Diffusion-weighted imaging to predict longer-term response in Crohn's disease patients commencing biological therapy: results from the MOTILITY trial.

IF 3.4 4区 医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Maira Hameed, Stuart A Taylor, Norin Ahmed, Kashfia Chowdhury, Anisha Patel, Emma Helbren, Anisha Bhagwanani, Rachel Hyland, Gauraang Bhatnagar, Harbir Sidhu, Hannah Lambie, James Franklin, Maryam Mohsin, Elen Thomson, Darren Boone, Damian Tolan, Safi Rahman, Naomi S Sakai, Gordon W Moran, Alisa Hart, Stuart Bloom, Alex Menys, Ilan Jacobs, Steve Halligan, Andrew A Plumb
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引用次数: 0

Abstract

Objectives: Predicting longer-term response to biological therapy for small bowel Crohn's disease (SBCD) is an unmet clinical need. Diffusion-weighted magnetic resonance (MR) imaging (DWI) may indicate disease activity, but its predictive ability, if any, is unknown. We investigated the prognostic value of DWI for 1 year response or remission (RoR) in SBCD patients commencing biologic therapy, including incremental value over C-reactive protein (CRP) and faecal calprotectin (FC).

Methods: A subset of participants in a prospective, multicentre study investigating the predictive ability of motility MRI for 1-year RoR in patients starting biologic therapy for active SBCD, underwent additional DWI at baseline and post-induction (12-30 weeks). CRP and FC were collected in a subgroup. RoR at 1 year was evaluated using clinical and morphological MR enterography (MRE) parameters. We calculated sensitivity and specificity to predict RoR and quality of life (QoL) at 1 year, comparing apparent diffusion coefficient (ADC) value, Clermont score, and CRP using multivariable logistic regression.

Results: A total of 25 participants were included (mean 36.9 years, 32% female). ADC changes and Clermont score had poor sensitivity (30.0% [95% CI, 6.7-65.2] and 40.0% [95% CI, 12.2-73.8], respectively) and poor-to-modest specificity (50.0 [95% CI, 27.2-72.8] and 65.0% [95% CI, 40.8-84.6]) for RoR. None of Clermont score, CRP, or FC predicted QoL.

Conclusions: DWI has inadequate sensitivity and specificity for RoR at 1 year. There is no significant incremental prognostic value of DWI over CRP and FC to predict RoR and/or QoL at 1 year.

Advances in knowledge: Early post-induction DWI has no prognostic value for RoR at 1 year.

弥散加权成像预测开始生物治疗的克罗恩病患者的长期反应:来自MOTILITY试验的结果
目的:预测对小肠克罗恩病(SBCD)生物治疗的长期反应是一个尚未满足的临床需求。弥散加权磁共振成像(DWI)可以显示疾病的活动性,但其预测能力,如果有的话,是未知的。我们研究了DWI对开始生物治疗的SBCD患者一年缓解或缓解(RoR)的预后价值,包括c反应蛋白(CRP)和粪便钙保护蛋白(FC)的增量价值。方法:在一项前瞻性多中心研究中,一组参与者在基线和诱导后(12-30周)接受了额外的DWI,研究运动MRI对开始生物治疗的活动性SBCD患者一年RoR的预测能力。CRP和FC作为一个亚组收集。使用临床和形态学MRE参数评估一年的RoR。采用多变量logistic回归,比较表观扩散系数(ADC)值、Clermont评分和CRP,计算预测一年内RoR和生活质量(QoL)的敏感性和特异性。结果:纳入25例受试者(平均36.9岁,32%为女性)。ADC变化和Clermont评分对RoR的敏感性较差(分别为30.0% [95%CI: 6.7-65.2]和40.0% [95%CI: 12.2-73.8]),特异性较差至中等(50.0% [95%CI: 27.2-72.8]和65.0% [95%CI: 40.8-84.6])。Clermont评分、CRP和FC均不能预测生活质量。结论:DWI对1年RoR的敏感性和特异性不足。与CRP和FC相比,DWI在预测一年内RoR和/或QoL方面没有显著的增加预后价值。知识进展:早期诱导后DWI对1年的RoR没有预后价值。
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来源期刊
British Journal of Radiology
British Journal of Radiology 医学-核医学
CiteScore
5.30
自引率
3.80%
发文量
330
审稿时长
2-4 weeks
期刊介绍: BJR is the international research journal of the British Institute of Radiology and is the oldest scientific journal in the field of radiology and related sciences. Dating back to 1896, BJR’s history is radiology’s history, and the journal has featured some landmark papers such as the first description of Computed Tomography "Computerized transverse axial tomography" by Godfrey Hounsfield in 1973. A valuable historical resource, the complete BJR archive has been digitized from 1896. Quick Facts: - 2015 Impact Factor – 1.840 - Receipt to first decision – average of 6 weeks - Acceptance to online publication – average of 3 weeks - ISSN: 0007-1285 - eISSN: 1748-880X Open Access option
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