Steward et al reported a number of indices related to Crohn's disease and its appearance on magnetic resonance enterography. One index is based on qualitative findings seen in the MR scans. The authors are from University College London.
Patient selection: Crohn's disease
Exam: magnetic resonance enteropathy
Parameters:
(1) mural thickness
(2) mural T2 signal compared to normal small bowel
(3) perimural T2 signal in mesentery
(4) mural enhancement pattern
(5) enhancement compared to normal small bowel
(6) lymph nodes
(7) lymph node enhancements compared to nearest vessel
(8) comb sign (increased mesenteric vascularity)
Parameter
Finding
Points
mural thickness
1 to 3 mm
0
3.1 to 5 mm
1
5.1 to 7 mm
2
> 7 mm
3
mural T2 signal
equivalent to normal bowel wall
0
minor increase
1
moderate increase
2
marked increase (areas of white high signal similar to luminal content)
3
perimural T2 signal
equivalent to normal mesentery
0
increase but no fluid
1
small fluid rim (<= 2 mm)
2
larger fluid rim (> 2 mm)
3
mural enhancement pattern
not applicable
0
homogeneous
1
mucosal
2
layered
3
enhancement
equivalent to normal bowel wall
0
minor enhancement
1
moderate enhancement
2
marked enhancement (same as nearby vessel)
3
lymph nodes
absent
0
cluster < 1 cm
1
1 or 2 nodes > 1 cm
2
3 nodes > 1 cm
3
lymph node enhancement
less than nearby vascular structure
0
equivalent or greater than nearby vessel
1
comb sign
absent
0
present
1
total score =
= SUM(findings on all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 20
• The higher the score the more severe the activity of the Crohn's disease.
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