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Multicenter Study
. 2025 Apr 1;98(1168):527-534.
doi: 10.1093/bjr/tqaf013.

Diffusion-weighted imaging to predict longer-term response in Crohn's disease patients commencing biological therapy: results from the MOTILITY trial

Maira Hameed  1   2 , Stuart A Taylor  1   2 , Norin Ahmed  3 , Kashfia Chowdhury  3 , Anisha Patel  4 , Emma Helbren  5 , Anisha Bhagwanani  6 , Rachel Hyland  7 , Gauraang Bhatnagar  2   6 , Harbir Sidhu  1   2 , Hannah Lambie  7 , James Franklin  8 , Maryam Mohsin  7 , Elen Thomson  7 , Darren Boone  1 , Damian Tolan  7 , Safi Rahman  9 , Naomi S Sakai  1   2 , Gordon W Moran  10   11 , Alisa Hart  12 , Stuart Bloom  1 , Alex Menys  13 , Ilan Jacobs  14 , Steve Halligan  1   2 , Andrew A Plumb  1   2 ; MOTILITY Trial Investigators
Collaborators, Affiliations
Multicenter Study

Diffusion-weighted imaging to predict longer-term response in Crohn's disease patients commencing biological therapy: results from the MOTILITY trial

Maira Hameed et al. Br J Radiol. .

Abstract

Objectives: Predicting longer-term response to biological therapy for small bowel Crohn's disease (SBCD) is an unmet clinical need. Diffusion-weighted magnetic resonance (MR) imaging (DWI) may indicate disease activity, but its predictive ability, if any, is unknown. We investigated the prognostic value of DWI for 1 year response or remission (RoR) in SBCD patients commencing biologic therapy, including incremental value over C-reactive protein (CRP) and faecal calprotectin (FC).

Methods: A subset of participants in a prospective, multicentre study investigating the predictive ability of motility MRI for 1-year RoR in patients starting biologic therapy for active SBCD, underwent additional DWI at baseline and post-induction (12-30 weeks). CRP and FC were collected in a subgroup. RoR at 1 year was evaluated using clinical and morphological MR enterography (MRE) parameters. We calculated sensitivity and specificity to predict RoR and quality of life (QoL) at 1 year, comparing apparent diffusion coefficient (ADC) value, Clermont score, and CRP using multivariable logistic regression.

Results: A total of 25 participants were included (mean 36.9 years, 32% female). ADC changes and Clermont score had poor sensitivity (30.0% [95% CI, 6.7-65.2] and 40.0% [95% CI, 12.2-73.8], respectively) and poor-to-modest specificity (50.0 [95% CI, 27.2-72.8] and 65.0% [95% CI, 40.8-84.6]) for RoR. None of Clermont score, CRP, or FC predicted QoL.

Conclusions: DWI has inadequate sensitivity and specificity for RoR at 1 year. There is no significant incremental prognostic value of DWI over CRP and FC to predict RoR and/or QoL at 1 year.

Advances in knowledge: Early post-induction DWI has no prognostic value for RoR at 1 year.

Keywords: Crohn’s disease; biological therapy; diffusion magnetic resonance imaging; prognosis; quality of life.

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Conflict of interest statement

A.M. holds shares in Motilent (an image analysis technology company). S.A.T. is a consultant to AstraZeneca, has research grant support from Takeda and shareholder in Motilent. G.B. is an employee of and shareholder in Motilent, is a consultant for Alimentiv, and owns patent for P295276.US.02: system to characterize topology and morphology of fistulae from medical imaging data. H.L. receives speaking honoraria from Takeda Pharmaceuticals. D.T. has research funding from GSK for an oncology trial unrelated to the current work.

Figures

Figure 1.
Figure 1.
CONSORT diagram of the flow of study participants. *Visit 1 eligible: includes baseline SES-CD score or baseline MRE score, baseline ADC/Clermont score. **Visit 2 eligible: includes visit 2 ADC/Clermont score. ***Visit 3 eligible: includes visit 3 SES-CD score or visit 3 MRE score. ∼Other reason (n=32): 32 patient’s consent were later ineligible due to a substantial amendment and consent was no longer appropriate. Abbreviations: ADC = apparent diffusion co-efficient; DWI = diffusion-weighted magnetic resonance imaging; MRE = magnetic resonance enterography; SES-CD = Simple Endoscopic Score for Crohn’s Disease.
See this image and copyright information in PMC

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