Anthony Buisson1, Constance Hordonneau2, Marion Goutte3, Julien Scanzi4, Felix Goutorbe4, Thomas Klotz2, Louis Boyer2, Bruno Pereira5, Gilles Bommelaer3. 1. University Hospital Estaing, Gastroenterology Department, Clermont-Ferrand, France; UMR 1071 Inserm/Université d'Auvergne, USC-INRA 2018, Microbes, Intestine, Inflammation et Susceptibility of the Host, Clermont-Ferrand, France. Electronic address: a_buisson@hotmail.fr. 2. University Hospital Estaing, Radiology Department, Clermont-Ferrand, France. 3. University Hospital Estaing, Gastroenterology Department, Clermont-Ferrand, France; UMR 1071 Inserm/Université d'Auvergne, USC-INRA 2018, Microbes, Intestine, Inflammation et Susceptibility of the Host, Clermont-Ferrand, France. 4. University Hospital Estaing, Gastroenterology Department, Clermont-Ferrand, France. 5. GM Clermont-Ferrand University and Medical Center, DRCI, Biostatistics Unit, Clermont-Ferrand, France.
Abstract
BACKGROUND: Diffusion-weighted magnetic resonance entero-colonography (DW-MREC) with no rectal distension and with no bowel cleansing is accurate to assess inflammatory activity in ileocolonic Crohn's disease (CD). AIM: To study DW-MREC parameters as predictors of remission (CDAI < 150 and CRP < 5mg/L) after anti-TNF induction therapy. METHODS: Forty consecutive CD patients were prospectively and consecutively included. All the patients underwent DW-MREC with apparent diffusion coefficient (ADC) and MaRIA calculation before starting anti-TNF. Mean ADC was defined as the mean of the segmental ADC. RESULTS: Twenty patients (50.0%) experienced remission at W12. Low mean ADC (2.05 ± 0.22 vs 1.89 ± 0.25, p = 0.03) and high total MaRIA (39.2 ± 16.6 vs 51.7 ± 18.2, p = 0.03) were predictive of remission at W12. Using a ROC curve, we determined a mean ADC of 1.96 as predictive cut-off of remission at W12 (AUC = 0.703 [0.535-0.872]) with sensitivity, specificity, positive predictive value and negative predictive value of 70.0%, 65.0%, 66.7% and 68.4%, respectively. In multivariate analysis, mean ADC < 1.96 (OR = 4.87, 95% CI [1.04-22.64]) and total MaRIA > 42.5 (OR = 5.11, 95% CI [1.03-25.37]), reflecting high inflammatory activity, were predictive of remission at week 12. CONCLUSIONS: DW-MREC using quantitative parameters i.e. ADC, is useful in detecting and assessing inflammatory activity but also to predict efficacy of anti-TNF induction therapy in CD.
BACKGROUND: Diffusion-weighted magnetic resonance entero-colonography (DW-MREC) with no rectal distension and with no bowel cleansing is accurate to assess inflammatory activity in ileocolonic Crohn's disease (CD). AIM: To study DW-MREC parameters as predictors of remission (CDAI < 150 and CRP < 5mg/L) after anti-TNF induction therapy. METHODS: Forty consecutive CDpatients were prospectively and consecutively included. All the patients underwent DW-MREC with apparent diffusion coefficient (ADC) and MaRIA calculation before starting anti-TNF. Mean ADC was defined as the mean of the segmental ADC. RESULTS: Twenty patients (50.0%) experienced remission at W12. Low mean ADC (2.05 ± 0.22 vs 1.89 ± 0.25, p = 0.03) and high total MaRIA (39.2 ± 16.6 vs 51.7 ± 18.2, p = 0.03) were predictive of remission at W12. Using a ROC curve, we determined a mean ADC of 1.96 as predictive cut-off of remission at W12 (AUC = 0.703 [0.535-0.872]) with sensitivity, specificity, positive predictive value and negative predictive value of 70.0%, 65.0%, 66.7% and 68.4%, respectively. In multivariate analysis, mean ADC < 1.96 (OR = 4.87, 95% CI [1.04-22.64]) and total MaRIA > 42.5 (OR = 5.11, 95% CI [1.03-25.37]), reflecting high inflammatory activity, were predictive of remission at week 12. CONCLUSIONS: DW-MREC using quantitative parameters i.e. ADC, is useful in detecting and assessing inflammatory activity but also to predict efficacy of anti-TNF induction therapy in CD.
Authors: Cécile Campos; Antoine Perrey; Céline Lambert; Bruno Pereira; Marion Goutte; Anne Dubois; Felix Goutorbe; Michel Dapoigny; Gilles Bommelaer; Constance Hordonneau; Anthony Buisson Journal: Dig Dis Sci Date: 2017-04-11 Impact factor: 3.199