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P167. Proposal of a modified phenotype-based radiological classification: the magnetic resonance Crohn's disease severity index (MR- CSI)

R. Sacco1, E. Neri2, R. Scandiffio2, L. Faggioni2, M. Bertini1, A. Romano1, F. Costa3, G. Federici1, G. Parisi1, S. Marchi3, G. Bresci1, C. Bartolozzi2, 1Gastroenterology and Metabolic Diseases, Gastroenterology, Pisa, Italy, 2Pisa University Hospital, Radiology, Pisa, Italy, 3Pisa University Hospital, Gastroenterology, Pisa, Italy

Background

Crohn's disease (CD) is a chronic inflammatory bowel disease, with different clinical features and pathological course, characterized by a relapsing and remitting trend. We worked out a radiological score in the assessment of Crohn's disease activity and severity.

Methods

From July 2011 to February 2012, 46 patients with suspected or established Crohn's disease underwent small bowel MRI on a 3T scanner. According to radiological findings and disease behaviour phenotype (as proposed in the Montreal classification), patients were divided into 5 classes:

  1. absence of disease
  2. disease activity (presence of one of following findings: mucosal abnormalities, submucosal edema, mucosal enhancement)
  3. presence of substenosis without obstruction
    1. active disease
    2. inactive disease
  4. presence of stenosis with obstruction
    1. active disease
    2. inactive disease
  5. extramural involvement (fistulas and/or abscess)

Data were correlated with endoscopical findings, CDAI, CRP and ESR.

Results

A significant correlation (r = 0.88, p < 0.001) was registered between endoscopical findings and MR score. A good correlation of MRI- CSI was observed with CDAI (r = 0.59, p < 0.01); correlation was superimposable (r = 0.59, p < 0.01) if subgroups were divided into active/ non active disease. A moderate correlation of MR- CSI was observed with ESR (0.49, p = 0.001) and CRP (0.47, p = 0.001). Correlation appears higher if subgroups were divided into active/inactive disease (0.66 and 0.59 respectively).

Conclusion

MR- CSI is a quick, manageable score, easy to apply in daily practice; furthermore, MR can be used in the evaluation of CD as an alternative to ileocolonoscopy.