Zhu Jianguo, Zhang Faming, Zhou Jinfa, Li Haige
Department of Radiology Center of Intestinal Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Medicine (Baltimore). 2017 Aug;96(32):e7759. doi: 10.1097/MD.0000000000007759.
The aim of the study was to investigate dynamic contrast enhanced MRI (DCE-MRI) as a potential marker to assess the therapeutic responses of fecal microbiota transplantation (FMT) in patients with Crohn's disease (CD) and to determine the parameter or combination of parameters most strongly associated with changes in clinical indicators after treatment.In 22 CD patients, DCE-MRI was performed with a 3.0T scanner. Parameters of DCE-MRI (vascular transfer constant [K] and blood volume [BV]) in the terminal ileum were compared between before and day 90 after FMT treatment. The differences of clinical indicators (C-reactive protein [CRP], Harvey-Bradshaw index [HBI]) and DCE-MRI parameters (K, BV) between pre- and post-treatment was calculated by Student's 2-tailed, paired t-test. The correlations between percent change of clinical indicators (ΔCRP, ΔHBI) with DCE-MRI parameters (ΔK, ΔBV) were analyzed by Pearson's correlation coefficients. A logistic regression model was used to identify the changes of DCE-MRI parameters related to the treatment outcomes. Receiver operating characteristic curves (ROCs) were generated to assess which DCE-MRI parameter showed the best accuracy for evaluation of therapeutic response.After treatment, mean values of clinical indicators decreased significantly (CRP: 62.68 ± 31.86 vs 43.55 ± 29.63 mg/L, P = .008; HBI: 7.18 ± 2.10 vs 5.73 ± 2.33, P = 0.012). Both DCE-MRI parameters showed prominent differences before and after treatment: K (1.86 ± 0.87 vs 1.39 ± 0.83 min, P = .017), BV (61.02 ± 28.49 vs 41.96 ± 22.75 mL/100 g, P = .005). There were significant correlations between ΔCRP or ΔHBI and percent change of CDE-MRI parameters (ΔK to ΔCRP: 0.659; ΔK to ΔHBI: 0.496; ΔBV to ΔCRP: 0.442; ΔBV to ΔHBI: 0.476). Compared to ΔK and ΔBV individually, the combination of both parameters performed best in assessment of therapeutic response with an area under the ROCs (AUC) of 0.948.K and BV parameters derived from DCE-MRI have the potential to assess for therapeutic response after FMT treatment for CD. The combination of K and BV measurements improved the predictive capability compared to the individual parameters.
本研究的目的是探讨动态对比增强磁共振成像（DCE-MRI）作为评估克罗恩病（CD）患者粪便微生物群移植（FMT）治疗反应的潜在标志物，并确定与治疗后临床指标变化最密切相关的参数或参数组合。对22例CD患者使用3.0T扫描仪进行DCE-MRI检查。比较FMT治疗前和治疗后90天末段回肠的DCE-MRI参数（血管转运常数[K]和血容量[BV]）。治疗前后临床指标（C反应蛋白[CRP]、哈维-布拉德肖指数[HBI]）和DCE-MRI参数（K、BV）的差异采用双侧配对t检验计算。临床指标变化百分比（ΔCRP、ΔHBI）与DCE-MRI参数变化百分比（ΔK、ΔBV）之间的相关性采用Pearson相关系数分析。采用逻辑回归模型确定与治疗结果相关的DCE-MRI参数变化。绘制受试者工作特征曲线（ROC）以评估哪个DCE-MRI参数对治疗反应评估的准确性最高。治疗后，临床指标的平均值显著下降（CRP：62.68±31.86 vs 43.55±29.63mg/L，P = 0.008；HBI：7.18±2.10 vs 5.73±2.33，P = 0.012）。两个DCE-MRI参数在治疗前后均有显著差异：K（1.86±0.87 vs 1.39±0.83min，P = 0.017），BV（61.02±28.49 vs 41.96±22.75mL/100g，P = 0.005）。ΔCRP或ΔHBI与CDE-MRI参数变化百分比之间存在显著相关性（ΔK与ΔCRP：0.659；ΔK与ΔHBI：0.496；ΔBV与ΔCRP：0.442；ΔBV与ΔHBI：0.476）。与单独的ΔK和ΔBV相比，两个参数的组合在评估治疗反应方面表现最佳，ROC曲线下面积（AUC）为0.948。DCE-MRI得出的K和BV参数有潜力评估CD患者FMT治疗后的治疗反应。与单个参数相比，K和BV测量值的组合提高了预测能力。
