P205 - Accuracy of MRE in predicting Colonoscopic and operative findings in Crohn's Disease

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Purpose/Background: Crohn’s disease can present in any portion of the GI tract and for years has posed a difficulty with monitoring disease progression. Mucosal healing is the treatment target in Crohn’s disease, however this poses a challenge for clinicians as endoscopy cannot fully assess the small bowel.1 Several studies evaluating the use of MRE in Crohn’s disease have shown that MRE improves accuracy in diagnosing and monitoring small bowel disease and avoids the ionizing radiation associated with CTE.2,3

While the accuracy between MRE and colonoscopy has been well established, there have been few studies comparing the accuracy of surgical intraoperative findings and histopathologic findings with MRE. Our study aims to evaluate the concordance between MRE, ileocolonoscopy and intraoperative surgical findings as well as histopathologic findings in patients with Crohn’s Disease.

Methods/Interventions: A retrospective single institution chart review of all patients who underwent surgery for Crohn’s disease between 1/1/2015 through 6/30/2023 was performed. Patients undergoing an MRE within 6 months of surgery were included in the study. Sensitivity and specificity analyses were performed comparing the findings on MRE with surgical, histopathologic and ileocolonoscopic findings. Findings on MRE and pathology that were evaluated included inflammation, stricture, abscess and fistula and no findings.

Results/Outcomes:: There were 120 patients included in the study and ultimately 69 had an MRE within 180 days of surgery. The median time from diagnosis of Crohn’s disease to surgery was 8 years. Percent agreement between MRE and colonoscopy were relatively high: 89.9% for none, 82.6% for abscess, 76.8% for fistula, 62.3% for inflammation, 50.7% for strictures. Percent agreement between MRE and operative findings were very high: 85.5% for abscess,
82.6% for none, 79.7% for fistula, 76.8% for strictures, and 68.1% inflammation (Table 1.). Percent agreement between MRE and pathology findings were also very high: 92.8% for none, 85.5% for abscess, 81.2% for fistula, 75.4% for inflammation and 68.1% for strictures (Table 2.). Overall, agreement between MRE and colonoscopy, operative, and pathology, was lowest for identification of inflammation and strictures compared to no findings, abscess, or fistula.

Conclusion/Discussion: Complications associated with Crohn’s disease remain a diagnostic challenge despite advances in imaging capabilities. Several studies have identified the utility of MRE in identifying complications of Crohn’s disease such as abscess, stricture and fistula. Multiple studies have identified a correlation between MRE findings and findings on ileocolonoscopy in Crohn’s disease; however, few studies have evaluated these findings in comparison to histopathologic and intraoperative surgical findings. Our study shows a good correlation between MRE and operative findings, thus further supporting the use of MRE in routine Crohn’s disease screening.