Evidence map›Paper›PMID 29914843›Full record

Trial reportThe lancet. Gastroenterology & hepatology2018

Diagnostic accuracy of magnetic resonance enterography and small bowel ultrasound for the extent and activity of newly diagnosed and relapsed Crohn's disease (METRIC): a multicentre trial.

Stuart A Taylor, Susan Mallett, Gauraang Bhatnagar, Rachel Baldwin-Cleland, Stuart Bloom, Arun Gupta, Peter J Hamlin, Ailsa L Hart, Antony Higginson, Ilan Jacobs and 17 more

Registry-linked trialAbstract readComparative StudyMulticenter StudyPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The lancet. Gastroenterology & hepatology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06800326 (Diagnostic Concordance of MR Enterography and Ultrasound for Treatment Response Assessment in Crohn's Disease), which is not on this map. Cited by 127 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
127citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06800326 recruitingnot on this mapstarted 2024, after this paper: background citation

Diagnostic Concordance of MR Enterography and Ultrasound for Treatment Response Assessment in Crohn's Disease (MANTRA): a Multicentre, Non-randomised, Multiple-arm, Prospective Cohort Comparison Study

TypeobservationalSponsorUniversity College, LondonRan2024 to 2026Enrolled155ConditionsCrohn DiseaseArmsUltrasound, MRE Scan
3 · Its place in the literature

Who cites it

127 citing papers in PubMed, 5 syntheses or guidelines pooled it.

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  12. Observational
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  19. [Diagnostic imaging of the small bowel].Radiologie (Heidelberg, Germany) · 2026
    Review
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67 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

27 authors.

Stuart A TaylorCentre for Medical Imaging, University College London (UCL), London, UK. Electronic address: stuart.taylor1@nhs.net.
Susan MallettInstitute of Applied Health Research, National Institute of Health and Research Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Gauraang BhatnagarCentre for Medical Imaging, University College London (UCL), London, UK.
Rachel Baldwin-ClelandIntestinal Imaging Centre, St Mark's Hospital, London North West University Healthcare (LNWUH) National Health Service (NHS) Trust, Harrow, UK.
Stuart BloomDepartment of Gastroenterology, University College Hospital, London, UK.
Arun GuptaIntestinal Imaging Centre, St Mark's Hospital, London North West University Healthcare (LNWUH) National Health Service (NHS) Trust, Harrow, UK.
Peter J HamlinDepartment of Gastroenterology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Ailsa L HartInflammatory Bowel Disease Unit, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK.
Antony HigginsonDepartment of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK.
Ilan JacobsCentre for Medical Imaging, UCL, London, UK.
Sara McCartneyDepartment of Gastroenterology, University College Hospital, London, UK.
Anne MilesDepartment of Psychological Sciences, Birkbeck University of London, London, UK.
Charles D MurrayDepartment of Gastroenterology and Endoscopy, Royal Free London NHS Foundation Trust, London, UK.
Andrew A PlumbCentre for Medical Imaging, University College London (UCL), London, UK.
Richard C PollokDepartment of Gastroenterology, St George's Hospital, London, UK.
Shonit PunwaniCentre for Medical Imaging, University College London (UCL), London, UK.
Laura QuinnInstitute of Applied Health Research, National Institute of Health and Research Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Manuel Rodriguez-JustoDepartment of Histopathology, University College Hospital, London, UK.
Zainib ShabirComprehensive Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, Holborn, London, UK.
Andrew SlaterDepartment of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK.
Damian TolanDepartment of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Simon TravisTranslational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK.
Alastair WindsorDepartment of Surgery, University College Hospital, London, UK.
Peter WylieDepartment of Radiology, Royal Free London NHS Foundation Trust, London, UK.
Ian ZealleyDepartment of Radiology, Ninewells Hospital, Dundee, UK.
Steve HalliganCentre for Medical Imaging, University College London (UCL), London, UK.
METRIC study investigators

Funding

Cancer Research UK 16463Department of Health 11/23/01Department of Health PDF-2017-10-081
6 · The paper itself

Abstract

backgroundMagnetic resonance enterography (MRE) and ultrasound are used to image Crohn's disease, but their comparative accuracy for assessing disease extent and activity is not known with certainty. Therefore, we did a multicentre trial to address this issue.

methodsWe recruited patients from eight UK hospitals. Eligible patients were 16 years or older, with newly diagnosed Crohn's disease or with established disease and suspected relapse. Consecutive patients had MRE and ultrasound in addition to standard investigations. Discrepancy between MRE and ultrasound for the presence of small bowel disease triggered an additional investigation, if not already available. The primary outcome was difference in per-patient sensitivity for small bowel disease extent (correct identification and segmental localisation) against a construct reference standard (panel diagnosis). This trial is registered with the International Standard Randomised Controlled Trial, number ISRCTN03982913, and has been completed.

findings284 patients completed the trial (133 in the newly diagnosed group, 151 in the relapse group). Based on the reference standard, 233 (82%) patients had small bowel Crohn's disease. The sensitivity of MRE for small bowel disease extent (80% [95% CI 72-86]) and presence (97% [91-99]) were significantly greater than that of ultrasound (70% [62-78] for disease extent, 92% [84-96] for disease presence); a 10% (95% CI 1-18; p=0·027) difference for extent, and 5% (1-9; p=0·025) difference for presence. The specificity of MRE for small bowel disease extent (95% [85-98]) was significantly greater than that of ultrasound (81% [64-91]); a difference of 14% (1-27; p=0·039). The specificity for small bowel disease presence was 96% (95% CI 86-99) with MRE and 84% (65-94) with ultrasound (difference 12% [0-25]; p=0·054). There were no serious adverse events.

interpretationBoth MRE and ultrasound have high sensitivity for detecting small bowel disease presence and both are valid first-line investigations, and viable alternatives to ileocolonoscopy. However, in a national health service setting, MRE is generally the preferred radiological investigation when available because its sensitivity and specificity exceed ultrasound significantly.

fundingNational Institute of Health and Research Health Technology Assessment.

Indexed as

Magnetic Resonance ImagingUltrasonographyAdolescentAdultCrohn DiseaseFemaleHumansIntestine, SmallMaleMiddle AgedProspective StudiesRecurrenceSensitivity and SpecificityYoung Adult

Identifiers

PMID29914843
PMCPMC6278907

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.