Université Clermont Auvergne, CHU Clermont-Ferrand, Service de Radiologie, Clermont-Ferrand, France.
CHU Rennes, Univ Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolisms and Cancer), F-35000 Rennes, France.
J Crohns Colitis. 2020 Nov 7;14(11):1524-1534. doi: 10.1093/ecco-jcc/jjaa098.
Magnetic resonance imaging [MRI] is a promising tool to evaluate therapeutic efficacy in ileocolonic Crohn's disease [CD].
We aimed to assess the feasibility of early MRI evaluation (week 12 [W12]) to predict corticosteroid-free remission [CFREM] at W52 and prevent long-term bowel damage.
All patients with active CD needing anti-tumour necrosis factor [anti-TNF] therapy were consecutively enrolled in this multicentre prospective study. MRI was performed before starting therapy, at W12 and W52. CFREM was defined as Crohn's Disease Activity Index < 150, C-reactive protein < 5 mg/L and faecal calprotectin < 250 µg/g, with no switch of anti-TNF agents, no bowel resection and no therapeutic intensification between W12 and W52.
Among 46 patients, 22 [47.8%] achieved CFREM at W52. Anti-TNF agents were able to heal almost all CD lesions as soon as W12 [p < 0.05]. Early transmural response defined as a 25% decrease of either Clermont score (odds ratio [OR] = 7.7 [1.7-34.0], p < 0.001) or Magnetic Resonance Index of Activity (OR = 4.2 [1.3-13.3], p = 0.015) was predictive of CFREM at W52. Achieving at least two items on W12-MRI among ulceration healing, disappearance of enlarged lymph nodes or sclerolipomatosis, ΔADC [apparent diffusion coefficient] > +10% or ΔRCE [relative contrast enhancement] > -30% was associated with a likelihood of CFREM at W52 of 84.6% vs 37.5% in patients without transmural response [p < 0.001]. Early transmural response could prevent bowel damage progression over time using Clermont score (hazard ratio = 0.21 [0.0-0.9]; p = 0.037).
Evaluation of early transmural response by MRI is feasible and is a promising end point to monitor therapeutic efficacy in patients with CD.
磁共振成像（MRI）是评估回肠结肠克罗恩病（CD）治疗效果的一种很有前途的工具。
我们旨在评估早期 MRI 评估（第 12 周[W12]）预测第 52 周时无皮质类固醇缓解（CFREM）和预防长期肠道损伤的可行性。
所有需要抗肿瘤坏死因子（抗-TNF）治疗的活动性 CD 患者均连续纳入这项多中心前瞻性研究。在开始治疗前、第 12 周和第 52 周进行 MRI。CFREM 定义为克罗恩病活动指数 < 150，C 反应蛋白 < 5 mg/L 和粪便钙卫蛋白 < 250 µg/g，第 12 周至第 52 周期间无抗-TNF 药物转换、无肠道切除术和无治疗强化。
在 46 名患者中，22 名（47.8%）在第 52 周时达到 CFREM。抗-TNF 药物几乎在第 12 周就能够治愈所有 CD 病变[P < 0.05]。定义为 Clermont 评分降低 25%（优势比[OR] = 7.7[1.7-34.0]，P < 0.001）或活动磁共振指数（OR = 4.2[1.3-13.3]，P = 0.015）的早期穿透性反应是第 52 周 CFREM 的预测因子。在第 12 周 MRI 上实现溃疡愈合、增大的淋巴结消失或硬化性脂膜炎、ΔADC[表观扩散系数] > +10%或 ΔRCE[相对对比增强] > -30%等至少两项的患者，与无穿透性反应的患者相比，第 52 周时 CFREM 的可能性为 84.6%比 37.5%[P < 0.001]。使用 Clermont 评分，早期穿透性反应可以防止肠道损伤随时间进展（风险比 = 0.21[0.0-0.9]；P = 0.037）。
通过 MRI 评估早期穿透性反应是可行的，是监测 CD 患者治疗效果的一个很有前途的终点。
