External validation of the MAGNIFI-CD index in patients with complex perianal fistulising Crohn's disease.

Autor: Beek KJ; Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands., Mulders LGM; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands.; Department of Gastroenterology and Hepatology, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands., van Rijn KL; Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands., Horsthuis K; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands.; Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands., Tielbeek JAW; Spaarne Gasthuis, Department of Radiology and Nuclear Medicine, Boerhaavelaan 22, Haarlem, The Netherlands., Buskens CJ; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands.; Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands., D'Haens GR; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands.; Department of Gastroenterology and Hepatology, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands., Gecse KB; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands.; Department of Gastroenterology and Hepatology, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands., Stoker J; Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands. j.stoker@amsterdamumc.nl.; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands. j.stoker@amsterdamumc.nl.
Jazyk: angličtina
Zdroj: European radiology [Eur Radiol] 2024 Aug 30. Date of Electronic Publication: 2024 Aug 30.
DOI: 10.1007/s00330-024-11029-3
Abstrakt: Background: There is an increasing need for objective treatment monitoring in perianal fistulising Crohn's disease (pfCD). Therefore, the magnetic resonance novel index for fistula imaging in CD (MAGNIFI-CD) index has been designed and internally validated on the ADMIRE-CD trial cohort. The aim of this study was to externally validate the MAGNIFI-CD index to monitor response to medical and surgical treatment regimens in pfCD.
Methods: A retrospective longitudinal cohort was established of consecutive patients with complex pfCD treated with surgical and/or medical therapy and a baseline and follow-up MRI between January 2007 and May 2021. The MAGNIFI-CD index was scored by two independent, abdominal radiologists blinded for time points and clinical outcomes. Responsiveness, reliability, and test accuracy regarding clinically important improvement were assessed. Cut-offs for response and remission were selected classified on fistula drainage assessment and physician global assessment.
Results: A total of 65 patients (51% female, median age 32 years) were included. A clinically relevant responsiveness of the MAGNIFI-CD was shown, with a significant decrease in clinical remitters and responders with a median MAGNIFI-CD of 18.0 [7.5-20.0] to 9.0 [0.8-16.0] (p < 0.001) and non-significant change in non-responders with a median MAGNIFI-CD of 20.0 [12.0-23.0] to 18.0 [13.0-21.0] (p = 0.22). There was an 'almost perfect' interobserver agreement (ICC = 0.87; 95% CI 0.80-0.92) for the MAGNIFI-CD index. An optimal cut-off value was defined as a decrease of 2 points for clinical response, and a MAGNIFI-CD ≤ 6 for remission at follow-up MRI.
Conclusion: The MAGNIFI-CD index is a responsive and reliable MRI scoring instrument for treatment monitoring in perianal fistulising Crohn's disease.
Clinical Relevance Statement: The MAGNIFI-CD index is a well-structured, responsive scoring instrument to assess fistula severity and activity that allows quantitative detection of changes in therapy response in patients with perianal fistulising Crohn's disease, thereby facilitating endpoints in clinical trials.
Key Points: Well-defined cut-offs for response and remission are needed for objective treatment monitoring of perianal fistulising Crohn's disease (pfCD). Cut-off values for remission and for response at 6 months follow-up were defined. Interobserver agreement was good. The MAGNIFI-CD index is responsive and reliable for treatment monitoring and is suitable for use in clinical trials.
(© 2024. The Author(s).)
Databáze: MEDLINE
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