Clinical implication of radiologic complete remission on Crohn's Disease: Compared with endoscopic remission. Issue 155 (October 2022)

• Record Type: Journal Article
• Authors: Kim, Min Cheol; Kim, Se Hyung; Koh, Seong‑Joon; Park, Ji Hoon; Yoon, Hyuk
• Is Part Of: European journal of radiology. Issue 155(2022)
• Publication Date: 2022-10
• Subjects: Crohn disease -- Treatment outcome -- Spiral computed tomography -- Magnetic resonance imaging -- Colonoscopy; CD Crohn's disease -- CR complete remission -- CTE CT enterography -- MRE MR enterography -- TNF tumor necrosis factor -- CDAI Crohn's Disease Activity Index -- CRP C-reactive protein -- SD standard deviation; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2022.110469
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: Radiologic complete remission (CR) outperformed endoscopic CR in predicting long-term clinical outcomes in Crohn's disease. Mean fecal calprotectin level was significantly lower in the radiologic CR group than in the non-CR group. Radiologic CR represents a better therapeutic endpoint in Crohn's disease, showing superiority over endoscopic CR in predicting both clinical and biochemical outcomes. Abstract: Objectives: To determine the clinical implications of radiologic complete remission (CR) in Crohn's disease (CD) evaluated by computed tomography (CT) or magnetic resonance enterography (MRE) in comparison with endoscopic CR. Methods: Twenty-five CD patients who achieved endoscopic CR after medical treatment were retrospectively enrolled in this study. All patients underwent ileocolonoscopy, CT, or MRE at baseline, at the time of endoscopic CR, and during follow-up. Two radiologists assessed the mural and perienteric abnormalities on pre- and post-treatment CT or MRE in consensus. Patients were divided into radiologic CR and non-CR groups at the time of endoscopic CR. CD recurrence during subsequent follow-up periods was evaluated using clinical, laboratory, and CT/MRI findings. Statistical analysis was performed to assess whether there were significant differences in patient outcomes between the groups. Results: At the time of endoscopic CR, nine patients (mean age, 36.6 years) showed normalization of all radiologic features and were designated as the radiologic CR group. However, 16 patients (mean age: 32.9 years) showed residual CT/MRE abnormalities, suggesting persistent active inflammation, and were designated as the radiologic non-CR group. During follow-up, there was a significant difference between the groups regarding clinical outcomes (deep CR, 8/9 vs 5/16, P = 0.011; CD recurrence, 1/9 vs 14/16, P < 0.001). The mean fecal calprotectin level was significantly lower in the radiologic CR group (287.5 ug/g) than in the non-CR group (652.4 ug/g) (P = 0.023). Conclusions: Radiologic CR can represent a better therapeutic endpoint in CD, showing superiority over endoscopic CR in predicting both clinical and biochemical outcomes.