J Am Coll Radiol. 2024 Mar;21(3):441-463. doi: 10.1016/j.jacr.2023.09.010. Epub 2023 Oct 17.

Grace C Lovett ¹, Julien D Schulberg ², Amy L Hamilton ², Helen E Wilding ³, Michael A Kamm ⁴, Emily K Wright ⁵

Author information

¹Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia. Electronic address: grace.lovett@svha.org.au.

²Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia.

³Library Service, St. Vincent's Hospital Melbourne, Melbourne, Australia.

⁴Professor of Gastroenterology, Department of Medicine, University of Melbourne, Melbourne, Australia.

⁵Associate Professor of Gastroenterology, Department of Medicine, University of Melbourne, Melbourne, Australia.

Abstract

Purpose: Cross-sectional imaging facilitates the assessment of transmural healing in patients with Crohn's disease. This systematic review addresses the utility of MRI and intestinal ultrasound (IUS) in the assessment of disease activity in response to drug therapy compared with endoscopy in patients with luminal Crohn's disease.

Methods: Database searches were undertaken using predefined terms. Studies with ≥10 patients with luminal Crohn's disease with paired endoscopy and imaging (MRI or IUS) after treatment initiation were included. Publications were identified through searches of six bibliographic databases, all run on June 24, 2022. Records were screened on title and abstract, then full text, by two independent reviewers.

Results: In total, 5,760 records were identified, with 24 studies meeting the inclusion criteria. Ten studies examined IUS and found good correlation between IUS and endoscopic remission (κ = 0.63-0.73). Early reduction in bowel wall thickness at 4 to 8 weeks predicted endoscopic response at 12 to 38 weeks (area under the receiver operating characteristic curve [AUROC], 0.77; odds ratio, 10.8; P = .01). Twelve studies examined MRI, with the Magnetic Resonance Index of Activity score having high accuracy for predicting endoscopic remission (AUROC, 0.97; sensitivity, 93%; specificity, 77%). A Simplified Magnetic Resonance Index of Activity score cutoff of ≥1 identifies active endoscopic disease (AUROC, 0.92; 95% confidence interval, 0.88-0.95; P < .0001).

Conclusions: IUS and MRI are both reliable, noninvasive modalities for assessing transmural healing in patients with Crohn's disease and are accurate in monitoring the response to drug therapy. These modalities can be used to monitor response to biologic induction therapy, with early changes predictive of response to treatment.