Plumb Andrew A, Moran Gordon, Chowdhury Kashfia, Ahmed Norin, Philpott Sue, Ahmad Tariq, Bloom Stuart, Hart Ailsa, Jacobs Ilan, Menys Alex, Mooney Peter, Tolan Damian, Travis Simon, Bhagwanani Anisha, Bhatnagar Gauraang, Boone Darren, Franklin James, Gangi-Burton Anmol, Hameed Maira, Helbren Emma, Hosseini-Ardehali Faraz, Hyland Rachel, Kilic Yakup, Kumar Shankar, Lambie Hannah, Mohsin Maryam, Patel Anisha, Rahman Safi, Sakai Naomi, Sidhu Harbir, Thomson Elen, Ahmed Saiam, Bannur Chikkeragowda Uday, Barratt Nina, Beeston Teresita, Fitzke Heather, Gibbons Nicola, Godfrey Edmund, Gupta Arun, Higginson Antony, Isaac Elizabeth, Kok Klaartje Bel, Langlands Sarah, Parkes Miles, Patel Jaymin, Patel Kamal, Patel Kamini, Patodi Nishant, Pollok Richard, Przemiosolo Robert, Robinson Charlotte, Thoua Nora, Wadke Anvi, Halligan Steve, Taylor Stuart A
Department of Radiology, University College London Hospitals, London, UK.
Centre for Medical Imaging, Division of Medicine, University College London, London, UK.
Inflamm Bowel Dis. 2025 Mar 7. doi: 10.1093/ibd/izaf023.
Small bowel Crohn's disease (SBCD) is increasingly treated with biological therapies. Predicting response or remission (RoR) for individual patients is difficult and complicates treatment strategy. We aimed to determine if motility magnetic resonance imaging (mMRI) is superior to CRP and fecal calprotectin (FC) for the prediction of RoR at 1 year in patients commencing biologics for SBCD.
Prospective, multicenter (n = 13) cohort study of patients with active non-stricturing SBCD requiring anti-TNFα or anti-IL-12/23 treatment. We measured mMRI and CRP at baseline and post-induction (visit 2: 12-30 weeks), and FC in a subset. RoR was assessed at 1 year using clinical and structural magnetic resonance enterography parameters. We compared sensitivity, specificity, and area under the receiver operating characteristic curve (ROC-AUC) of changes in mMRI and CRP to predict RoR at 1 year. Secondary outcomes compared mMRI with FC, and prediction of improved quality of life (QoL).
Eighty-six participants completed all assessments. Stable or improved mMRI at visit 2 was more sensitive than normalization of CRP for RoR (mMRI:71.0%, 95%CI 52.0-85.8; CRP:45.2%, 95%CI 27.3-64.0%, P = .008) but less specific (mMRI:30.9%, 95%CI 19.1-44.8; CRP:67.3%, 95%CI 53.3-79.3%, P < .001). There was no significant difference in ROC-AUC (mMRI:0.48; CRP:0.53, P = .65). Similar results were obtained for FC. None of mMRI, CRP, or FC predicted patient QoL at 1 year.
Although improved mMRI is more sensitive than CRP and FC to predict RoR at 1 year, it is less specific. No factor predicted patient QoL. Motility MRI remains a marker of disease activity at given timepoints.
小肠克罗恩病（SBCD）越来越多地采用生物疗法进行治疗。预测个体患者的反应或缓解情况（RoR）具有难度，这使治疗策略变得复杂。我们旨在确定在开始使用生物制剂治疗SBCD的患者中，运动磁共振成像（mMRI）在预测1年时的RoR方面是否优于C反应蛋白（CRP）和粪便钙卫蛋白（FC）。
对需要抗TNFα或抗IL-12/23治疗的活动性非狭窄性SBCD患者进行前瞻性、多中心（n = 13）队列研究。我们在基线和诱导治疗后（访视2：12 - 30周）测量了mMRI和CRP，并在一个亚组中测量了FC。使用临床和结构磁共振小肠造影参数在1年时评估RoR。我们比较了mMRI和CRP变化的敏感性、特异性以及受试者操作特征曲线下面积（ROC-AUC），以预测1年时的RoR。次要结局比较了mMRI与FC，以及对生活质量（QoL）改善的预测。
86名参与者完成了所有评估。在访视2时mMRI稳定或改善对于RoR的预测比CRP正常化更敏感（mMRI：71.0%，95%CI 52.0 - 85.8；CRP：45.2%，95%CI 27.3 - 64.0%，P = 0.008），但特异性较低（mMRI：30.9%，95%CI 19.1 - 44.8；CRP：67.3%，95%CI 53.3 - 79.3%，P < 0.001）。ROC-AUC无显著差异（mMRI：0.48；CRP：0.53，P = 0.65）。FC也得到了类似结果。mMRI、CRP或FC均未预测1年时患者的QoL。
尽管改善的mMRI在预测1年时的RoR方面比CRP和FC更敏感，但特异性较低。没有因素能够预测患者的QoL。运动磁共振成像在特定时间点仍然是疾病活动的一个标志物。
