Assessing the Precision of MRI in Identifying Strictures in Inflammatory Bowel Disease: A Comprehensive Systematic Review and Meta-Analysis

Introduction: This comprehensive systematic review and meta-analysis aimed to evaluate the precision of magnetic resonance imaging (MRI) in differentiating between fibrotic and inflammatory strictures in patients suffering from inflammatory bowel disease (IBD). Methods: An exhaustive and systematic survey of 5 essential databases identified studies that satisfied the pre-set criteria. Information was culled for an all-inclusive meta-analysis utilizing MetaDiSC and MetaDTA software, which yielded measures of diagnostic accuracy. The methodological quality and potential biases present in the studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Results: The systematic review scrutinized 7437 records, leading to the selection of 22 studies for inclusion. For the detection of fibrotic strictures in patients with IBD, MRI demonstrated an aggregate sensitivity of 85.20% (95% CI: 76.10% - 91.20%) and a specificity of 96.00% (95% CI: 87.80% - 98.70%). When distinguishing fibrotic strictures from inflammatory stenosis, the sensitivity and specificity were 81.5% (95% CI: 70.2% - 89.20%) and 97.2% (95% CI: 90.0% - 99.3%), respectively. Regarding the evaluation of stricture severity, sensitivity was at 90.4% (95% CI: 78.1% - 96.1%), and specificity was at 89.4% (95% CI: 57.4% - 98.2%). It was noted that the diagnostic accuracy remained consistent across diverse geographical areas and various reference tests used in the studies (Figure 1). Conclusion: This meta-analysis emphasizes the strong diagnostic precision of MRI in identifying fibrotic strictures, differentiating fibrotic from inflammatory strictures, and assessing the severity of strictures in patients with IBD. These conclusions advocate for the incorporation of MRI into routine diagnostic procedures for IBD patients. To validate these findings and to discern any potential constraints linked with the use of MRI in this clinical context, additional large-scale, multicenter studies are necessary.Figure 1.: The overall A) Sensitivity and B) Specificity of MRI in detecting fibrotic strictures.