MRI Follow-through evaluation in patients with Crohn's disease of the terminal ileum using an activity score including motility study: preliminary results.

Pur pose: to investigate the value of an MRI scoring system including dynamic motility evaluation in assessing small bowel Crohn’s disease activity. Materials and Methods: from March 2005 to December 2006 52 symptomatic patients with suspected Crohn’s disease onset or relapse underwent MRI on a 1.5T magnet. Bowel distension was achieved orally assuming a mean of 1.6L of a Poli-etylen-glicole (PEG) preparation. Per-patient assessment of disease activity was based on a scoring system including morphological and kinematic evaluation of the small bowel and perivisceral structures (true-FISP, cine-true-FISP and HASTE T2w sequences), and dynamic assessment of parietal contrast enhancement (VIBE T1w sequence). Patients were classified in three categories, using endoscopic biopsy as the standard reference: no activity/quiescent disease, low to moderate activity, severe activity. Patients without terminal ileum involvement were excluded from data analysis. Results: MRI achieved a detailed and panoramic evaluation of the small bowel in all cases, showing . terminal ileum involvement in 45 cases. Overall, MRI determined a per-patient misdiagnosis of disease activity in a not significant proportion of subjects (4/45; 8.8%) (p>0.05), showing sensitivity, specificity, PPV, NPV and overall accuracy in determining disease activity of 93.1%, 87.5%, 93.1%, 87.5% and 91.1%, respectively. Conclusion: MRI follow-trough provides a highly accurate assessment of Crohn’s disease activity. Clinical relevance/Application: MRI is a promising tool in assessing Crohn’s disease activity, but to date no activity scores have proven suitable for everyday clinical use. A simple activity score to provide an overall interpretation of MRI findings of Crohn’s disease is proposed in this study.