La resonancia magnética y el índice MaRIA en la valoración preoperatoria de la enfermedad de Crohn ileal / Use of magnetic resonance index of activity (MaRIA) in the preoperative assessment of small bowel Crohn's disease

Introducción: Es necesaria la correcta cuantificación de la actividad inflamatoria de las lesiones de la enfermedad de Crohn para establecer cuál es el tratamiento más adecuado para cada paciente. El objetivo del presente estudio es valorar la relación entre el índice de actividad inflamatorio por resonancia magnética (MaRIA) preoperatorio y el grado de inflamación histológico de las lesiones obtenidas en la cirugía. Métodos: Estudio prospectivo observacional consecutivo que incluye una serie de pacientes con enfermedad de Crohn ileal. Se realizó una enterografía mediante resonancia magnética, con protocolo y secuencias preestablecidas, en los 3 meses previos a la cirugía y se calculó el índice MaRIA. Todos los pacientes fueron intervenidos quirúrgicamente y se remitieron muestras de cada lesión parietal completa a estudio anatomopatológico. En el análisis histológico se empleó la clasificación de Chiorean. Se realizó un análisis de regresión ordinal e intergrupos. Resultados: Se incluye a 35 pacientes con 59 lesiones. A medida que aumenta el grado de inflamación, se obtienen, de forma significativa (p = 0,002), valores mayores de MaRIA. El índice de MaRIA fue considerablemente diferente (p < 0,001) en los diferentes tipo de lesiones por enfermedad de Crohn (inflamatoria/fibrótica). El mejor valor de corte del índice MaRIA para establecer la existencia de inflamación grave en una lesión ha resultado ser 20 (ABC, 0,741; sensibilidad, 74,1%, y especificidad, 78,1%). Conclusiones: En el estudio de la enfermedad de Crohn ileal, la resonancia y el índice MaRIA son herramientas de gran utilidad para diferenciar entre lesiones inflamatorias y fibrosas, y por tanto, imprescindible para decidir el tratamiento más adecuado

Background: Accurate quantification of the inflammatory activity in Crohn's Disease is essential to determine adequate treatment for each patient. The aim of the present study is to assess the correlation between the pre-operative Magnetic Resonance Index of Activity (MaRIA) and the histologic degree of inflammation from surgically resected intestinal Crohn's Disease lesions. Methods: This is a prospective study including a consecutive case series of patients with small bowel Crohn's Disease, who underwent surgical resection. Magnetic resonance enterography was performed in the 3months prior to surgery, applying a pre-established protocol. Relative contrast enhancements, wall thickness, presence of edema or ulcerations were the parameters used to calculate the MaRIA Index. All patients underwent surgery and every specimen was analyzed. The modified Chiorean classification was applied for the histological analysis and an ordinal regression analysis was used to correlate MaRIA and the grade of inflammation for each lesion. Results: 59 lesions from 35 different patients were analyzed. The degree of inflammation of the lesions was statistically correlated to the MaRIA values (P = .002). The MaRIA index was significantly different (P < .001) between the different histological types of the Crohn's Disease lesions (inflammatory/ fibrotic). The best cut-off for detecting severe inflammation using MaRIA was 20 (AUC: 0.741; 74.1% sensitivity and 78.1% specificity). Conclusion: MaRIA is a reliable tool to distinguish inflammatory from fibrotic lesions. Therefore, it could be considered essential for determining the most appropriate Crohn's Disease treatment for each patient

Use of magnetic resonance index of activity (MaRIA) in the preoperative assessment of small bowel Crohn's disease. / La resonancia magnética y el índice MaRIA en la valoración preoperatoria de la enfermedad de Crohn ileal.

BACKGROUND: Accurate quantification of the inflammatory activity in Crohn's Disease is essential to determine adequate treatment for each patient. The aim of the present study is to assess the correlation between the pre-operative Magnetic Resonance Index of Activity (MaRIA) and the histologic degree of inflammation from surgically resected intestinal Crohn's Disease lesions. METHODS: This is a prospective study including a consecutive case series of patients with small bowel Crohn's Disease, who underwent surgical resection. Magnetic resonance enterography was performed in the 3months prior to surgery, applying a pre-established protocol. Relative contrast enhancements, wall thickness, presence of edema or ulcerations were the parameters used to calculate the MaRIA Index. All patients underwent surgery and every specimen was analyzed. The modified Chiorean classification was applied for the histological analysis and an ordinal regression analysis was used to correlate MaRIA and the grade of inflammation for each lesion. RESULTS: 59 lesions from 35 different patients were analyzed. The degree of inflammation of the lesions was statistically correlated to the MaRIA values (P=.002). The MaRIA index was significantly different (P<.001) between the different histological types of the Crohn's Disease lesions (inflammatory/ fibrotic). The best cut-off for detecting severe inflammation using MaRIA was 20 (AUC: 0.741; 74.1% sensitivity and 78.1% specificity). CONCLUSION: MaRIA is a reliable tool to distinguish inflammatory from fibrotic lesions. Therefore, it could be considered essential for determining the most appropriate Crohn's Disease treatment for each patient.

Contemporary non-echo-planar diffusion-weighted imaging of middle ear cholesteatomas.

Middle ear cholesteatoma is a common inflammatory disease that requires surgery due to potentially serious intracranial complications. Diagnosis of cholesteatoma is mainly clinical, with computed tomography (CT) used to evaluate disease extension before surgery. Certain patterns of bone erosion are specific, but CT attenuation does not allow differentiation from other inflammatory middle ear diseases. With its high tissue discrimination and contrast resolution, magnetic resonance imaging is valuable in diagnosis of cholesteatomas. Absent enhancement at delayed postcontrast imaging has been used for diagnosis. Diffusion-weighted imaging (DWI) is highly specific due to the high keratin content of cholesteatomas. New non-echo-planar DWI sequences, such as periodically rotated overlapping parallel lines with enhanced reconstruction, are superior to conventional echo-planar DWI, since they minimize susceptibility artifacts at the skull base and increase sensitivity for detection of lesions as small as 2 mm. This technique is indicated when clinical diagnosis is difficult and high tissue specificity is necessary, as in congenital, temporal bone, or atypical acquired middle ear cholesteatomas and residual or recurrent disease after surgery. Non-echo-planar DWI has been proposed for screening of postsurgical (residual or recurrent) cholesteatomas, thus obviating many second-look revision surgeries, especially after more conservative canal wall up surgery.