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Findings of ulceration and severe stricture on MRE can predict prognosis of Crohn’s disease in patients treated with anti-TNF treatment

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Abstract

Background

MR enterography (MRE) is useful for evaluating transmural lesions and extra-intestinal complications of Crohn’s disease (CD). The aim of this study was to prospectively evaluate whether MRE could detect severe strictures and inflammatory lesions in patients who lost the responsiveness to anti-TNF treatment and whether MRE could predict prognosis of CD patients with clinical remission.

Patients and methods

MRE were conducted in 50 patients who were treated with infliximab or adalimumab. The main aims of this study were as follows; (1) to compare the rates of CD lesions of the patients with clinical remission and active disease at the baseline and (2) to assess the MRE findings that were predictors of clinical recurrence among patients with clinical remission at the baseline.

Results

The MRE detection rates of markedly increased contrast uptake, severe strictures, and the presence of ulcers were significantly higher in patients with Crohn Disease Activity Index ≥150 than in patients with clinical remission. Over a mean follow-up of 18.2 months, the absence of ulceration (p = 0.001) or severe stricture (p = 0.01) prolonged clinical recurrence among patients with clinical remission at baseline. Expected duration of recurrence significantly prolonged in patients with total magnetic resonance index of activity (MaRIA) <36.3 [29.8 months (95% CI 23.7–35.9)] than in patients with total MaRIA ≥36.3 (13.9 months (95% CI 7.7–20.1). A cut-off value of total MaRIA score of 36.3 had a sensitivity of 75% and specificity of 70% for predicting recurrence.

Conclusion

Findings of ulceration and severe stricture on MRE predict prognosis of CD patients who were treated with anti-TNF treatment. MRE might be useful for making treatment decisions in patients who lost the effectiveness of medical treatments.

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Acknowledgments

Makoto Naganuma contributed to study design, data interpretation, and writing, review, and final approval of the manuscript. Dr. Shigeo Okuda contributed to the evaluation of CD lesions on MRE. Tadakazu Hisamatsu contributed to study design and data interpretation. Katsuyoshi Matsoka supported to writing and review of the manuscript. Takanori Kanai contributed to study design and review of the manuscript. All other authors contributed to data collection and review of the manuscript. We are thankful to Drs. Shyunsuke Matsumoto and Tatsuya Suzuki for the support in evaluating CD lesions on MRE.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Makoto Naganuma, Tadakazu Hisamatsu, Katsuyoshi Matsuoka, Kiyoto Mori & Takanori Kanai

  2. Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan

    Makoto Naganuma, Naoki Hosoe, Yoshihiro Nakazato & Haruhiko Ogata

  3. Department of Radiology, School of Medicine, Keio University, Tokyo, Japan

    Shigeo Okuda

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  1. Makoto Naganuma
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Corresponding author

Correspondence to Makoto Naganuma.

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Conflict of interest

There are no grant support and conflict of interest for this study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Electronic supplementary material

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Supplementary material 1 (DOCX 11 kb)

261_2016_878_MOESM2_ESM.tiff

Supplemental Figure 1: Patients’ status at procedures of MRE and clinical outcome. Supplementary material 2 (TIFF 1522 kb)

261_2016_878_MOESM3_ESM.tiff

Supplemental Figure 2: Correlation between CDAI and total MaRIA score in patients treated with infliximab/adalimumab. (per patient). Supplementary material 3 (TIFF 1522 kb)

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Naganuma, M., Okuda, S., Hisamatsu, T. et al. Findings of ulceration and severe stricture on MRE can predict prognosis of Crohn’s disease in patients treated with anti-TNF treatment. Abdom Radiol 42, 141–151 (2017). https://doi.org/10.1007/s00261-016-0878-5

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  • DOI: https://doi.org/10.1007/s00261-016-0878-5

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