Hameed Maira, Taylor Stuart A, Ahmed Norin, Chowdhury Kashfia, Patel Anisha, Helbren Emma, Bhagwanani Anisha, Hyland Rachel, Bhatnagar Gauraang, Sidhu Harbir, Lambie Hannah, Franklin James, Mohsin Maryam, Thomson Elen, Boone Darren, Tolan Damian, Rahman Safi, Sakai Naomi S, Moran Gordon W, Hart Alisa, Bloom Stuart, Menys Alex, Jacobs Ilan, Halligan Steve, Plumb Andrew A
Department of Radiology, University College London Hospitals, London NW1 2BU, United Kingdom.
Centre for Medical Imaging, Division of Medicine, University College London, London W1W 7TS, United Kingdom.
Br J Radiol. 2025 Apr 1;98(1168):527-534. doi: 10.1093/bjr/tqaf013.
Predicting longer-term response to biological therapy for small bowel Crohn's disease (SBCD) is an unmet clinical need. Diffusion-weighted magnetic resonance (MR) imaging (DWI) may indicate disease activity, but its predictive ability, if any, is unknown. We investigated the prognostic value of DWI for 1 year response or remission (RoR) in SBCD patients commencing biologic therapy, including incremental value over C-reactive protein (CRP) and faecal calprotectin (FC).
A subset of participants in a prospective, multicentre study investigating the predictive ability of motility MRI for 1-year RoR in patients starting biologic therapy for active SBCD, underwent additional DWI at baseline and post-induction (12-30 weeks). CRP and FC were collected in a subgroup. RoR at 1 year was evaluated using clinical and morphological MR enterography (MRE) parameters. We calculated sensitivity and specificity to predict RoR and quality of life (QoL) at 1 year, comparing apparent diffusion coefficient (ADC) value, Clermont score, and CRP using multivariable logistic regression.
A total of 25 participants were included (mean 36.9 years, 32% female). ADC changes and Clermont score had poor sensitivity (30.0% [95% CI, 6.7-65.2] and 40.0% [95% CI, 12.2-73.8], respectively) and poor-to-modest specificity (50.0 [95% CI, 27.2-72.8] and 65.0% [95% CI, 40.8-84.6]) for RoR. None of Clermont score, CRP, or FC predicted QoL.
DWI has inadequate sensitivity and specificity for RoR at 1 year. There is no significant incremental prognostic value of DWI over CRP and FC to predict RoR and/or QoL at 1 year.
Early post-induction DWI has no prognostic value for RoR at 1 year.
预测小肠克罗恩病（SBCD）生物治疗的长期反应是一项尚未满足的临床需求。扩散加权磁共振（MR）成像（DWI）可能提示疾病活动，但它的预测能力（如果有的话）尚不清楚。我们研究了DWI对开始生物治疗的SBCD患者1年反应或缓解（RoR）的预后价值，包括其相对于C反应蛋白（CRP）和粪便钙卫蛋白（FC）的增量价值。
一项前瞻性多中心研究的部分参与者，该研究调查了动态MRI对开始接受生物治疗的活动性SBCD患者1年RoR的预测能力，这些参与者在基线和诱导后（12 - 30周）接受了额外的DWI检查。在一个亚组中收集了CRP和FC数据。使用临床和形态学MR小肠造影（MRE）参数评估1年时的RoR。我们通过多变量逻辑回归比较表观扩散系数（ADC）值、克莱蒙评分和CRP，计算预测1年时RoR和生活质量（QoL）的敏感性和特异性。
共纳入25名参与者（平均年龄36.9岁，32%为女性）。ADC变化和克莱蒙评分对RoR的敏感性较差（分别为30.0% [95% CI，6.7 - 65.2]和40.0% [95% CI，12.2 - 73.8]），特异性为中等至较差（分别为50.0% [95% CI，27.2 - 72.8]和65.0% [95% CI，40.8 - 84.6]）。克莱蒙评分、CRP或FC均不能预测QoL。
DWI对1年RoR的敏感性和特异性不足。在预测1年时的RoR和/或QoL方面，DWI相对于CRP和FC没有显著的增量预后价值。
诱导后早期DWI对1年RoR没有预后价值。
