Carl Alejandro Julien Puylaert MSc, Presenter: Nothing to Disclose

Jeroen Tielbeek MD, Abstract Co-Author: Nothing to Disclose

Shandra Bipat MS, Abstract Co-Author: Nothing to Disclose

Jaap Stoker MD, PhD, Abstract Co-Author: Research Consultant, Robarts Clinical Trials

To assess the role of computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US) and scintigraphy in grading Crohn’s disease (CD) activity.

MEDLINE, EMBASE and Cochrane databases were searched for studies evaluating CT, MRI, US and scintigraphy in grading CD activity as compared to (ileo)-colonoscopy, biopsies or intraoperative findings as the reference test. Two independent reviewers assessed the data. Three by three tables (none, mild, frank disease) were constructed for all studies and overall grading accuracy, overgrading and undergrading were calculated/summarized by fixed or random effects models.

Our search yielded 9356 articles, from which 19 articles were determined eligible for inclusion. A total of 549 patients were included. Per-patient data showed overall grading accuracy values for CT, MRI, US and scintigraphy of 86% (95%CI: 75–93%), 84% (95%CI: 67–93%), 44% (95%CI: 28–61%) and 40% (95%CI: 16–70%), respectively. CT and MRI data were pooled and showed similar overall grading accuracy estimates (P=0.8). CT and MRI showed similar overgrading (P=0.8) and undergrading (P=0.5). Per-segment data showed overall grading accuracy values for CT, MRI, US and scintigraphy of 87% (95%CI: 77–93%), 78% (95%CI: 72–82%), 66% (95%CI: 52–78%) and 86% (95%CI: 80–91%), respectively. CT showed similar grading accuracy to MRI (P=0.08) and scintigraphy (P=0.8). Both CT and scintigraphy showed higher grading accuracy than US (P=0.001 and P=0.003, respectively). Similar overgrading was seen between CT and MRI (P=0.7), CT and scintigraphy (P=0.2) and MRI and scintigraphy (P=0.09). MRI undergraded more than scintigraphy (P=0.004), while comparisons between CT and MRI and between CT and scintigraphy showed similar undergrading (P=0.1 and P=0.5, respectively).  

CT and MRI showed similar high accuracy values and similar over- and undergrading both in the per-patient and per-segment analyses. Results for US and scintigraphy were inconsistent and limited data was available. 

Both CT and MRI can be used for grading of Crohn's disease activity, with MRI being preferable as it lacks ionizing radiation exposure.

Puylaert, C, Tielbeek, J, Bipat, S, Stoker, J, Grading of Crohn’s Disease Activity Using CT, MRI, US and Scintigraphy: A Meta-analysis .  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14012815.html