MRE Boosts Confidence in Managing Crohn Disease
Gastroenterologists have more confidence in managing small bowel (SB) Crohn disease (CD) when using structured magnetic resonance enterography (MRE) reporting, according to findings from a retrospective study presented at the American College of Gastroenterology Annual Meeting 2018.
“Structured MRE reporting significantly changes medical management of small bowel CD,” said Dr Chiplunker, third-year fellow in the division of gastroenterology at Washington University School of Medicine in St. Louis, during her presentation.
IF YOU LIKE THIS, READ MORE...
The Future of IBD Is Personalized Medicine
In IBD, Can Identifying Risk Factors Improve Drug Adherence?
The Society of Abdominal Radiology Crohn’s Disease-Focused Panel (SAR CDFP) encourages structured reporting of MRE for diagnosis and assessment of severity of CD with SB involvement. However, its use in clinical practice is erratic and the effect on management has remained unknown.
For their study, Chiplunker and colleagues reviewed 269 consecutive charts of 556 patients who received treatment for CD between 2010 and 2017. A total of 25 patients had at least 2 consecutive MREs available for evaluation and were further analyzed in the review.
The researchers created a structured MRE report based on SAR CDFP recommendations.
Two gastroenterologists with 1 and 10 years of expertise in IBD received 50 clinical vignettes for review, as well as nonstructured or structured MRE reports in alternating fashion with a washout period of 2 months.
The clinicians provided CD management decisions along with confidence levels connected with change in therapy choice and dose escalation or de-escalation for each occasion within the nonstructured or structured report.
Analysis using paired data from the gastroenterologists’ responses (n = 100) to vignettes and MRE reports was performed using the McNemar test.
Overall, the structured MRE report altered CD management compared with the nonstructured clinical report for both gastroenterologists. The MRE also changed CD management for initiation of corticosteroids (24% vs 11%) and biologic usage to starting and changing dose or type (88% vs 73%).
The MRE was associated with a higher confidence among the gastroenterologists for presence or absence of active disease (100% vs 63%) and stricturing disease (97% vs 47%) compared with the clinical report.
“Implementation of a structured MRE report may allow non-CD focused radiologists to comment of radiographic findings pertinent to the clinical management of CD,” Chiplunker said.
Reference:
Chiplunker A, Tsai R, Christophi G, et al. Impact of a standardized reporting system for magnetic resonance enterography on small bowel Crohn’s disease management. Paper presented at: American College of Gastroenterology Annual Meeting 2018; October 5-10, 2018; Philadelphia, PA. https://www.eventscribe.com/2018/ACG/agenda.asp?h=Full%20Schedule&BCFO=P|G. Accessed October 9, 2018.