Skip to main content

Advertisement

SpringerLink
Log in

Effective communication of cross-sectional imaging findings in Crohn’s disease: comparing conventional EMR reporting to a published scoring system

  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

The purpose of the article is to compare information regarding small bowel lesions in Crohn’s disease (CD) patients communicated by a published scoring system and radiology reports from electronic medical record (EMR) of cross-sectional abdominal imaging.

Methods

Two gastrointestinal radiologists (reference readers) blinded to EMR reports scored cross-sectional imaging exams using a published scoring system. Investigators compared EMR and radiologist scores based on the mentioned findings and severity documentation of each variable. Statistical analysis involved means and difference in proportions and logistic regression modeling.

Results

Seventy-three CD patients, with average age 40.6 years (± SD 14.4), having 80 small bowel lesions on imaging were included. EMR reports reliably mentioned within the consensus score included thickness (79%, p = 0.000), enhancement (70%, p = 0.000), active inflammation (86%, p = 0.000), perienteric fluid (82%, p = 0.000), and presence of stricture (62%, p = 0.002). Minimal lumen diameter (19%, p = 0.000), comb sign (19%, p = 0.000), lesion length (57%, p = 0.06), and fistula (50%, p = 1.0) were reported less often. There was a strong association between the EMR and scoring scale in noting severity of active inflammation (88%, p = 0.000), perienteric fluid (76%, p = 0.000), and internal fistula (71%, p = 0.000). The proportion matching severity values of comb sign and minimal lumen were 24% and 21%, respectively (p = 0.000). Severity matches for stricture were less likely among the non-GI radiologists (odds ratio = 0.33, SE = 0.168, p = 0.029). The odds of reporting stricture and fistula severity were 3.6 and 5.7, respectively, on MRE.

Conclusions

Findings and severity of inflammation were communicated consistently. Stricture severity including minimal luminal diameter, was less reliably reported, though its prognostic significance impacts management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Grand DJ, Guglielmo FF, Al-Hawary MM (2015) MR enterography in Crohn’s disease: current consensus on optimal imaging technique and future advances from the SAR Crohn’s disease-focused panel. Abdom Imaging 40(5):953–964. doi:10.1007/s00261-015-0361-8

    Article  PubMed  Google Scholar 

  2. Dillman JR, Trout AT, Smith EA (2016) MR enterography: how to deliver added value. Pediatr Radiol 46(6):829–837. doi:10.1007/s00247-016-3555-5

    Article  PubMed  Google Scholar 

  3. Pazahr S, Blume I, Frei P, et al. (2013) Magnetization transfer for the assessment of bowel fibrosis in patients with Crohn’s disease: initial experience. MAGMA 26(3):291–301. doi:10.1007/s10334-012-0355-2

    Article  PubMed  CAS  Google Scholar 

  4. Deepak P, Fletcher JG, Fidler JL, et al. (2016) Radiological response is associated with better long-term outcomes and is a potential treatment target in patients with small bowel Crohn’s disease. Am J Gastroenterol 111(7):997–1006. doi:10.1038/ajg.2016.177

    Article  PubMed  Google Scholar 

  5. Rieder F, Zimmermann EM, Remzi FH, Sandborn WJ (2013) Crohn’s disease complicated by strictures: a systematic review. Gut 62(7):1072–1084. doi:10.1136/gutjnl-2012-304353

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Adler J, Punglia DR, Dillman JR, et al. (2012) Computed tomography enterography findings correlate with tissue inflammation, not fibrosis in resected small bowel Crohn’s disease. Inflamm Bowel Dis 18(5):849–856. doi:10.1002/ibd.21801

    Article  PubMed  Google Scholar 

  7. Gibson DJ, Murphy DJ, Smyth AE, et al. (2015) Magnetic resonance enterography findings as predictors of clinical outcome following antitumor necrosis factor treatment in small bowel Crohn’s disease. Eur J Gastroenterol Hepatol 27(8):956–962. doi:10.1097/MEG.0000000000000399

    Article  PubMed  Google Scholar 

  8. Quencer KB, Nimkin K, Mino-Kenudson M, Gee MS (2013) Detecting active inflammation and fibrosis in pediatric Crohn’s disease: prospective evaluation of MR-E and CT-E. Abdom Imaging 38(4):705–713. doi:10.1007/s00261-013-9981-z

    Article  PubMed  PubMed Central  Google Scholar 

  9. Higgins PD, Fletcher JG (2015) Characterization of inflammation and fibrosis in Crohn’s disease lesions by magnetic resonance imaging. Am J Gastroenterol 110(3):441–443. doi:10.1038/ajg.2015.26

    Article  PubMed  CAS  Google Scholar 

  10. Deepak P, Fletcher JG, Fidler JL, Bruining DH (2016) Computed tomography and magnetic resonance enterography in Crohn’s disease: assessment of radiologic criteria and endpoints for clinical practice and trials. Inflamm Bowel Dis 22(9):2280–2288. doi:10.1097/MIB.0000000000000845

    Article  PubMed  PubMed Central  Google Scholar 

  11. Chaudhry NA, Riverso M, Grajo JR, et al. (2017) A fixed stricture on routine cross-sectional imaging predicts disease-related complications and adverse outcomes in patients with Crohn’s disease. Inflamm Bowel Dis 23(4):641–649. doi:10.1097/MIB.0000000000001054

    Article  PubMed  Google Scholar 

  12. Rimola J, Ordás I, Rodriguez S, et al. (2011) Magnetic resonance imaging for evaluation of Crohn’s disease: validation of parameters of severity and quantitative index of activity. Inflamm Bowel Dis 17(8):1759–1768. doi:10.1002/ibd.21551

    Article  PubMed  Google Scholar 

  13. Hill NS, DiSantis DJ (2015) The comb sign. Abdom Imaging 40(5):1010. doi:10.1007/s00261-014-0285-8

    Article  PubMed  Google Scholar 

  14. StataCorp (2015) Stata Statistical Software: Release 14. College Station, TX: StataCorp LP

    Google Scholar 

  15. Gale HI, Sharatz SM, Taphey M, et al. (2017) Comparison of CT enterography and MR enterography imaging features of active Crohn disease in children and adolescents. Pediatr Radiol . doi:10.1007/s00247-017-3876-z

    Article  PubMed  Google Scholar 

  16. Amitai MM, Raviv-Zilka L, Hertz M, et al. (2015) Main imaging features of Crohn’s Disease: agreement between MR-enterography and CT-enterography. Isr Med Assoc J 17(5):293–297

    PubMed  Google Scholar 

  17. Ippolito D, Invernizzi F, Galimberti S, Panelli MR, Sironi S (2010) MR enterography with polyethylene glycol as oral contrast medium in the follow-up of patients with Crohn disease: comparison with CT enterography. Abdom Imaging 35(5):563–570

    Article  PubMed  Google Scholar 

  18. Qiu Y, Mao R, Chen BL, et al. (2014) Systematic review with meta-analysis: magnetic resonance enterography vs. computed tomography enterography for evaluating disease activity in small bowel Crohn’s disease. Aliment Pharmacol Ther 40(2):134–146. doi:10.1111/apt.12815

    Article  PubMed  CAS  Google Scholar 

  19. Fiorino G, Bonifacio C, Peyrin-Biroulet L, et al. (2011) Prospective comparison of computed tomography enterography and magnetic resonance enterography for assessment of disease activity and complications in ileocolonic Crohn’s disease. Inflamm Bowel Dis 17(5):1073–1080. doi:10.1002/ibd.21533

    Article  PubMed  CAS  Google Scholar 

  20. Desai D (2015) Disease behaviour in patients with Crohn’s Disease: a review. Gastroenterol Hepatol Open Access 3(2):00076. doi:10.15406/ghoa.2015.03.00076

    Article  Google Scholar 

  21. Cosnes J, Cattan S, Blain A, et al. (2002) Long-term evolution of disease behavior of Crohn’s disease. Inflamm Bowel Dis 8(4):244–250

    Article  PubMed  Google Scholar 

  22. Sauer CG, Middleton JP, McCracken C, et al. (2016) Magnetic resonance enterography healing and magnetic resonance enterography remission predicts improved outcome in pediatric Crohn disease. J Pediatr Gastroenterol Nutr 62(3):378–383. doi:10.1097/MPG.0000000000000976

    Article  PubMed  Google Scholar 

  23. Mandel MD, Miheller P, Müllner K, Golovics PA, Lakatos PL (2014) Have biologics changed the natural history of Crohn’s disease? Dig Dis 32(4):351–359. doi:10.1159/000358135

    Article  PubMed  Google Scholar 

Download references

Acknowledgement

This work was supported by the Gatorade Trust through funds distributed by the University of Florida, Department of Medicine.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA

    Andrew Flint, Naueen A. Chaudhry, Michael Riverso, Angela Pham, Lazarus K. Mramba & Ellen M. Zimmermann

  2. Division of Abdominal Imaging, Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA

    Patricia P. Moser & Joseph R. Grajo

Authors
  1. Andrew Flint
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naueen A. Chaudhry
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Riverso
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Angela Pham
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Patricia P. Moser
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lazarus K. Mramba
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ellen M. Zimmermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Joseph R. Grajo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joseph R. Grajo.

Ethics declarations

Funding

This study was not funded by a grant.

Conflict of interest

None of the authors have any conflict of interest to declare in the context of this study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

This was a retrospective study, using pre-existing data in medical records, and no patient interaction was necessary. Hence, the requirement of informed consent was waived by institutional IRB.

Additional information

Andrew Flint and Naueen A. Chaudhry are co-first authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Flint, A., Chaudhry, N.A., Riverso, M. et al. Effective communication of cross-sectional imaging findings in Crohn’s disease: comparing conventional EMR reporting to a published scoring system. Abdom Radiol 43, 1798–1806 (2018). https://doi.org/10.1007/s00261-017-1368-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-017-1368-0

Keywords

Search

Navigation