Prospective Validation of the LCrossed D sign©mann Index in Children: A Report from the Multicentre Image Kids Study

Gili Focht, Ruth Cytter Kuint, Mary Louise C. Greer, Li Tal Pratt, Denise A. Castro, Peter C. Church, Víctor Manuel Navas-López, Robert N. Baldassano, Joachim Høg Mortensen, Florian Rieder, Baruch Yerushalmi, Anat Ilivitzki, Osnat Konen, Anne M. Griffiths, Dan Turner*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


BACKGROUND: The Lémann Index [LI] and the recently updated LI are tools for measuring structural bowel damage in adults with Crohn's disease [CD] but have not been evaluated in children. We aimed to validate the updated LI in the prospective multicentre ImageKids study of paediatric CD.

METHODS: We included children with CD undergoing magnetic resonance enterography [MRE], pelvic magnetic resonance imaging [MRI] and ileocolonoscopy. Half were followed for 18 months, when MRE was repeated. Serum was collected for fibrosis-related proteomic markers. The LI was calculated by central readers from the MRE, ileocolonoscopy, physical examination and surgical data. Reliability and construct validity were assessed at baseline, while responsiveness and test-retest reliability were explored longitudinally.

RESULTS: In total, 240 children were included (mean age, 14.2 ± 2.5 years; median disease duration, 2.2 years [interquartile range, IQR 0.25-4.42]; median baseline LI, 4.23 [IQR 2.0-8.8]). The updated LI had excellent inter-observer reliability (interclass correlation coefficient [ICC] = 0.94, 95% confidence interval [CI] 0.92-0.95) but poor, although statistically significant, correlation with radiologist and gastroenterologist global assessments of damage and with serum proteomic levels of fibrotic markers [rho = 0.15-0.30, most p < 0.05]. The updated LI had low discriminative validity for detecting damage (area under the receiver operating characteristic curve [AUC-ROC] 0.69, 95% CI 0.62-0.75). In 116 repeated MREs, responsiveness was suboptimal for differentiating improved from unchanged disease [AUC-ROC 0.58, 95% CI 0.45-0.71]. Test-retest reliability was high among stable patients [ICC = 0.84, 95% CI 0.72-0.91].

CONCLUSION: Overall, the updated LI had insufficient psychometric performance for recommending its use in children. An age-specific index may be needed for children with shorter disease duration than typical adult cohorts.

Original languageAmerican English
Pages (from-to)943-949
Number of pages7
JournalJournal of Crohn's and Colitis
Issue number6
StatePublished - 16 Jun 2023

Bibliographical note

Publisher Copyright:
© 2023 Oxford University Press. All rights reserved.


  • Crohn's disease
  • Lemann score
  • MRE
  • Paediatrics


Dive into the research topics of 'Prospective Validation of the LCrossed D sign©mann Index in Children: A Report from the Multicentre Image Kids Study'. Together they form a unique fingerprint.

Cite this