessing quality of magnetic resonance enterography and its impact on disease assessment of ileal Crohn’s disease

• Bohra A
• Connoley DJ
• Con D
• Segal JP
• Niewiadomski O
• Vasudevan A
• Langenberg DRV
• Kutaiba N

• KMID: 2554659
• DOI: http://doi.org/10.5217/ir.2023.00095

Abstract

Background/Aims
Assessment of quality of magnetic resonance enterography (MRE) in small bowel Crohn’s disease (CD) activity evaluation has received little attention. We assessed the impact of bowel distention and motion artifact on MRE activity indices in ileal CD.
Methods
A cohort of patients who underwent contemporaneous MRE and colonoscopy for ileal CD assessment between 2014 and 2021 at 2 centers were audited. An abdominal radiologist blinded to clinical data reviewed each MRE, graded bowel distention and motion artifact upon a pre-specified 3-point scale and calculated the original magnetic resonance index of activity (MaRIA) and simplified MaRIA (sMaRIA), London index and CD MRE index (CDMI). Ileal endoscopic activity was graded via the Simplified Endoscopy Score for CD (SES-CD). The performance of MRE indices in discriminating active disease (SES-CD ≥3) stratified by MRE quality was measured by receiver operator characteristic analyses.
Results
One hundred and thirty-seven patients had MRE and colonoscopy within a median of 16 days (range, 0–30 days) with 63 (46%) exhibiting active disease (SES-CD ≥3). Forty-four MREs (32%) were deemed low quality due to motion artifact and/or moderate to poor distention. Low-quality MREs demonstrated reduced discriminative performance between ileal SES-CD ≥3 and MRE indices (MaRIA 0.838 vs. 0.634, sMaRIA 0.834 vs. 0.527, CDMI 0.850 vs. 0.595, London 0.748 vs. 0.511, P<0.05 for all). Individually the presence of any motion artifact markedly impacted the discriminative performance (e.g., sMaRIA area under the curve 0.544 vs. 0.814, P<0.05).
Conclusions
Image quality parameters can significantly impact MRE disease activity interpretation. Quality metrics should be reported, enabling cautious interpretation in lower-quality studies.

Keyword

Diagnostic imaging; Crohn disease; Intestine, small

Figure

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  Fig. 1. Summary of grading applied to quality parameters. MRE, magnetic resonance enterography.

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  Fig. 2. Coronal T1 post-contrast sequence showing poor distension and marked movement artifact in proximal small bowel (arrow) and good distension and minor movement artifact in distal small bowel (arrowhead).

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  Fig. 3. (A) Coronal T2 sequence showing a long segment of inflammatory disease in distal small bowel (arrowhead) with high T2 signal in bowel wall and adjacent fat. (B) Corresponding coronal T1 post-contrast sequence showing poor distension and mark (arrow).

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  Fig. 4. Coronal T1 post-contrast sequence showing good distension and nil movement artifact (arrow).

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  Fig. 5. Coronal T1 post-contrast sequence showing moderate distension and marked movement artifact (arrow).

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