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

Sonja Gordic; Octavia Bane; Shingo Kihira; Steven Peti; Stefanie Hectors; Joana Torres; Judy Cho; Jean-Frederic Colombel; Bachir Taouli

doi:10.1016/j.ejro.2020.01.006

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

Eur J Radiol Open. 2020 Jan 28:7:100217. doi: 10.1016/j.ejro.2020.01.006. eCollection 2020.

Authors

Sonja Gordic^{1

2}, Octavia Bane^{1

3}, Shingo Kihira¹, Steven Peti³, Stefanie Hectors¹, Joana Torres⁴, Judy Cho⁵, Jean-Frederic Colombel⁴, Bachir Taouli^{1

3}

Affiliations

¹ BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
² Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
³ Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁴ Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁵ Department of Genetics and Genomic Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

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.