Diffusion-weighted magnetic resonance enterocolonography in predicting remission after anti-TNF induction therapy in Crohn's disease. Issue 3 (March 2016)

• Record Type: Journal Article
• Authors: Buisson, Anthony; Hordonneau, Constance; Goutte, Marion; Scanzi, Julien; Goutorbe, Felix; Klotz, Thomas; Boyer, Louis; Pereira, Bruno; Bommelaer, Gilles
• Is Part Of: Digestive and liver disease. Volume 48:Issue 3(2016)
• Page Start: 260
• Page End: 266
• Publication Date: 2016-03
• Subjects: Anti-TNF -- Crohn's disease -- Diffusion-weighted MRI -- Predictive factor; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2015.10.019
• Languages: English
• ISSNs: 1590-8658

Abstract

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 < 5 mg/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.