Grading of Crohn’s disease activity using CT, MRI, US and scintigraphy: a meta-analysis

• Published in: European radiology 2015-11, Vol.25 (11), p.3295-3313
• Main Authors: Puylaert, C. A. J., Tielbeek, J. A. W., Bipat, S., Stoker, J.
• Format: Article
• Language: English
• Subjects: Accuracy; Adolescent; Adult; Aged; Biopsy; Case reports; Crohn Disease - diagnostic imaging; Crohn Disease - pathology; Crohn's disease; Diagnostic Radiology; Endoscopy; Female; Gastrointestinal; Humans; Imaging; Inflammatory bowel disease; Internal Medicine; Interventional Radiology; Irritable Bowel Syndrome - diagnostic imaging; Irritable Bowel Syndrome - pathology; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Meta-analysis; Middle Aged; Neuroradiology; Patients; Positron-Emission Tomography; Radiology; Reference Standards; Scintigraphy; Sensitivity and Specificity; Small intestine; Tomography; Tomography, X-Ray Computed; Ultrasonic imaging; Ultrasonography; Ultrasound; Young Adult
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-015-3737-9

Purpose To assess the grading of Crohn’s disease activity using CT, MRI, US and scintigraphy. Materials and methods MEDLINE, EMBASE and Cochrane databases were searched (January 1983–March 2014) for studies evaluating CT, MRI, US and scintigraphy in grading Crohn’s disease activity compared to endoscopy, biopsies or intraoperative findings. Two independent reviewers assessed the data. Three-by-three tables (none, mild, frank disease) were constructed for all studies, and estimates of accurate, over- and under-grading were calculated/summarized by fixed or random effects models. Results Our search yielded 9356 articles, 19 of which were included. Per-patient data showed accurate grading 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. In the per-patient analysis, CT and MRI showed similar accurate grading estimates ( P  = 0.8). Per-segment data showed accurate grading values for CT and scintigraphy of 87 % (95 % CI: 77–93 %) and 86 % (95 % CI: 80–91 %), respectively. MRI and US showed grading accuracies of 67–82 % and 56–75 %, respectively. Conclusions CT and MRI showed comparable high accurate grading estimates in the per-patient analysis. Results for US and scintigraphy were inconsistent, and limited data were available. Key Points • CT and MRI have comparable high accuracy in grading Crohn’s disease . • Data on US and scintigraphy is inconsistent and limited . • MRI is preferable over CT as it lacks ionizing radiation exposure .