Comparative Performance of Contrast-enhanced versus Abbreviated Non-contrast MR Enterography in Crohn Disease Evaluation: a Retrospective Study

OBJECTIVES: In this study, we compared full protocol MR enterography (including contrast-enhanced images) and modified non-contrast protocol in assessment of CD activity. MATERIAL AND METHOD: In this retrospective cross-sectional study, we included 182 patients with histologically confirmed CD who underwent MR enterography examination in ANONYMISED. For all patients, CD activity was interpreted by two independents, first based on abbreviated protocol (including T2-weighted imaging and balanced steady-state free precession (b-SSFP)) and then based on full protocol MRI. Agreement was assessed by concordance rates and Cohen's kappa. RESULTS: We found a high inter-modality agreement in CD activity assessment, with abbreviated non-contrast MRE demonstrating 98.4% concordance (179/182 cases) to contrast-enhanced MRE. Discordant findings (1.6%, 3/182) included one case misclassified as fibrostenotic and two as non-specific findings. Inter-reader agreement in MR enterography examination was also high (κ = 0.977 for final diagnosis, κ = 0.969 for fibrostenosis, and κ = 0.978 for comb sign detection), supporting high reproducibility between two radiologists. CONCLUSION: Our findings demonstrate that abbreviated MR enterography (including T2-weighted sequence and b-SSFP) had substantial agreement with full protocol MR enterography in CD activity assessment, supporting its value as a reliable contrast-free alternative for practicing in clinical centers. ADVANCES IN KNOWLEDGE: Our investigation represents an advancement in CD imaging, leveraged by a large sample size, rigorous methodology, and comprehensive evaluation of different CD characterizations.