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Dynamic contrast-enhanced MRI in determining disease activity in perianal fistulizing Crohn disease: a pilot study
Manon L W Ziech1, Cristina Lavini, Shandra Bipat
1Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. m.l.ziech@amc.uva.nl
Objective:
The objective of our study was to perform a semiquantitative analysis of dynamic contrast-enhanced MRI for the evaluation of disease activity and therapeutic response in patients with perianal fistulizing Crohn disease.
Subjects And Methods:
Sixteen consecutively registered patients with perianal Crohn disease underwent pelvic MRI. A dynamic contrast-enhanced sequence was performed at 3 T (temporal resolution, 4.2 seconds) during i.v. contrast injection. Maximum enhancement, initial slope of increase, volume transfer constant (K(trans)), and the extravascular space fractional volume (x028B;(e)) were calculated in a region of interest drawn around the fistula. Perianal disease activity index, C-reactive protein concentration, and an MRI-based activity score were calculated as reference standards. Six patients underwent a second MRI examination 6 weeks after starting treatment with anti-tumor necrosis factor α (anti-TNF-α).
Results:
Perianal disease activity index moderately correlated with maximum enhancement (r = 0.67, p = 0.005), initial slope of increase (r = 0.58, p = 0.018), and volume of enhancing pixels (r = 0.79, p < 0.001) but not with K(trans) or x028B;(e). Volume of enhancing pixels also correlated with C-reactive protein concentration and the MRI-based score (r = 0.52, p = 0.041; r = 0.79, p < 0.001). The K(trans) values had decreased significantly 6 weeks after the start of anti-TNF-α therapy.
Conclusion:
Maximum enhancement and initial slope of increase correlate with disease activity in perianal Crohn disease. K(trans) may be an indicator of the effect of therapy on patients starting anti-TNF-α treatment.
Insights
Dynamic contrast-enhanced MRI effectively assesses Crohn disease activity. Key metrics like maximum enhancement and initial slope correlate with disease severity, while K(trans) indicates therapeutic response to anti-tumor necrosis factor α therapy.
Area of Science:
- Gastroenterology
- Radiology
- Medical Imaging
Background:
- Perianal fistulizing Crohn disease (PFCD) presents diagnostic challenges.
- Accurate assessment of disease activity and treatment response is crucial for patient management.
Purpose of the Study:
- To evaluate dynamic contrast-enhanced MRI (DCE-MRI) for semiquantitative analysis of disease activity in PFCD.
- To assess the utility of DCE-MRI parameters in predicting therapeutic response to anti-tumor necrosis factor α (anti-TNF-α) therapy.
Main Methods:
- Pelvic MRI with a 3 T DCE sequence was performed on 16 patients with PFCD.
- Quantitative parameters including maximum enhancement, initial slope, K(trans), and V e were calculated.
- Disease activity was assessed using Perianal Disease Activity Index, C-reactive protein, and an MRI-based score.
- Six patients underwent follow-up MRI after 6 weeks of anti-TNF-α treatment.
Main Results:
- Maximum enhancement and initial slope of increase showed moderate correlation with disease activity indices.
- Volume of enhancing pixels strongly correlated with disease activity and MRI-based scores.
- K(trans) values significantly decreased after 6 weeks of anti-TNF-α therapy, suggesting treatment efficacy.
Conclusions:
- DCE-MRI parameters, particularly maximum enhancement and initial slope, are valuable for assessing disease activity in PFCD.
- K(trans) shows promise as a biomarker for monitoring therapeutic response to anti-TNF-α treatment in PFCD.
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