Background: The Rutgeerts' score is the standard measure used for endoscopic quantification of post-operative recurrence in Crohn's disease, providing valuable prognostic information used to guide prophylactic treatment decisions. Magnetic resonance imaging of the small intestine or enterography (MRE) is increasingly used to assess disease burden, phenotype and activity in small bowel Crohn's disease. There are limited data on whether MRE to assess the presence/degree of recurrent Crohn's in the pre-anastomotic ileum correlates well enough with the Rutgeerts' score to offer a non-invasive alternative.
The aim of this study is to compare Rutgeerts' scores from ileocolonoscopy with measures of inflammatory activity in the pre-anastomotic ileum on MRE performed at a single high volume centre.
Methods: Patients who had a diagnosis of Crohn's disease and history of ileal resection who underwent colonoscopy with prospective Rutgeerts' score evaluation were identified from an endoscopy electronic reporting system and cross-referenced with the hospital radiology system to identify those who had an MRE study within 6 months of ileocolonoscopy.
Results: 64 patients were identified who met the criteria. Mean age was 38.7 years (SD 13) with 52% female. 31 patients (48%) were classified as having active inflammatory disease in the pre-anastomotic ileum by MRI standards. 18 (28%), 13 (20%), 11 (17%), 15 (23%) and 7 (11%) of patients had a Rutgeerts' score of 0, 1, 2, 3 and 4, respectively. The median time between MRE and colonoscopy was 1.2 months (3.2 IQR).
There was no significant association between inflammatory activity as measured by the Rutgeert's score and MRE evidence of activity. The median Rutgeerts' score for patients classed as active by MRE was 2 (IQR 2.5), while for inactive disease was 2 (IQR 3) (P 0.34). A subset of 17 patients had colonoscopy and MRE on the same day and again there was no association between Rutgeerts' score and inflammatory activity on MRE (active 1 (IQR 1.25) versus inactive 2 (IQR 1), P 0.2).
Conclusions: Our data suggest that endoscopic evaluation remains important for accurate grading of inflammatory activity in this group.