Diffusion-weighted magnetic resonance enterography for prediction of response to tumor necrosis factor inhibitors in stricturing Crohn’s disease

• Published in: Abdominal imaging 2018-12, Vol.43 (12), p.3207-3212
• Main Authors: Amitai, Marianne M., Klang, Eyal, Levartovsky, Asaf, Rozendorn, Noa, Soffer, Shelly, Taha, Gadeer Ali, Ungar, Bella, Greener, Tomer, Ben-Horin, Shomron, Eliakim, Rami, Kopylov, Uri
• Format: Article
• Language: English
• Subjects: Adult; Constriction, Pathologic; Crohn Disease - diagnostic imaging; Crohn Disease - drug therapy; Crohn Disease - pathology; Crohn's disease; Demographics; Diffusion Magnetic Resonance Imaging - methods; Failure; Female; Fibrosis; Gastroenterology; Hepatology; Humans; Imaging; Inflammation; Intestine; Intestines - diagnostic imaging; Intestines - pathology; Magnetic resonance; Male; Medical imaging; Medicine; Medicine & Public Health; Necrosis; Parameters; Patients; Predictive Value of Tests; Radiology; Resonance; Retrospective Studies; Risk; Stricture; Surgery; Treatment Outcome; Tumor necrosis factor; Tumor Necrosis Factor Inhibitors - therapeutic use; Tumor necrosis factor-TNF; Tumors; Young Adult
• ISSN: 2366-004X; 2366-0058
• DOI: 10.1007/s00261-018-1626-9

Background and aims Distinguishing between fibrotic and inflammatory strictures in Crohn’s disease (CD) is still challenging. The capacity of diffusion-weighted (DWI) magnetic resonance (MRE) to identify intestinal fibrosis was recently demonstrated; however, the therapeutic implications of this association have never been evaluated. The aim of the current study was to identify imaging features, including DWI, which can predict response to anti-inflammatory treatment in patients with stricturing CD. Methods Consecutive CD patients with intestinal strictures that initiated treatment with anti-tumor necrosis alpha (anti-TNF) between June 2012 and April 2017 with MRE adjacent to treatment onset were retrospectively collected. The primary outcome was treatment failure, defined as drug discontinuation, CD-related surgery, or endoscopic dilatation of the stricture. Clinical, demographic, and imaging data were compared between patients who did and did not develop treatment failure within 12 months of anti-TNF treatment initiation. Results A total of 21 patients were included in the study; 9/21 (42.8%) developed treatment failure. None of the clinical/demographic parameters were associated with the risk of treatment failure. Among imaging parameters, only ADC value (