{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T12:09:45Z","timestamp":1791806985158,"version":"4.3.4"},"reference-count":118,"publisher":"National Institute for Health and Care Research","issue":"42","license":[{"start":{"date-parts":[[2019,8,1]],"date-time":"2019-08-01T00:00:00Z","timestamp":1564617600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/non-commercial-government-licence\/non-commercial-government-licence.htm"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment programme","doi-asserted-by":"publisher","award":["11\/23\/01"],"award-info":[{"award-number":["11\/23\/01"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Health Technol Assess"],"abstract":"Background<\/jats:title>Magnetic resonance enterography and enteric ultrasonography are used to image Crohn\u2019s disease patients. Their diagnostic accuracy for presence, extent and activity of enteric Crohn\u2019s disease was compared.<\/jats:p><\/jats:sec>Objective<\/jats:title>To compare diagnostic accuracy, observer variability, acceptability, diagnostic impact and cost-effectiveness of magnetic resonance enterography and ultrasonography in newly diagnosed or relapsing Crohn\u2019s disease.<\/jats:p><\/jats:sec>Design<\/jats:title>Prospective multicentre cohort study.<\/jats:p><\/jats:sec>Setting<\/jats:title>Eight NHS hospitals.<\/jats:p><\/jats:sec>Participants<\/jats:title>Consecutive participants aged \u2265\u200916 years, newly diagnosed with Crohn\u2019s disease or with established Crohn\u2019s disease and suspected relapse.<\/jats:p><\/jats:sec>Interventions<\/jats:title>Magnetic resonance enterography and ultrasonography.<\/jats:p><\/jats:sec>Main outcome measures<\/jats:title>The primary outcome was per-participant sensitivity difference between magnetic resonance enterography and ultrasonography for small bowel Crohn\u2019s disease extent. Secondary outcomes included sensitivity and specificity for small bowel Crohn\u2019s disease and colonic Crohn\u2019s disease extent, and sensitivity and specificity for small bowel Crohn\u2019s disease and colonic Crohn\u2019s disease presence; identification of active disease; interobserver variation; participant acceptability; diagnostic impact; and cost-effectiveness.<\/jats:p><\/jats:sec>Results<\/jats:title>Out of the 518 participants assessed, 335 entered the trial, with 51 excluded, giving a final cohort of 284 (133 and 151 in new diagnosis and suspected relapse cohorts, respectively). Across the whole cohort, for small bowel Crohn\u2019s disease extent, magnetic resonance enterography sensitivity [80%, 95% confidence interval (CI) 72% to 86%] was significantly greater than ultrasonography sensitivity (70%, 95% CI 62% to 78%), with a 10% difference (95% CI 1% to 18%;p<\/jats:italic>\u2009=\u20090.027). For small bowel Crohn\u2019s disease extent, magnetic resonance enterography specificity (95%, 95% CI 85% to 98%) was significantly greater than ultrasonography specificity (81%, 95% CI 64% to 91%), with a 14% difference (95% CI 1% to 27%). For small bowel Crohn\u2019s disease presence, magnetic resonance enterography sensitivity (97%, 95% CI 91% to 99%) was significantly greater than ultrasonography sensitivity (92%, 95% CI 84% to 96%), with a 5% difference (95% CI 1% to 9%). For small bowel Crohn\u2019s disease presence, magnetic resonance enterography specificity was 96% (95% CI 86% to 99%) and ultrasonography specificity was 84% (95% CI 65% to 94%), with a 12% difference (95% CI 0% to 25%). Test sensitivities for small bowel Crohn\u2019s disease presence and extent were similar in the two cohorts. For colonic Crohn\u2019s disease presence in newly diagnosed participants, ultrasonography sensitivity (67%, 95% CI 49% to 81%) was significantly greater than magnetic resonance enterography sensitivity (47%, 95% CI 31% to 64%), with a 20% difference (95% CI 1% to 39%). For active small bowel Crohn\u2019s disease, magnetic resonance enterography sensitivity (96%, 95% CI 92% to 99%) was significantly greater than ultrasonography sensitivity (90%, 95% CI 82% to 95%), with a 6% difference (95% CI 2% to 11%). There was some disagreement between readers for both tests. A total of 88% of participants rated magnetic resonance enterography as very or fairly acceptable, which is significantly lower than the percentage (99%) of participants who did so for ultrasonography. Therapeutic decisions based on magnetic resonance enterography alone and ultrasonography alone agreed with the final decision in 122 out of 158 (77%) cases and 124 out of 158 (78%) cases, respectively. There were no differences in costs or quality-adjusted life-years between tests.<\/jats:p><\/jats:sec>Limitations<\/jats:title>Magnetic resonance enterography and ultrasonography scans were interpreted by practitioners blinded to clinical data (but not participant cohort), which does not reflect use in clinical practice.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Magnetic resonance enterography has higher accuracy for detecting the presence, extent and activity of small bowel Crohn\u2019s disease than ultrasonography does. Both tests have variable interobserver agreement and are broadly acceptable to participants, although ultrasonography produces less participant burden. Diagnostic impact and cost-effectiveness are similar. Recommendations for future work include investigation of the comparative utility of magnetic resonance enterography and ultrasonography for treatment response assessment and investigation of non-specific abdominal symptoms to confirm or refute Crohn\u2019s disease.<\/jats:p><\/jats:sec>Trial registration<\/jats:title>Current Controlled Trials ISRCTN03982913.<\/jats:p><\/jats:sec>Funding<\/jats:title>This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment<\/jats:italic>; Vol. 23, No. 42. See the NIHR Journals Library website for further project information.<\/jats:p><\/jats:sec>","DOI":"10.3310\/hta23420","type":"journal-article","created":{"date-parts":[[2019,8,21]],"date-time":"2019-08-21T10:50:20Z","timestamp":1566384620000},"page":"1-162","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Magnetic resonance enterography compared with ultrasonography in newly diagnosed and relapsing Crohn\u2019s disease patients: the METRIC diagnostic accuracy study"],"prefix":"10.3310","volume":"23","clinical-trial-number":[{"clinical-trial-number":"isrctn03982913","registry":"10.18810\/isrctn","type":"results"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6765-8806","authenticated-orcid":true,"given":"Stuart A","family":"Taylor","sequence":"first","affiliation":[{"name":"Centre for Medical Imaging, University College London, London, 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