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Diffusion-weighted magnetic resonance enterocolonography in predicting remission after anti-TNF induction therapy in
Anthony Buisson1, Constance Hordonneau2, Marion Goutte1
1University Hospital Estaing, Gastroenterology Department, Clermont-Ferrand, France; UMR 1071 Inserm/Université d'Auvergne, USC-INRA 2018, Microbes, Intestine, Inflammation et Susceptibility of the Host, Clermont-Ferrand, France.
Background:
Diffusion-weighted magnetic resonance entero-colonography (DW-MREC) with no rectal distension and with no bowel cleansing is accurate to assess inflammatory activity in ileocolonic Crohn's disease (CD).
Aim:
To study DW-MREC parameters as predictors of remission (CDAI < 150 and CRP < 5mg/L) after anti-TNF induction therapy.
Methods:
Forty consecutive CD patients were prospectively and consecutively included. All the patients underwent DW-MREC with apparent diffusion coefficient (ADC) and MaRIA calculation before starting anti-TNF. Mean ADC was defined as the mean of the segmental ADC.
Results:
Twenty patients (50.0%) experienced remission at W12. Low mean ADC (2.05 ± 0.22 vs 1.89 ± 0.25, p = 0.03) and high total MaRIA (39.2 ± 16.6 vs 51.7 ± 18.2, p = 0.03) were predictive of remission at W12. Using a ROC curve, we determined a mean ADC of 1.96 as predictive cut-off of remission at W12 (AUC = 0.703 [0.535-0.872]) with sensitivity, specificity, positive predictive value and negative predictive value of 70.0%, 65.0%, 66.7% and 68.4%, respectively. In multivariate analysis, mean ADC < 1.96 (OR = 4.87, 95% CI [1.04-22.64]) and total MaRIA > 42.5 (OR = 5.11, 95% CI [1.03-25.37]), reflecting high inflammatory activity, were predictive of remission at week 12.
Conclusions:
DW-MREC using quantitative parameters i.e. ADC, is useful in detecting and assessing inflammatory activity but also to predict efficacy of anti-TNF induction therapy in CD.
Insights
Diffusion-weighted magnetic resonance entero-colonography (DW-MREC) accurately assesses Crohn's disease (CD) activity. Quantitative DW-MREC parameters, like apparent diffusion coefficient (ADC), predict treatment response to anti-TNF therapy.
Area of Science:
- Gastroenterology
- Radiology
- Medical Imaging
Background:
- Diffusion-weighted magnetic resonance entero-colonography (DW-MREC) without rectal distension or bowel cleansing accurately assesses inflammatory activity in ileocolonic Crohn's disease (CD).
- Predicting treatment response is crucial for optimizing patient management in CD.
Purpose of the Study:
- To evaluate DW-MREC quantitative parameters as predictors of clinical and biochemical remission following anti-tumor necrosis factor (anti-TNF) induction therapy in CD patients.
- To establish if imaging biomarkers can forecast treatment success.
Main Methods:
- Forty consecutive CD patients underwent DW-MREC, including apparent diffusion coefficient (ADC) and MaRIA scoring, before initiating anti-TNF therapy.
- Mean ADC was calculated as the average segmental ADC value.
- Remission was defined as a Crohn's Disease Activity Index (CDAI) < 150 and C-reactive protein (CRP) < 5 mg/L at week 12.
Main Results:
- Fifty percent of patients achieved remission at week 12.
- Lower mean ADC values (2.05 ± 0.22 vs 1.89 ± 0.25, p=0.03) and higher total MaRIA scores (39.2 ± 16.6 vs 51.7 ± 18.2, p=0.03) were associated with remission.
- A mean ADC cutoff of 1.96 predicted remission with 70% sensitivity and 65% specificity (AUC=0.703).
- Multivariate analysis indicated mean ADC < 1.96 (OR=4.87) and total MaRIA > 42.5 (OR=5.11) predicted week 12 remission.
Conclusions:
- DW-MREC, utilizing quantitative parameters like ADC, effectively detects and quantifies inflammatory activity in CD.
- These quantitative DW-MREC parameters serve as valuable biomarkers for predicting the efficacy of anti-TNF induction therapy in CD patients.
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