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    Diagnostic accuracy for the extent and activity of newly diagnosed and relapsed Crohn’s disease: a multicentre prospective comparison of magnetic resonance enterography and small bowel ultrasound –The METRIC Trial

    Taylor, S. and Mallett, S. and Bhatnagar, G. and Baldwin-Cleland, R. and Bloom, S. and Gupta, A. and Hamlin, P. and Hart, A. and Higginson, A. and Jacobs, I. and McCartney, S. and Miles, Anne and Murray, C. and Plumb, A. and Pollok, R. and Punwani, S. and Quinn, L. and Rodriguez-Justo, M. and Shabir, Z. and Slater, A. and Tolan, D. and Travis, S. and Windsor, A. and Wylie, P. and Zealley, I. and Halligan, S. (2018) Diagnostic accuracy for the extent and activity of newly diagnosed and relapsed Crohn’s disease: a multicentre prospective comparison of magnetic resonance enterography and small bowel ultrasound –The METRIC Trial. Lancet Gastroenterology and Hepatology , ISSN 2468-1253. (In Press)

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    Abstract

    Background Magnetic resonance enterography (MRE) and ultrasound (US) are used to image Crohn’s disease, but comparative accuracy for disease extent and activity is not known with certainty. We undertook a prospective multicentre cohort trial to address this Methods We recruited from 8 UK hospitals. Eligible patients were 16 years or older, newly diagnosed with Crohn’s disease, or had established disease with suspected relapse. Consecutive patients underwent MRE and US in addition to standard investigations. Discrepancy between MRE and US for small bowel (SB) disease presence triggered an additional investigation, if not already available. The primary outcome was difference in per patient sensitivity for SB disease extent (correct identification and segmental localisation) against a construct reference standard (panel diagnosis). Accuracy for SB and colonic disease presence and activity were secondary outcomes. The trial is completed (ISRCTN03982913). Findings 284 patients completed the trial (133 new diagnosis, 151 relapse). MRE sensitivity (n=233) for SB disease extent (80% [95%CI 72 to 86]) and presence (97% [91 to 99]) were significantly greater than US (70% [62 to 78], 92% [84 to 96]); a 10% (1 to 18; p=0.027), and 5% (1 to 9), difference respectively. MRE specificity for SB disease extent (95% [85 to 98]) was significantly greater than US (81% [64 to 91]). Sensitivity for active SB disease was significantly greater for MRE than US (96% [92 to 99] vs. 90% [82 to 95]), difference 6% (2 to 11). Overall, there were no significant accuracy differences for colonic disease presence. Accuracy in newly diagnosed and relapse patients was similar, although US had significantly greater sensitivity for colonic disease than MRE in newly diagnosed patients (67% [49 to 81) vs. 47% [31 to 64]), difference 20% (1 to 39). There were no serious adverse events. Interpretation MRE has higher diagnostic accuracy for the extent and activity of SB Crohn’s disease than US when tested in a prospective multi centre cohort trial setting.

    Metadata

    Item Type: Article
    School: Birkbeck Schools and Departments > School of Science > Psychological Sciences
    Depositing User: Anne Miles
    Date Deposited: 30 Apr 2018 12:36
    Last Modified: 26 Jul 2019 16:46
    URI: http://eprints.bbk.ac.uk/id/eprint/22280

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