Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229.
Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH.
AJR Am J Roentgenol. 2022 Oct;219(4):655-664. doi: 10.2214/AJR.22.27792. Epub 2022 May 11.
Changes in intestinal motility in patients with newly diagnosed Crohn disease have historically been evaluated primarily in a subjective manner. The purpose of this study was to assess longitudinal changes in objective intestinal motility scores in children and young adults with newly diagnosed ileal Crohn disease treated with biologic (anti-tumor necrosis factor-α) medical therapy compared with those in control participants. This prospective study included 20 children and young adults (eight female and 12 male patients; mean age, 14.6 ± 2.1 [SD] years) with newly diagnosed ileal Crohn disease who were recruited between December 2018 and October 2021 as well as 15 control participants without any known gastrointestinal conditions (eight female and seven male patients; mean age, 18.1 ± 4.4 years). All participants underwent research MRI examinations of the small bowel, including dynamic cine 2D SSFP sequences. Patients with Crohn disease underwent additional research MRI examinations performed at both 6 weeks and 6 months after initiation of biologic therapy. Two operators independently derived terminal ileal intestinal motility scores from the dynamic cine sequences by use of FDA-approved software (with higher scores indicating greater intestinal motility). Intestinal motility scores were compared between patient and control groups by use of tests, whereas changes in intestinal motility scores after treatment were assessed using linear mixed models. Interoperator absolute agreement was assessed using the intra-class correlation coefficient (ICC). Mean terminal ileal intestinal motility scores were not significantly different between patients with newly diagnosed ileal Crohn disease and control participants (for operator 1, 180.9 ± 63.3 vs 229.7 ± 115.2, respectively [ = .12]; for operator 2, 175.0 ± 62.2 vs 236.4 ± 117.4, respectively [ = .05]). Mean intestinal motility scores changed over time compared with baseline in response to biologic therapy, for operator 1 (180.9 ± 63.3 at baseline, 248.1 ± 104.9 at 6 weeks after treatment initiation, and 249.1 ± 73.2 at 6 months after treatment initiation [ = .04]) and operator 2 (175.0 ± 62.2 at baseline, 247.8 ± 112.7 at 6 weeks after treatment initiation, and 239.6 ± 72.7 at 6 months after treatment initiation [ = .03]). Absolute agreement in intestinal motility scores was excellent between operators (ICC = 0.89). MRI measurements of intestinal motility are dynamic in children and adults with newly diagnosed small-bowel Crohn disease, showing early increases in response to biologic therapy. MRI-based intestinal motility scores may aid individualized assessment of disease activity and treatment response in patients with small-bowel Crohn disease.
新诊断克罗恩病患者的肠道动力变化在过去主要以主观方式进行评估。本研究的目的是评估新诊断为回肠克罗恩病的儿童和年轻成年人在接受生物治疗（抗肿瘤坏死因子-α）时，与对照组相比，客观肠道动力评分的纵向变化。这项前瞻性研究纳入了 20 名新诊断为回肠克罗恩病的儿童和年轻成年人（8 名女性和 12 名男性患者；平均年龄 14.6 ± 2.1[标准差]岁）和 15 名无任何已知胃肠道疾病的对照组参与者（8 名女性和 7 名男性患者；平均年龄 18.1 ± 4.4 岁）。所有参与者均接受了小肠的研究性 MRI 检查，包括动态电影 2D SSFP 序列。克罗恩病患者在生物治疗开始后 6 周和 6 个月时还接受了额外的研究性 MRI 检查。两名操作人员使用 FDA 批准的软件（得分越高表示肠道动力越大）分别从动态电影序列中得出回肠末端的肠道动力评分。使用 t 检验比较患者组和对照组之间的肠道动力评分，使用线性混合模型评估治疗后肠道动力评分的变化。采用组内相关系数（ICC）评估操作人员之间的绝对一致性。新诊断为回肠克罗恩病的患者与对照组参与者的回肠末端肠道动力评分无显著差异（对于操作人员 1，分别为 180.9 ± 63.3 和 229.7 ± 115.2[ =.12]；对于操作人员 2，分别为 175.0 ± 62.2 和 236.4 ± 117.4[ =.05]）。在生物治疗的作用下，与基线相比，肠道动力评分随时间发生变化，对于操作人员 1（基线时为 180.9 ± 63.3，治疗开始后 6 周时为 248.1 ± 104.9，治疗开始后 6 个月时为 249.1 ± 73.2[ =.04]）和操作人员 2（基线时为 175.0 ± 62.2，治疗开始后 6 周时为 247.8 ± 112.7，治疗开始后 6 个月时为 239.6 ± 72.7[ =.03]）。操作人员之间的肠道动力评分绝对一致性良好（ICC = 0.89）。在新诊断的小肠克罗恩病儿童和成人中，MRI 测量的肠道动力是动态的，在接受生物治疗后会立即增加。基于 MRI 的肠道动力评分可能有助于对小肠克罗恩病患者的疾病活动度和治疗反应进行个体化评估。
