Plumb A A, Menys A, Russo E, Prezzi D, Bhatnagar G, Vega R, Halligan S, Orchard T R, Taylor S A
Centre for Medical Imaging, University College London, London, UK.
Department of Gastroenterology, Imperial College London, London, UK.
Aliment Pharmacol Ther. 2015 Aug;42(3):343-55. doi: 10.1111/apt.13275. Epub 2015 Jun 8.
Magnetic resonance enterography (MRE) can measure small bowel motility, reduction in which reflects inflammatory burden in Crohn's Disease (CD). However, it is unknown if motility improves with successful treatment.
To determine if changes in segmental small bowel motility reflect response to anti-TNFα therapy after induction and longer term.
A total of 46 patients (median 29 years, 19 females) underwent MRE before anti-TNFα treatment; 35 identified retrospectively underwent repeat MRE after median 55 weeks of treatment and 11 recruited prospectively after median 12 weeks. Therapeutic response was defined by physician global assessment (retrospective group) or a ≥3 point drop in the Harvey-Bradshaw Index (prospective group), C-reactive protein (CRP) and the MaRIA score. Two independent radiologists measured motility using an MRE image-registration algorithm. We compared motility changes in responders and nonresponders using the Mann-Whitney test.
Anti-TNFα responders had significantly greater improvements in motility (median = 73.4% increase from baseline) than nonresponders (median = 25% reduction, P < 0.001). Improved MRI-measured motility was 93.1% sensitive (95%CI: 78.0-98.1%) and 76.5% specific (95% CI: 52.7-90.4%) for anti-TNFα response. Patients with CRP normalisation (<5 mg/L) had significantly greater improvements in motility (median = 73.4% increase) than those with persistently elevated CRP (median = 5.1%, P = 0.035). Individuals with post-treatment MaRIA scores of <11 had greater motility improvements (median = 94.7% increase) than those with post-treatment MaRIA score >11 (median 15.2% increase, P = 0.017).
Improved MRI-measured small bowel motility accurately detects response to anti-TNFα therapy for Crohn's disease, even as early as 12 weeks. Motility MRI may permit early identification of nonresponse to anti-TNFα agents, allowing personalised treatment.
磁共振小肠造影（MRE）可测量小肠蠕动，其降低反映克罗恩病（CD）的炎症负担。然而，尚不清楚成功治疗后蠕动是否会改善。
确定节段性小肠蠕动的变化是否反映诱导期及长期抗TNFα治疗的反应。
共46例患者（中位年龄29岁，19例女性）在抗TNFα治疗前接受MRE检查；35例回顾性纳入患者在治疗中位时间55周后接受重复MRE检查，11例前瞻性纳入患者在治疗中位时间12周后接受检查。治疗反应通过医生整体评估（回顾性组）或Harvey-Bradshaw指数（前瞻性组）、C反应蛋白（CRP）和MaRIA评分下降≥3分来定义。两名独立放射科医生使用MRE图像配准算法测量蠕动。我们使用Mann-Whitney检验比较反应者和无反应者的蠕动变化。
抗TNFα反应者的蠕动改善程度（中位数：较基线增加73.4%）显著大于无反应者（中位数：降低25%，P<0.001）。MRI测量的蠕动改善对抗TNFα反应的敏感性为93.1%（95%CI：78.0 - 98.1%），特异性为76.5%（95%CI：52.7 - 90.4%）。CRP正常化（<5mg/L）的患者蠕动改善程度（中位数：增加73.4%）显著大于CRP持续升高的患者（中位数：5.1%，P = 0.035）。治疗后MaRIA评分<11的个体蠕动改善程度（中位数：增加94.7%）大于治疗后MaRIA评分>11的个体（中位数：增加15.2%，P = 0.017）。
MRI测量的小肠蠕动改善可准确检测克罗恩病抗TNFα治疗的反应，甚至早在12周时即可检测到。蠕动MRI可能有助于早期识别对抗TNFα药物无反应的情况，从而实现个性化治疗。
