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Faecal Calprotectin and Magnetic Resonance Enterography in Ileal Crohn's Disease: Correlations Between Disease
G R Jones1,2, F Fascì-Spurio1,3, N A Kennedy1,2
1Western General Hospital, Gastrointestinal Unit, Edinburgh, UK.
Background And Aims:
Magnetic resonance enterography [MRE] is the gold standard for assessing ileal inflammation in Crohn's disease [CD]. The aim of the present study was to correlate faecal calprotectin [FC] to MRE via a simple score in an exclusive ileal cohort with long-term follow-up for association with time to surgery or biologic therapy.
Methods:
In total, 150 MRE studies with matched FC [±30 days] were identified from the Edinburgh FC Register [2008-12; n = 18138]. Scans were re-read blinded to clinical data, independently, by two expert gastrointestinal radiologists, to generate a simple MRE score [range 0-10] from assessment of the worst intestinal segment plus total disease extent.
Results:
In total, 119 MRE scans were evaluated from 104 patients with ileal CD [L1 or L3 with panproctocolectomy]. Receiver operating characteristic analysis showed an area under the curve of 0.77 [0.67-0.87, p < 0.0001] for FC and MRE score >1, with an optimal cut-off of 145 μg/g for severe inflammation on MRE with 69.3% [57.6-79.5] sensitivity and 71.4% [53.7-85.4] specificity. Long-term follow-up over a median [interquartile range] of 2086 days [1786-2353] revealed FC ≥ 145 μg/g was associated with reduced biologic-free survival until 3 years following MRE, whereas MRE score [severe vs absent] was associated with reduced surgery- and biologic-free survival throughout follow-up. Backwards stepwise logistic regression revealed that length of ileal disease (odds ratio [OR] 3.8, 1.1-13.2, p = 0.034) and increased bowel wall thickness at MRE [OR 4.2, 1.6-10.7, p < 0.0001] or female sex [OR 5.2, 1.5-18.7, p = 0.011] increased the risk of biologic use or surgery, respectively.
Conclusions:
FC correlates well with MRE assessment of ileal CD with MRE parameters associated with long-term biologic- and surgery-free remission.
Insights
Faecal calprotectin (FC) correlates with magnetic resonance enterography (MRE) in Crohn's disease (CD) ileal inflammation. High FC and MRE scores predict reduced time to surgery or biologic therapy, aiding treatment decisions.
Area of Science:
- Gastroenterology
- Medical Imaging
- Inflammatory Bowel Disease Research
Background:
- Magnetic resonance enterography (MRE) is the standard for assessing ileal inflammation in Crohn's disease (CD).
- Correlation of faecal calprotectin (FC) with MRE findings is crucial for disease management.
Purpose of the Study:
- To correlate faecal calprotectin (FC) levels with MRE scores in patients with isolated ileal Crohn's disease.
- To assess the association between FC, MRE findings, and long-term outcomes like surgery or biologic therapy initiation.
Main Methods:
- 150 MRE studies with matched FC measurements (±30 days) were analyzed.
- Two expert gastrointestinal radiologists independently scored MREs (0-10) based on disease extent and severity.
- Long-term follow-up data was collected for time to surgery or biologic therapy.
Main Results:
- An optimal FC cutoff of 145 μg/g predicted severe ileal inflammation on MRE with 69.3% sensitivity and 71.4% specificity.
- FC ≥ 145 μg/g was linked to reduced biologic-free survival up to 3 years post-MRE.
- MRE scores and factors like ileal disease length, bowel wall thickness, and female sex predicted the need for surgery or biologics.
Conclusions:
- Faecal calprotectin (FC) is a reliable non-invasive marker correlating with MRE findings in ileal Crohn's disease (CD).
- MRE parameters are associated with long-term outcomes, including surgery-free and biologic-free remission durations.
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