Reliability of Measuring Ileo-Colonic Disease Activity in Crohn's Disease by Magnetic Resonance Enterography

Jairath V1,2,3, Ordas I4, Zou G2,3, Panes J4, Stoker J5, Taylor SA6, Santillan C7, Horsthuis K8, Samaan MA3,9, Shackelton LM3, Stitt LW3, Hindryckx P3,10, Khanna R1,3, Sandborn WJ3,7, D'Haens G3,5, Feagan BG1,2,3, Levesque BG3,7, Rimola J4. Inflamm Bowel Dis. 2018 Jan 18;24(2):440-449. doi: 10.1093/ibd/izx040.

Author information

1 Department of Medicine, Division of Gastroenterology, University of Western Ontario, London, Ontario, Canada.

2 Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada.

3 Robarts Clinical Trials Inc, London, Ontario, Canada.

4 Hospital Clinic Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.

5 Academic Medical Center, Amsterdam, The Netherlands.

6 University College London, London, United Kingdom.

7 University of California San Diego, La Jolla, United States.

8 VU Medical Center, Amsterdam, The Netherlands.

9 Department of Gastroenterology, Guy's & St Thomas' Hospital, London, UK.

10 Ghent University, Ghent, Belgium.


BACKGROUND: Magnetic resonance enterography is increasingly utilized for assessment of luminal Crohn's disease activity. The Magnetic Resonance Index of Activity and the London Index are the most commonly used outcome measures in clinical trials. We assessed the reliability of these indices and several additional items.

METHODS: A consensus process clarified scoring conventions and identified additional items based on face validity. Four experienced radiologists evaluated 50 images in triplicate, in random order, at least 1 month apart, using a central image management system. Intra- and interrater reliability were assessed by calculating and comparing intraclass correlation coefficients.

RESULTS: Intrarater intraclass correlation coefficients (95% confidence intervals) for the Magnetic Resonance Index of Activity, London, and London "extended" indices and a visual analogue scale were 0.89 (0.84 to 0.91), 0.87 (0.83 to 0.90), 0.89 (0.85 to 0.92), and 0.86 (0.81 to 0.90). Corresponding interrater intraclass correlation coefficients were 0.71 (0.61 to 0.77), 0.67 (0.55 to 0.75), 0.70 (0.61 to 0.76), and 0.71 (0.62 to 0.77). Reliability for each index was greatest in the terminal ileum and poorest in the rectum. All 3 indices were highly correlated with the visual analogue scale; 0.79 (0.71 to 0.85), 0.78 (0.71 to 0.84), and 0.79 (0.72 to 0.85) for the Magnetic Resonance Index of Activity, London, and the London "extended" indices, respectively.

CONCLUSIONS: "Substantial" interrater reliability was observed for all 3 indices. Future studies should assess responsiveness to treatment in order to confirm their utility as evaluative indices in clinical trials and clinical practice.

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