Assessment of intestinal involvement in patients with Crohn’s disease using the MaRIA scoring system

Summary: Introduction: Imaging methods have an irreplaceable role in the diagnosis of Crohn’s disease. Several scoring systems are currently available to objectify the assessment of inflammatory bowel disease using predetermined parameters. The aim of this study was to compare the findings of inflammatory bowel involvement on colonoscopy and MRI using the MaRIA scoring system. Materials and methods: Patients with Crohn’s disease underwent colonoscopy and MR-enterography at the University Hospital Brno within 2 months between 2020 and 2022. Disease activity on colonoscopy was evaluated by SES-CD and Rutgeerts score; and on MRI by MaRIA score (wall thickening, wall enhancement, edema, and presence of ulceration). Findings from both imaging modalities were compared, and colonoscopy was chosen as the gold standard. In each patient, the terminal ileum, colon (divided anatomically into 4 segments), and rectum were analyzed. Results: 203 intestinal segments in 43 consecutive patients (42% male) were analyzed in this retrospective study. The sensitivity of MR enterography in the evaluation of intestinal inflammation activity was 62% and specificity was 94%. All parameters determining the activity of inflammation on MR were significantly higher in patients with activity according to the colonoscopy, and the overall MaRIA score was also higher in this group (12.76 ± 7.48 vs. 5.27 ± 3.45; P < 0.001). Sensitivity increased to 90% in isolated small bowel analysis, but decreased to 34% in colonic analysis. Conclusion: In our study, we demonstrated concordance between MRI using the MaRIA scoring system and colonoscopy in the evaluation of intestinal inflammation in patients with Crohn’s disease. Key words: magnetic resonance imaging – colonoscopy – Crohn’s disease – MaRIA