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. 2020 Jan 28:7:100217.
doi: 10.1016/j.ejro.2020.01.006. eCollection 2020.

Evaluation of ileal Crohn's disease response to TNF antagonists: Validation of MR enterography for assessing response. Initial results

Sonja Gordic  1   2 , Octavia Bane  1   3 , Shingo Kihira  1 , Steven Peti  3 , Stefanie Hectors  1 , Joana Torres  4 , Judy Cho  5 , Jean-Frederic Colombel  4 , Bachir Taouli  1   3
Affiliations

Evaluation of ileal Crohn's disease response to TNF antagonists: Validation of MR enterography for assessing response. Initial results

Sonja Gordic et al. Eur J Radiol Open. .

Abstract

Purpose: To assess the value of MRI obtained before and after treatment in detecting mucosal healing in patients with ileal Crohn's disease (CD) treated with anti-TNF drugs.

Methods: In this IRB approved retrospective study, 24 patients (M/F 11/13, age 34.0 ± 12.5 years, age range 19-55 years) with ileal CD who underwent anti-TNF treatment, with pre- and post-treatment MRI (mean delay between MRIs 92 ± 57 weeks) were included. All patients underwent routine MR enterography (MRE), which included diffusion-weighted imaging (DWI). Two readers evaluated qualitative features (wall thickness, presence of edema and length of involvement) in consensus and one reader measured the following quantitative variables: relative contrast enhancement (RCE) and apparent diffusion coefficient (ADC) to derive the MaRIA and Clermont scores at baseline, post-treatment and their changes (ΔMaRIA, ΔClermont). Ileocolonoscopy results were used as the reference standard. Data was evaluated using Mann-Whitney U test and receiver operating characteristics analysis to assess the utility of the measures for the detection of mucosal healing.

Results: Twenty-four ileal segments were assessed in 24 patients. Nine patients showed mucosal healing while 15 had no mucosal healing on post-treatment endoscopy. Pre-treatment Clermont score and wall thickness and post-treatment MaRIA and Clermont scores, wall thickness, edema, length of involvement as well as ΔMaRIA and ΔClermont were all significantly different in patients with and without mucosal healing (p-range: 0.001-0.041) while MaRIA pre-treatment and ADC pre- and post-treatment were not. Pre-treatment Clermont score as well as post-treatment MaRIA and Clermont scores, wall thickness and ΔMaRIA were all significantly predictive of detection of mucosal healing (AUC 0.813-0.912; p = 0.003-0.024) after anti-TNF treatment.

Conclusion: Pre-treatment Clermont score as well as post-treatment MaRIA and Clermont scores, wall thickness and ΔMaRIA are significantly predictive of response to anti-TNF drugs in ileal Crohn's disease. These results need to be verified in a larger study.

Keywords: ADC, apparent diffusion coefficient; CD, Crohn’s Disease; Crohn’s disease; DWI, diffusion-weighted imaging; MRE, magnetic resonance enterography; MRI, Magnetic resonance imaging; MaRIA, Magnetic Resonance Index of Activity; Magnetic resonance imaging; TNF antagonist; Treatment response.

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Conflict of interest statement

BT: Research Grant, Guerbet, Bayer

Figures

Fig. 1
Fig. 1
Flow chart showing inclusion and exclusion of patients from the retrospective study. CD = Crohn’s disease; MRE = magnetic resonance enterography; TNF = tumor necrosis factor.
Fig. 2
Fig. 2
20-year old man with ileal Crohn’s Disease (CD). A) T2WI (TR/TE: 550/90 ms) shows thickened (12 mm) and edematous terminal ileum. B) T1WI post-contrast (TR/TE: 2.7/1.2 ms) shows avid enhancement (relative contrast enhancement, RCE 553.9) in the terminal ileum. C) DWI image (TR/TE: 4000/70 ms, b = 500 s2/mm) shows diffusion restriction with low ADC (1.47 × 10−3mm/s2, not shown). After anti-TNF treatment: T2WI (D) shows normal TI thickness, T1WI post-contrast (E) shows normal enhancement (RCE 0.4). On DWI (F) there is no residual signal intensity with increased ADC (2.34 × 10−3mm/s2), with concomitant mucosal healing on endoscopy. MaRIA pre was 34.1, MaRIA post 4.5, ΔMaRIA -86.8; Clermont pre was 28.5, Clermont post 6.9 and ΔClermont -75.8.
Fig. 3
Fig. 3
21-year old woman with ileal Crohn’s Disease (CD). A) T2WI (TR/TE: 606/90 ms) shows thickened (11 mm) and edematous terminal ileum. B) T1WI post-contrast (TR/TE: 3.9/1.2 ms) shows avid enhancement (relative contrast enhancement, RCE 241.6). C) DWI image (TR/TE: 6300/60, b = 400 s2/mm) shows diffusion restriction with a low ADC (0.61 × 10−3mm/s2, not shown). After anti-TNF treatment: T2WI (D) shows continuous thickening (11 mm), T1WI post-contrast (E) shows avid enhancement (RCE 242.9). On DWI (F) the signal intensity is continuously high indicating diffusion restriction with a low ADC (1.18 × 10−3mm/s2, not shown), with no mucosal healing on endoscopy. MaRIA pre was 26.3, MaRIA post 26.4, ΔMaRIA 0.10; Clermont pre was 28.0, Clermont post 27.2 and ΔClermont -2.8.
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