IBD

52 - Impact of a Standardized Reporting System for Magnetic Resonance Enterography on Small Bowel Crohn’s Disease Management

Tuesday, October 9
3:15 PM - 3:25 PM
Location: Terrace Ballroom 2-3 (level 400)

Category: IBD
Adeeti Chiplunker, MD1, Richard Tsai, MD1, George Christophi, MD1, David Bruining, MD2, Aaron Mintz, MD1, Matthew Ciorba, MD3, Michael Lin, MD1, Kathryn Fowler, MD1, Parakkal Deepak, MBBS, MS1
1Washington University School of Medicine, St. Louis, MO; 2Mayo Clinic, St. Louis, MO; 3Washington University, St. Louis, MO

Introduction: Magnetic resonance enterography (MRE) is an established imaging tool for diagnosis and assessment of severity of Crohn’s disease (CD) with small bowel (SB) involvement. Use of structured reporting is promoted by the Society of Abdominal Radiology Crohn’s Disease-Focused Panel (SAR CDFP); however, use in practice is inconsistent and impact on management unknown. The aim of this study was to assess the impact of structured MRE reports, on CD management.

Methods: We retrospectively identified 25 CD patients with SB involvement with at least 2 consecutive MREs (N = 50 MRE scans) during the course of therapy from 2010 - 2017. A structured report (Figure 1) was prepared based on SAR CDFP recommendations including MRE Global Score for the single worst SB segment, length of SB disease, and presence of any strictures with pre-stenotic dilation. Clinical, laboratory and endoscopic data were abstracted and presented as vignettes. Two IBD focused gastroenterologists (1 and 10 years’ experience) were presented with fifty clinical vignettes each along with either clinical (non-structured) or structured MRE reports in alternating fashion with a washout period of at least 30 days. The IBD physicians provided management decisions (Figure 2) along with confidence levels related to change in immunomodulator or biologic agent choice, and dose escalation or de-escalation for each instance of the clinical or structured report. Statistical analysis of paired data from the two gastroenterologists’ responses (total N = 100) to vignettes and MRE reports was performed using McNemar test.

Results: A majority of the patients were female (16, 64%), with a median age of 37 years (Interquartile range (IQR), 30-54) and stricturing phenotype (15, 60%) and small bowel only location (15, 60%). Overall, the standardized report changed management compared to the clinical read (77% vs. 48%, p = 0.001) with initiation of corticosteroids (24% vs 11%, p = 0.007) and biologic usage to start/change dose or type (88% vs 73%, p = 0.004). The standardized report was also associated with a higher confidence of gastroenterologist for presence or absence of active disease (100% vs 63%) and stricturing disease (97% vs 47%, p < 0.001).

Discussion: Use of standardized MRE reports including a disease activity scoring system has a statistically significant impact on the management of SB CD. The feasibility of implementing this approach in clinical practice requires further assessment of radiology workflow.

MRE structured report
Gastroenterologist response datasheet

Disclosures:
Adeeti Chiplunker indicated no relevant financial relationships.
Richard Tsai indicated no relevant financial relationships.
George Christophi indicated no relevant financial relationships.
David Bruining indicated no relevant financial relationships.
Aaron Mintz indicated no relevant financial relationships.
Matthew Ciorba: Abbvie – Speaker's Bureau. AbbVie – Grant/Research Support. Incyte – Grant/Research Support. Pfizer – Advisory Committee/Board Member. Takeda – Speaker's Bureau.
Michael Lin indicated no relevant financial relationships.
Kathryn Fowler indicated no relevant financial relationships.
Parakkal Deepak: Abbvie – Speaker's Bureau. Janssen – Consultant. Pfizer – Consultant. Takeda – Grant/Research Support.

Adeeti Chiplunker

Washington University in St Louis School of Medicine
St. Louis, Missouri

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