Jonathan R Dillman, Jean A Tkach, Joel G Fletcher, David H Bruining, Aiming Lu, Subra Kugathasan, Adina L Alazraki, Jack Knight-Scott, Ryan W Stidham, Jeremy Adler, Bruce C Trapnell, Scott D Swanson, Lin Fei, Lucia Qian, Alexander J Towbin, Murat Kocaoglu, Christopher G Anton, Rebecca A Imbus, Jonathan A Dudley, Lee A Denson
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Noncontrast research MRI examinations measured bowel wall 3-dimensional magnetization transfer ratio normalized to skeletal muscle (normalized 3D MTR), modified Look-Locker inversion recovery (MOLLI) T1 relaxation, intravoxel incoherent motion (IVIM) diffusion-weighted imaging metrics, and the simplified magnetic resonance index of activity (sMaRIA). Circulating biomarkers were measured on the same day as the research MRI and included CD64, extracellular matrix protein 1 (ECM1), and granulocyte-macrophage colony-stimulating factor (GM-CSF) autoantibodies (Ab). Associations between MRI and circulating biomarkers and need for ileal resection were tested using univariate and multivariable LASSO regression.</p><p><strong>Results: </strong>Our study sample included 50 patients with CD undergoing ileal resection and 83 patients with CD receiving medical therapy; mean participant age was 23.9 ± 13.1 years. Disease duration and treatment exposures did not vary between the groups. Univariate biomarker associations with ileal resection included log GM-CSF Ab (odds ratio [OR], 2.87; P = .0009), normalized 3D MTR (OR, 1.05; P = .002), log MOLLI T1 (OR, 0.01; P = .02), log IVIM perfusion fraction (f; OR, 0.38; P = .04), and IVIM apparent diffusion coefficient (ADC; OR, 0.3; P = .001). The multivariable model for surgery based upon corrected Akaike information criterion included age (OR, 1.03; P = .29), BMI (OR, 0.91; P = .09), log GM-CSF Ab (OR, 3.37; P = .01), normalized 3D MTR (OR, 1.07; P = .007), sMaRIA (OR, 1.14; P = .61), luminal narrowing (OR, 10.19; P = .003), log C-reactive protein (normalized; OR, 2.75; P = .10), and hematocrit (OR, 0.90; P = .13).</p><p><strong>Conclusion: </strong>After accounting for clinical and MRI measures of severity, normalized 3D MTR and GM-CSF Ab are associated with the need for surgery in ileal CD.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":"2181-2190"},"PeriodicalIF":4.5000,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"MRI and Blood-based Biomarkers Are Associated With Surgery in Children and Adults With Ileal Crohn's Disease.\",\"authors\":\"Jonathan R Dillman, Jean A Tkach, Joel G Fletcher, David H Bruining, Aiming Lu, Subra Kugathasan, Adina L Alazraki, Jack Knight-Scott, Ryan W Stidham, Jeremy Adler, Bruce C Trapnell, Scott D Swanson, Lin Fei, Lucia Qian, Alexander J Towbin, Murat Kocaoglu, Christopher G Anton, Rebecca A Imbus, Jonathan A Dudley, Lee A Denson\",\"doi\":\"10.1093/ibd/izae101\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Despite advances in medical therapy, many children and adults with ileal Crohn's disease (CD) progress to fibrostenosis requiring surgery. We aimed to identify MRI and circulating biomarkers associated with the need for surgical management.</p><p><strong>Methods: </strong>This prospective, multicenter study included pediatric and adult CD cases undergoing ileal resection and CD controls receiving medical therapy. Noncontrast research MRI examinations measured bowel wall 3-dimensional magnetization transfer ratio normalized to skeletal muscle (normalized 3D MTR), modified Look-Locker inversion recovery (MOLLI) T1 relaxation, intravoxel incoherent motion (IVIM) diffusion-weighted imaging metrics, and the simplified magnetic resonance index of activity (sMaRIA). Circulating biomarkers were measured on the same day as the research MRI and included CD64, extracellular matrix protein 1 (ECM1), and granulocyte-macrophage colony-stimulating factor (GM-CSF) autoantibodies (Ab). Associations between MRI and circulating biomarkers and need for ileal resection were tested using univariate and multivariable LASSO regression.</p><p><strong>Results: </strong>Our study sample included 50 patients with CD undergoing ileal resection and 83 patients with CD receiving medical therapy; mean participant age was 23.9 ± 13.1 years. Disease duration and treatment exposures did not vary between the groups. Univariate biomarker associations with ileal resection included log GM-CSF Ab (odds ratio [OR], 2.87; P = .0009), normalized 3D MTR (OR, 1.05; P = .002), log MOLLI T1 (OR, 0.01; P = .02), log IVIM perfusion fraction (f; OR, 0.38; P = .04), and IVIM apparent diffusion coefficient (ADC; OR, 0.3; P = .001). 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引用次数: 0
摘要
背景：尽管药物治疗取得了进展，但许多患有回肠克罗恩病（CD）的儿童和成人仍会发展为纤维狭窄，需要进行手术治疗。我们旨在确定与手术治疗需求相关的核磁共振成像和循环生物标志物：这项前瞻性多中心研究包括接受回肠切除术的儿童和成人 CD 病例以及接受药物治疗的 CD 对照组。非对比研究磁共振成像检查测量了肠壁三维磁化转移比归一化骨骼肌（归一化三维MTR）、改良锁相反转恢复（MOLLI）T1弛豫、体内非相干运动（IVIM）扩散加权成像指标和简化磁共振活动指数（sMaRIA）。在研究磁共振成像的同一天测量了循环生物标志物，包括 CD64、细胞外基质蛋白 1 (ECM1) 和粒细胞-巨噬细胞集落刺激因子 (GM-CSF) 自身抗体 (Ab)。采用单变量和多变量 LASSO 回归法检验了 MRI 和循环生物标志物与回肠切除术需求之间的关联：我们的研究样本包括 50 名接受回肠切除术的 CD 患者和 83 名接受药物治疗的 CD 患者；参与者的平均年龄为 23.9 ± 13.1 岁。两组患者的病程和接受治疗的情况没有差异。与回肠切除术相关的单变量生物标志物包括对数 GM-CSF Ab（比值比 [OR]，2.87；P = .0009）、归一化三维 MTR（OR，1.05；P = .002）、对数 MOLLI T1（OR，0.01；P = .02）、对数 IVIM 灌注分数（f；OR，0.38；P = .04）和 IVIM 表观扩散系数（ADC；OR，0.3；P = .001）。基于校正 Akaike 信息标准的手术多变量模型包括年龄（OR，1.03；P = .29）、体重指数（OR，0.91；P = .09）、GM-CSF Ab 对数（OR，3.37；P = .01）、归一化 3D MTR（OR，1.07；P = .007）、sMaRIA（OR，1.14；P = .61）、管腔狭窄（OR，10.19；P = .003）、对数 C 反应蛋白（归一化；OR，2.75；P = .10）和血细胞比容（OR，0.90；P = .13）：结论：考虑到临床和 MRI 测量的严重程度，正常化 3D MTR 和 GM-CSF Ab 与回肠 CD 的手术需求相关。
MRI and Blood-based Biomarkers Are Associated With Surgery in Children and Adults With Ileal Crohn's Disease.
Background: Despite advances in medical therapy, many children and adults with ileal Crohn's disease (CD) progress to fibrostenosis requiring surgery. We aimed to identify MRI and circulating biomarkers associated with the need for surgical management.
Methods: This prospective, multicenter study included pediatric and adult CD cases undergoing ileal resection and CD controls receiving medical therapy. Noncontrast research MRI examinations measured bowel wall 3-dimensional magnetization transfer ratio normalized to skeletal muscle (normalized 3D MTR), modified Look-Locker inversion recovery (MOLLI) T1 relaxation, intravoxel incoherent motion (IVIM) diffusion-weighted imaging metrics, and the simplified magnetic resonance index of activity (sMaRIA). Circulating biomarkers were measured on the same day as the research MRI and included CD64, extracellular matrix protein 1 (ECM1), and granulocyte-macrophage colony-stimulating factor (GM-CSF) autoantibodies (Ab). Associations between MRI and circulating biomarkers and need for ileal resection were tested using univariate and multivariable LASSO regression.
Results: Our study sample included 50 patients with CD undergoing ileal resection and 83 patients with CD receiving medical therapy; mean participant age was 23.9 ± 13.1 years. Disease duration and treatment exposures did not vary between the groups. Univariate biomarker associations with ileal resection included log GM-CSF Ab (odds ratio [OR], 2.87; P = .0009), normalized 3D MTR (OR, 1.05; P = .002), log MOLLI T1 (OR, 0.01; P = .02), log IVIM perfusion fraction (f; OR, 0.38; P = .04), and IVIM apparent diffusion coefficient (ADC; OR, 0.3; P = .001). The multivariable model for surgery based upon corrected Akaike information criterion included age (OR, 1.03; P = .29), BMI (OR, 0.91; P = .09), log GM-CSF Ab (OR, 3.37; P = .01), normalized 3D MTR (OR, 1.07; P = .007), sMaRIA (OR, 1.14; P = .61), luminal narrowing (OR, 10.19; P = .003), log C-reactive protein (normalized; OR, 2.75; P = .10), and hematocrit (OR, 0.90; P = .13).
Conclusion: After accounting for clinical and MRI measures of severity, normalized 3D MTR and GM-CSF Ab are associated with the need for surgery in ileal CD.
期刊介绍：
Inflammatory Bowel Diseases® supports the mission of the Crohn''s & Colitis Foundation by bringing the most impactful and cutting edge clinical topics and research findings related to inflammatory bowel diseases to clinicians and researchers working in IBD and related fields. The Journal is committed to publishing on innovative topics that influence the future of clinical care, treatment, and research.
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