Diffusion-weighted imaging to predict longer-term response in Crohn's disease patients commencing biological therapy: Results from the MOTILITY trial
Hameed M., Taylor SA., Ahmed N., Chowdhury K., Patel A., Helbren E., Bhagwanani A., Hyland R., Bhatnagar G., Sidhu H., Lambie H., Franklin J., Mohsin M., Thomson E., Boone D., Tolan D., Rahman S., Sakai NS., Moran GW., Hart A., Bloom S., Menys A., Jacobs I., Halligan S., Plumb AA., Ahmad T., Ahmed S., Ahmed-Timms F., Baldwin-Cleland R., Chikkeragowda UB., Barratt N., Beeston T., Brezina B., Cetroni A., Choudhury J., Cipriano B., Dilawershah M., Fitzke H., Foster T., Gangi A., Gibbons N., Godfrey E., Gupta A., Higginson A., Holmes J., Hosseini-Ardehali F., Isaac E., Jastrub R., Joseph M., Kaur J., Kilic Y., Kok KB., Kpodo F., Kumar S., Langlands S., Loveday E., McCartney S., Mooney P., Onoviran F., Parkes M., Patel J., Patel K., Patel K., Patodi N., Philpott S., Pollok R., Przemiosolo R., Rafferty H., Ramsami J., Robinson C., Roffe S., Rogers L., Rosiou K., Seward A., Theis B., Thoua N., Travis S., Wadke A., Ward L., Wilce A., Williams S.
Objectives: 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). Methods: 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. Results: 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. Conclusions: 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. Advances in knowledge: Early post-induction DWI has no prognostic value for RoR at 1 year.