Semiautomatic Assessment of the Terminal Ileum and Colon in Patients with Crohn Disease Using MRI (the VIGOR++ Project)
Carl A.J. Puylaert (Universiteit van Amsterdam)
Peter J. Schüffler (ETH Zürich, Memorial Sloan-Kettering Cancer Center)
Robiel E. Naziroglu (TU Delft - ImPhys/Quantitative Imaging)
Jeroen A.W. Tielbeek (Universiteit van Amsterdam)
Zhang Li (TU Delft - ImPhys/Quantitative Imaging, National University of Defense Technology)
Jesica C. Makanyanga (University College London)
Charlotte J. Tutein Nolthenius (Universiteit van Amsterdam)
C. Yung Nio (Universiteit van Amsterdam)
Douglas A. Pendsé (University College London)
Alex Menys (University College London)
Cyriel Y. Ponsioen (Universiteit van Amsterdam)
David Atkinson (University College London)
Alastair Forbes (University of East Anglia)
Joachim M. Buhmann (ETH Zürich)
Thomas J. Fuchs (Memorial Sloan-Kettering Cancer Center)
Haralambos Hatzakis (Biotronics3D Inc.)
Lucas J. van Vliet (TU Delft - ImPhys/Computational Imaging)
Jaap Stoker (Universiteit van Amsterdam)
Stuart A. Taylor (University College London)
Frans M. Vos (TU Delft - ImPhys/Quantitative Imaging, Universiteit van Amsterdam)
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Abstract
Rationale and Objectives: The objective of this study was to develop and validate a predictive magnetic resonance imaging (MRI) activity score for ileocolonic Crohn disease activity based on both subjective and semiautomatic MRI features. Materials and Methods: An MRI activity score (the “virtual gastrointestinal tract [VIGOR]” score) was developed from 27 validated magnetic resonance enterography datasets, including subjective radiologist observation of mural T2 signal and semiautomatic measurements of bowel wall thickness, excess volume, and dynamic contrast enhancement (initial slope of increase). A second subjective score was developed based on only radiologist observations. For validation, two observers applied both scores and three existing scores to a prospective dataset of 106 patients (59 women, median age 33) with known Crohn disease, using the endoscopic Crohn's Disease Endoscopic Index of Severity (CDEIS) as a reference standard. Results: The VIGOR score (17.1 × initial slope of increase + 0.2 × excess volume + 2.3 × mural T2) and other activity scores all had comparable correlation to the CDEIS scores (observer 1: r = 0.58 and 0.59, and observer 2: r = 0.34–0.40 and 0.43–0.51, respectively). The VIGOR score, however, improved interobserver agreement compared to the other activity scores (intraclass correlation coefficient = 0.81 vs 0.44–0.59). A diagnostic accuracy of 80%–81% was seen for the VIGOR score, similar to the other scores. Conclusions: The VIGOR score achieves comparable accuracy to conventional MRI activity scores, but with significantly improved reproducibility, favoring its use for disease monitoring and therapy evaluation.