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MRI and Blood-based Biomarkers Are Associated With Surgery in Children and Adults With Ileal Crohn's Disease

Jonathan R Dillman¹, Jean A Tkach¹, Joel G Fletcher²

¹Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.

Inflammatory Bowel Diseases

|May 13, 2024

Insights

Normalized 3D MTR and GM-CSF autoantibodies are linked to surgical needs in ileal Crohn's disease. These biomarkers may help predict which patients require surgery, improving treatment strategies for this condition.

Area of Science:

Gastroenterology
Radiology
Immunology

Background:

Ileal Crohn's disease (CD) often progresses to fibrostenosis, necessitating surgery despite medical advancements.
Identifying predictive biomarkers for surgical intervention in CD is crucial for patient management.

Purpose of the Study:

To identify magnetic resonance imaging (MRI) and circulating biomarkers associated with the need for surgical management in pediatric and adult patients with ileal CD.

Main Methods:

A prospective, multicenter study involving pediatric and adult CD patients undergoing ileal resection or medical therapy.
MRI techniques included normalized 3D MTR, MOLLI T1, IVIM, and sMaRIA.
Circulating biomarkers measured were CD64, ECM1, and GM-CSF autoantibodies (Ab).
LASSO regression was used to analyze associations between biomarkers and the need for ileal resection.

Main Results:

Univariate analysis showed associations between ileal resection and log GM-CSF Ab, normalized 3D MTR, log MOLLI T1, log IVIM perfusion fraction (f), and IVIM ADC.
Multivariable analysis identified log GM-CSF Ab, normalized 3D MTR, and luminal narrowing as significant predictors for surgery.
Normalized 3D MTR and GM-CSF Ab remained associated with surgical need after adjusting for clinical and MRI severity measures.

Conclusions:

Normalized 3D MTR and GM-CSF Ab are independently associated with the need for surgery in patients with ileal CD.
These biomarkers show potential for predicting surgical outcomes in ileal CD patients.
Further research can explore integrating these biomarkers into clinical decision-making for CD management.

Read full analysis

Abstract

Background:

Despite advances in medical therapy, many children and adults with ileal Crohn's disease (CD) progress to fibrostenosis requiring surgery. We aimed to identify MRI and circulating biomarkers associated with the need for surgical management.

Methods:

This prospective, multicenter study included pediatric and adult CD cases undergoing ileal resection and CD controls receiving medical therapy. Noncontrast research MRI examinations measured bowel wall 3-dimensional magnetization transfer ratio normalized to skeletal muscle (normalized 3D MTR), modified Look-Locker inversion recovery (MOLLI) T1 relaxation, intravoxel incoherent motion (IVIM) diffusion-weighted imaging metrics, and the simplified magnetic resonance index of activity (sMaRIA). Circulating biomarkers were measured on the same day as the research MRI and included CD64, extracellular matrix protein 1 (ECM1), and granulocyte-macrophage colony-stimulating factor (GM-CSF) autoantibodies (Ab). Associations between MRI and circulating biomarkers and need for ileal resection were tested using univariate and multivariable LASSO regression.

Results:

Our study sample included 50 patients with CD undergoing ileal resection and 83 patients with CD receiving medical therapy; mean participant age was 23.9 ± 13.1 years. Disease duration and treatment exposures did not vary between the groups. Univariate biomarker associations with ileal resection included log GM-CSF Ab (odds ratio [OR], 2.87; P = .0009), normalized 3D MTR (OR, 1.05; P = .002), log MOLLI T1 (OR, 0.01; P = .02), log IVIM perfusion fraction (f; OR, 0.38; P = .04), and IVIM apparent diffusion coefficient (ADC; OR, 0.3; P = .001). The multivariable model for surgery based upon corrected Akaike information criterion included age (OR, 1.03; P = .29), BMI (OR, 0.91; P = .09), log GM-CSF Ab (OR, 3.37; P = .01), normalized 3D MTR (OR, 1.07; P = .007), sMaRIA (OR, 1.14; P = .61), luminal narrowing (OR, 10.19; P = .003), log C-reactive protein (normalized; OR, 2.75; P = .10), and hematocrit (OR, 0.90; P = .13).

Conclusion:

After accounting for clinical and MRI measures of severity, normalized 3D MTR and GM-CSF Ab are associated with the need for surgery in ileal CD.

Keywords:

Crohn’s disease biomarkers granulocyte-macrophage colony-stimulating factor autoantibodies magnetic resonance imaging surgery

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