# MaRIA — Magnetic Resonance Index of Activity for Crohn disease

> Continuous segmental MR-enterography activity index for ileocolonic Crohn disease using wall thickness, noise-corrected relative contrast enhancement, mural edema and ulceration. The validated segmental thresholds are nested (7 or more active; 11 or more severe/ulcerative), do not apply to the global sum and cannot select treatment or replace complication reporting.

**Situação:** vigente · **Órgão:** Gastrointestinal · **Órgão emissor:** Rimola et al. / ECCO / ESGAR / ESP / IBUS · **Versão:** 2009 original; 2018 validation guidance; 2024-2025 monitoring context · **Ano:** 2009

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: MRI
- Fonte primária: Rimola J, Rodriguez S, Garcia-Bosch O, et al.. Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn's disease (MaRIA) (2009) — https://pubmed.ncbi.nlm.nih.gov/19136510/
- Última verificação: 2026-07-24
- Última checagem: 2026-08-12

## Lógica de decisão
Calculate the original score per segment from measured components. Thresholds 7 and 11 are inclusive and segmental; severe is nested inside active. Keep sMaRIA, complications, fibrosis, prognosis and treatment separate.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| inactive | Segmental MaRIA below 7, inactive threshold state | Inactive threshold state: segmental MaRIA below 7. Calculate original segmental MaRIA as 1.5 x wall thickness in mm + 0.02 x noise-corrected relative contrast enhancement + 5 x mural edema present + 10 x ulceration present; the 7 cutoff applies to a segment, not the global sum. | Use the result as one objective imaging input alongside symptoms, biomarkers, endoscopy when indicated, complications and prior therapy. A segment below 7 does not independently justify treatment de-escalation or prove whole-patient, mucosal or transmural remission. | A score below 7 did not meet the validated active-endoscopic-lesion threshold in the scored segment. It does not exclude activity in unscored or poorly distended bowel, fibrosis, stricture, penetrating disease or future relapse and is not a personal prognosis. | Rimola et al. 2009, PMID 19136510 and DOI 10.1136/gut.2008.167957, derivation variables and endoscopic reference; Sturm et al. 2018, DOI 10.1093/ecco-jcc/jjy114, section 4.3 and segmental cutoff below 7; Yanai et al. 2025, DOI 10.1093/ecco-jcc/jjaf107, current score context. | ✓ |
| active | Segmental MaRIA 7 or more, active inflammation | Active inflammation: segmental MaRIA 7 or more. The threshold is inclusive and identifies an endoscopic lesion of any severity; scores of 11 or more remain active and additionally meet the nested severe or ulcerative threshold. Do not apply 7 to the global six-segment sum. | Communicate the active segments, continuous scores, affected lengths and comparison change for multidisciplinary treatment review. The threshold supports objective monitoring but does not choose a drug, dose, escalation, endoscopy interval, admission or operation by itself. | The threshold is associated with active endoscopic lesions in validation cohorts, not with a fixed individual probability of hospitalization, surgery, bowel damage or relapse. Protocol quality, segment distension and complications remain visible. | Rimola et al. 2009, DOI 10.1136/gut.2008.167957, activity model; Sturm et al. 2018, DOI 10.1093/ecco-jcc/jjy114, MaRIA at least 7 for active segments and six-segment sum; Bhatnagar et al. 2024, DOI 10.1093/ecco-jcc/jjae042, original-versus-simplified index boundary. | ✓ |
| severe | Segmental MaRIA 11 or more, severe ulcerative activity (nested within active) | Severe ulcerative activity: segmental MaRIA 11 or more. The threshold is inclusive, corresponds to superficial or deep ulceration at the endoscopic reference and is a subset of active disease, so the segment should retain both active and severe states. | Flag the ulcerative activity for timely multidisciplinary correlation and separately report obstruction, strictures, fistulas, abscess or other urgent findings. MaRIA 11 alone is not an emergency, hospitalization, surgery or medication mandate. | The score marks a severe endoscopic phenotype in the scored segment but is not a calibrated personal outcome forecast. It cannot determine fibrosis, penetrating behavior, overall clinical severity or future complication risk without the rest of the examination and clinical course. | Rimola et al. 2009, PMID 19136510, ulceration and severity reference; Sturm et al. 2018, DOI 10.1093/ecco-jcc/jjy114, segmental MaRIA at least 11 and ulcerative-lesion performance; Kucharzik et al. and Yanai et al. 2025, DOI 10.1093/ecco-jcc/jjaf106 and jjaf107, current diagnostics and monitoring context. | ✓ |

### Citações por categoria
- **inactive**: Rimola J, Rodriguez S, Garcia-Bosch O, et al.. Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn's disease (MaRIA) (2009) — https://pubmed.ncbi.nlm.nih.gov/19136510/ · Rimola et al. 2009, PMID 19136510 and DOI 10.1136/gut.2008.167957, derivation variables and endoscopic reference; Sturm et al. 2018, DOI 10.1093/ecco-jcc/jjy114, section 4.3 and segmental cutoff below 7; Yanai et al. 2025, DOI 10.1093/ecco-jcc/jjaf107, current score context.
- **active**: Rimola J, Rodriguez S, Garcia-Bosch O, et al.. Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn's disease (MaRIA) (2009) — https://pubmed.ncbi.nlm.nih.gov/19136510/ · Rimola et al. 2009, DOI 10.1136/gut.2008.167957, activity model; Sturm et al. 2018, DOI 10.1093/ecco-jcc/jjy114, MaRIA at least 7 for active segments and six-segment sum; Bhatnagar et al. 2024, DOI 10.1093/ecco-jcc/jjae042, original-versus-simplified index boundary.
- **severe**: Rimola J, Rodriguez S, Garcia-Bosch O, et al.. Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn's disease (MaRIA) (2009) — https://pubmed.ncbi.nlm.nih.gov/19136510/ · Rimola et al. 2009, PMID 19136510, ulceration and severity reference; Sturm et al. 2018, DOI 10.1093/ecco-jcc/jjy114, segmental MaRIA at least 11 and ulcerative-lesion performance; Kucharzik et al. and Yanai et al. 2025, DOI 10.1093/ecco-jcc/jjaf106 and jjaf107, current diagnostics and monitoring context.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2025-07-03 | revised | The ECCO-ESGAR-ESP-IBUS guideline updated multidisciplinary diagnostic and monitoring context for MRE and formal IBD scores without turning a MaRIA threshold into a treatment mandate. | confirmed |
| 2024-04-04 | revised | A current ECCO journal review positioned original MaRIA and sMaRIA as separate validated MRE activity indices and emphasized their different components, time burden and trial-oriented use. | confirmed |
| 2018-08-27 | revised | The ECCO-ESGAR diagnostic guideline summarized the segmental 7 and 11 thresholds, six-segment global sum, performance and original colonic-distension limitation. | confirmed |
| 2009-08-01 | published | MaRIA index published by Rimola et al. in Gut. | confirmed |


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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