Evaluating MR enterography and intestinal ultrasound for ileal Crohn’s disease activity: a multicentre agreement study

Abstract Objectives We aimed to establish the level of agreement between signs of Crohn’s disease activity common to MR Enterography (MRE) and Intestinal Ultrasound (IUS). Materials and methods Retrospective review of the METRIC multicentre prospective cohort trial (ISRCTN03982913) of newly diagnosed or suspected relapsed Crohn’s disease undergoing contemporaneous MRE and IUS. Intermodality agreement for prespecified disease variables (10 MRE, 14 IUS) from the terminal ileum was assessed using Bland–Altman plots and percentage agreement against a multidisciplinary consensus panel reference standard. Imputation was used to account for disease not identified on either modality. Results 284 patients were included, median age 36 years (interquartile range, IQR: 17–68), 154/284 (54%) female. In the full cohort, intermodality 95% limits of agreement for terminal ileal mural thickness and disease length were −4.8 to 6.7 mm and −22.8 to 23.6 cm, respectively, and in the 158 patients with disease identified on both modalities, −4.0 to 6.3 mm and −27.5 to 29.1 cm, respectively. Increased mural T2 signal demonstrated the highest concordance with IUS submucosal layer thickening (91%, 141/155). Increased perimural T2 signal showed limited agreement with various IUS mesenteric observations (32–48%). There was 95% (147/155) agreement for global judgement of segmental disease severity and 74% (116/157) for obstruction. Conclusion While intermodality agreement for disease severity and obstruction is reasonable in patients with disease identified on both modalities, clinically important disagreement for mural thickness and disease length is frequent. Findings suggest caution in comparing individual parameters in isolation with potentially clinically significant intermodality disagreement. Key Points Question MR Enterography and Intestinal Ultrasound are used interchangeably in Crohn’s disease, but comparison between modalities is challenging. Findings We found reasonable intermodality agreement for global segmental disease activity but poor agreement for mural thickness, disease length, and most modality-specific activity parameters. Relevance statement This limited agreement is clinically significant with the potential to impact management decisions. Findings suggest caution in comparing individual disease parameters in isolation between MR Enterography and Intestinal Ultrasound. Instead, a holistic judgement of activity is more reliable.

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Published
2026-09-11
DOI
https://doi.org/10.1007/s44501-026-00002-8
Primary Topic
Inflammatory Bowel Disease
Type
article
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Evaluating MR enterography and intestinal ultrasound for ileal Crohn’s disease activity: a multicentre agreement study

S Tebbs, Farooq Rahman, Wivijin Piga, Fergus Thursby‐Pelham et al.
Inflammatory Bowel Disease
article

Evaluating MR enterography and intestinal ultrasound for ileal Crohn’s disease activity: a multicentre agreement study

S Tebbs, Farooq Rahman, Wivijin Piga, Fergus Thursby‐Pelham, S McCartney, Stuart A. Taylor, Maggie Betts, Stephen Morris, P. J. Hamlin, Christopher Alexakis, Nigel Scott, Rebecca Greenhalgh, Simona Caro, Jade Dyer, Mairead Tennent, Alastair Windsor, Richard Beable, Anne Miles, François Porte, Niall Power, Jonny Vlahos, Roman Jastrub, Florian Tomini, Hannah Lambie, Hameed Rafiee, Craig Mowat, S Bloom, Rajapandian Ilangovan, Anthony Higginson, Maira Hameed, Ilan Jacobs, Anita Wale, S Fourie, Helen Bungay, Roger Lapham, Doris Quartey, Zainib Shabir, Evgenia Mainta, Morgan Moorghen, Steve Hibbert, Claire Ward, Deborah Scrimshaw, Rachel Baldwin‐Cleland, Caron Innes, Gillian Duncan, Mani Naghibi, Richard Pollok, Teresita Beeston, Joey Clemente, Sue Mallett, Laura Quinn, Damian Tolan, Arun Gupta, Nicola Gibbons, Simon Travis, Adriana Martinez, Busola Adebusoye, Gauraang Bhatnagar, Harbir Sidhu, Peter Wylie, Uday Patel, Roser Vega, Shonit Punwani, Prinitha Veeramalla, Andrew Slater, James Pilcher, On Behalf Of the METRIC trial investigators, Anthony O’Connor, Shameer Metha, Richard Ellis, Phillip Lung, Rachel Hyland, Steve Halligan, Manuel Rodriguez-Justo, Andrew AO Plumb, Ian Zealley, Charles D. Murray, Anisur Rahman, Ailsa L. Hart, Ian Johnston
article en

Abstract

Abstract Objectives We aimed to establish the level of agreement between signs of Crohn’s disease activity common to MR Enterography (MRE) and Intestinal Ultrasound (IUS). Materials and methods Retrospective review of the METRIC multicentre prospective cohort trial (ISRCTN03982913) of newly diagnosed or suspected relapsed Crohn’s disease undergoing contemporaneous MRE and IUS. Intermodality agreement for prespecified disease variables (10 MRE, 14 IUS) from the terminal ileum was assessed using Bland–Altman plots and percentage agreement against a multidisciplinary consensus panel reference standard. Imputation was used to account for disease not identified on either modality. Results 284 patients were included, median age 36 years (interquartile range, IQR: 17–68), 154/284 (54%) female. In the full cohort, intermodality 95% limits of agreement for terminal ileal mural thickness and disease length were −4.8 to 6.7 mm and −22.8 to 23.6 cm, respectively, and in the 158 patients with disease identified on both modalities, −4.0 to 6.3 mm and −27.5 to 29.1 cm, respectively. Increased mural T2 signal demonstrated the highest concordance with IUS submucosal layer thickening (91%, 141/155). Increased perimural T2 signal showed limited agreement with various IUS mesenteric observations (32–48%). There was 95% (147/155) agreement for global judgement of segmental disease severity and 74% (116/157) for obstruction. Conclusion While intermodality agreement for disease severity and obstruction is reasonable in patients with disease identified on both modalities, clinically important disagreement for mural thickness and disease length is frequent. Findings suggest caution in comparing individual parameters in isolation with potentially clinically significant intermodality disagreement. Key Points Question MR Enterography and Intestinal Ultrasound are used interchangeably in Crohn’s disease, but comparison between modalities is challenging. Findings We found reasonable intermodality agreement for global segmental disease activity but poor agreement for mural thickness, disease length, and most modality-specific activity parameters. Relevance statement This limited agreement is clinically significant with the potential to impact management decisions. Findings suggest caution in comparing individual disease parameters in isolation between MR Enterography and Intestinal Ultrasound. Instead, a holistic judgement of activity is more reliable.

Vol. 1(1)
Royal Free London NHS Foundation Trust (GB), Leeds Teaching Hospitals NHS Trust (GB), Norfolk and Norwich University Hospitals NHS Foundation Trust (GB), St George’s University Hospitals NHS Foundation Trust (GB), Frimley Park Hospital (GB), Royal London Hospital (GB), St James's University Hospital (GB), Ninewells Hospital (GB), Portsmouth Hospitals NHS Trust (GB), Oxford University Hospitals NHS Trust (GB), St Mark's Hospital (GB), NIHR Birmingham Biomedical Research Centre (GB), University College London (GB), University of Birmingham (GB), Birkbeck, University of London (GB)
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Inflammatory Bowel Disease
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