Magnetic resonance enterography has high diagnostic accuracy in detecting fibrotic bowel strictures in Crohn’s Disease——A systematic review and meta-analysis

Abstract Background and Aims Magnetic resonance enterography (MRE) has been reported to identify intestinal strictures in Crohn's disease (CD) patients, and the diagnostic accuracy of MR techniques in differentiating fibrotic from inflammatory strictures remains unclear. This systematic review and meta-analysis was conducted to evaluate the diagnostic performance of current modes of MRE parameters for the detection of fibrosis in stricture lesions of CD patients. Methods A systematic search of EMBASE and MEDLINE up to Nov 2022 identified studies examining the diagnostic accuracy of MRE in the detection of fibrotic strictures in CD patients, using histology as the reference standard. Data was pooled using a bivariate random-effects model to estimate the diagnostic efficiency of fibrotic strictures. Results The final analysis included 17 studies, involving 1012 stricture lesions of 544 CD patients. MRE had a pooled sensitivity of 93% (95% CI: 86%-97%) and specificity of 89% (95% CI: 82%-93%) for the diagnosis of fibrotic strictures. AUC for the detection of fibrosis was 95% (95% CI: 93%-97%). The specificity significantly increased when the diagnosis was conducted per patient (98%; 95%CI: 95%-100%) rather than per segment (84%; 95%CI:80%-88%; P = 0.01). The application of novel MR analytic parameters could significantly improve the sensitivity of MRE in the diagnosis of fibrous stenosis, compared with conventional MRE imaging (P < 0.01). Conclusions MRE has shown excellent potential in the detection of fibrotic strictures in CD patients, with outstanding diagnostic sensitivity and specificity. The application of novel MR analytic parameters could improve the sensitivity of MRE in the diagnosis of fibrous stenosis.