Open AccessThe new simplified MARIA score applies beyond clinical trials: A suitable clinical practice tool for Crohn’s disease that parallels a simple endoscopic index and fecal calprotectin
Author(s) -
Roseira Joana,
Ventosa Ana Rita,
Sousa Helena Tavares,
Brito Jorge
Publication year - 2020
Publication title -
ueg journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 35
eISSN - 2050-6414
pISSN - 2050-6406
DOI - 10.1177/2050640620943089
Subject(s) - medicine , intraclass correlation , calprotectin , confidence interval , gastroenterology , endoscopy , crohn's disease , colonoscopy , correlation , inter rater reliability , clinical practice , cohort , magnetic resonance imaging , nuclear medicine , disease , radiology , inflammatory bowel disease , colorectal cancer , physical therapy , statistics , clinical psychology , rating scale , geometry , mathematics , cancer , psychometrics
Background A simplified magnetic resonance enterography (MRe) index (sMARIA) for Crohn’s disease (CD) was recently developed and validated. Objective Our aims were (a) to assess sMARIA’s accuracy in a sample other than the validation cohort; (b) to evaluate its correlation with a simpler endoscopy index (SES‐CD) and fecal calprotectin (FC); and (c) to assess the need of an expert radiologist to reliably use sMARIA. Methods Patients with CD who underwent MRe, ileocolonoscopy and FC within 2–4 weeks had their MRe retrospectively reviewed by two blinded raters. Disease activity was evaluated through sMARIA, SES‐CD and FC. sMARIA’s accuracy, indices correlation, and interrater reliability were assessed. Results In total, 84 patients were included, comprising 420 intestinal segments evaluations. sMARIA ≥1 accurately identified segments with active disease (90% sensitivity, 98% specificity; area under the curve 0.94, 95% confidence interval (CI) 0.91–0.97; p < 0.01). sMARIA correlated with endoscopy, both for ileal and colonic segments (R = 0.94 and R = 0.82; p < 0.01). Per patient, there was a strong correlation between sMARIA, endoscopy (R = 0.95; p < 0.01) and FC (R = 0.91; p < 0.01). Interrater agreement was excellent (intraclass correlation coefficient 0.95; 95% CI 0.94–0.96; p < 0.01). Conclusion sMARIA accurately measured CD activity using SES‐CD as standard of reference, and exhibited high correlation with a simple endoscopic index and a biomarker. The interrater reliability between a radiology resident and an expert was excellent.