MRI 和基于血液的生物标志物与小儿和成人回肠克罗恩病的手术相关。
MRI and Blood-based Biomarkers Are Associated With Surgery in Children and Adults With Ileal Crohn's Disease.
机构信息
Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Department of Radiology, Mayo Clinic, Rochester, MN, USA.
出版信息
Inflamm Bowel Dis. 2024 Nov 4;30(11):2181-2190. doi: 10.1093/ibd/izae101.
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.
背景
尽管医学治疗取得了进展，但许多患有回肠克罗恩病（CD）的儿童和成人仍会进展为需要手术的纤维狭窄。我们旨在确定与手术管理相关的 MRI 和循环生物标志物。
方法
本前瞻性、多中心研究纳入了接受回肠切除术的儿科和成年 CD 病例以及接受药物治疗的 CD 对照。非对比性研究性 MRI 检查测量了肠壁的 3 维磁化传递率与骨骼肌的归一化（归一化 3D MTR）、改良 Look-Locker 反转恢复（MOLLI）T1 弛豫、体素内不相干运动（IVIM）扩散加权成像指标和简化的磁共振活动指数（sMaRIA）。循环生物标志物与研究性 MRI 同日测量，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）。使用单变量和多变量 LASSO 回归检验 MRI 和循环生物标志物与回肠切除术之间的关联。
结果
我们的研究样本包括 50 例接受回肠切除术的 CD 患者和 83 例接受药物治疗的 CD 患者；平均参与者年龄为 23.9±13.1 岁。两组之间疾病持续时间和治疗暴露没有差异。与回肠切除术相关的单变量生物标志物包括 GM-CSF Ab 的对数（比值比 [OR]，2.87；P=0.0009）、归一化 3D MTR（OR，1.05；P=0.002）、MOLLI T1 的对数（OR，0.01；P=0.02）、IVIM 灌注分数（f；OR，0.38；P=0.04）和 IVIM 表观扩散系数（ADC；OR，0.3；P=0.001）。基于校正赤池信息量准则的手术多变量模型包括年龄（OR，1.03；P=0.29）、BMI（OR，0.91；P=0.09）、GM-CSF Ab 的对数（OR，3.37；P=0.01）、归一化 3D MTR（OR，1.07；P=0.007）、sMaRIA（OR，1.14；P=0.61）、管腔狭窄（OR，10.19；P=0.003）、C 反应蛋白的对数（归一化；OR，2.75；P=0.10）和红细胞压积（OR，0.90；P=0.13）。
结论
在考虑到严重程度的临床和 MRI 测量后，归一化 3D MTR 和 GM-CSF Ab 与回肠 CD 手术的需要相关。
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