Utility of Magnetic Resonance Enterography For Small Bowel Endoscopic Healing in Patients With Crohn's Disease

Takenaka, Katsuto; Ohtsuka, Kazuo; Kitazume, Yoshio; Matsuoka, Katsuyoshi; Nagahori, Masakazu; Fujii, Toshimitsu; Saito, Eiko; Kimura, Maiko; Fujioka, Tomoyuki; Watanabe, Mamoru

doi:10.1038/ajg.2017.464

Cited by 61 publications

(79 citation statements)

References 28 publications

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“…The increasing use of MRE in CD has introduced new challenges, including how to define remission and how to interpret discrepancies between endoscopic healing and persistence of transmural abnormalities in MRE assessments. While mucosal healing as assessed by ileocolonoscopy has been studied in depth, few studies have evaluated the characteristics of transmural healing assessed by means of MRE . Of note, residual mural abnormalities, such as wall thickening, or extramural lesions, like creeping fat, can persist in intestinal segments with endoscopic remission .…”

Section: Introductionmentioning

confidence: 99%

“…Of note, residual mural abnormalities, such as wall thickening, or extramural lesions, like creeping fat, can persist in intestinal segments with endoscopic remission . From the clinical point of view, it is crucial to determine whether these lesions represent established persistent damage (likely irreversible) or an inflammatory component that can heal with appropriate anti‐inflammatory therapy …”

Section: Introductionmentioning

confidence: 99%

“…While mucosal healing as assessed by ileocolonoscopy has been studied in depth, few studies have evaluated the characteristics of transmural healing assessed by means of MRE. [9][10][11] Of note, residual mural abnormalities, such as wall thickening, or extramural lesions, like creeping fat, can persist in intestinal segments with endoscopic remission. 9,[12][13][14] From the clinical point of view, it is crucial to determine whether these lesions represent established persistent damage (likely irreversible) or an inflammatory component that can heal with appropriate anti-inflammatory therapy.…”

Section: Introductionmentioning

confidence: 99%

“…9,[12][13][14] From the clinical point of view, it is crucial to determine whether these lesions represent established persistent damage (likely irreversible) or an inflammatory component that can heal with appropriate anti-inflammatory therapy. 11,14 To date, no prospective studies have addressed the prevalence of these persistent MRE abnormalities in patients with sustained mucosal healing, their relationship with pre-treatment findings, or their prognostic implications. To shed light on these aspects, we systematically assessed MRE examinations obtained at baseline and after 1 year in patients with severe endoscopic lesions that achieved endoscopic remission in response to autologous haematopoietic stem cell transplantation (HSCT) or TNF inhibitors.…”

Section: Introductionmentioning

confidence: 99%

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Persistent damage on magnetic resonance enterography in patients with Crohn’s disease in endoscopic remission

Rimola

Alfaro

Fernández-Clotet

et al. 2018

Aliment Pharmacol Ther

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Summary Background In Crohn's disease, it is essential to distinguish between persistent damage and abnormalities that can heal with anti‐inflammatory therapy. Aim To assess magnetic resonance enterography (MRE) lesions that persist in patients in long‐standing endoscopic remission, analyse their relationship with baseline characteristics, and determine their prognostic implications. Methods We systematically reviewed pre‐ and post‐treatment MRE findings in patients with Crohn's disease and severe inflammation (segmental CDEIS ≥ 7 or ulcers in at least one segment) who achieved endoscopic remission (CDEIS < 2) after 1 year of treatment with TNF‐inhibitors or autologous haematopoietic stem‐cell transplantation. Logistic regression analysis was used to identify predictors of persistent abnormalities. Results Endoscopic remission was achieved in 73 intestinal segments in 28 patients (69% females; 9.95 years disease duration, 67.9% inflammatory phenotype; 39.3% ileal location). Creeping fat and intestinal wall fat deposits were unchanged on pre‐ and post‐treatment MRE despite the endoscopic remission. Luminal strictures persisted in 6 out of the 8 segments with baseline strictures, and wall thickening in 23 out of the 72 of segments with thickening at baseline. Predictors of persistent mural thickening were pre‐treatment wall thickness > 5.9 mm (OR = 4.38, P = 0.027) and refractory disease prior to baseline (OR = 2.35, P = 0.001). Creeping fat was the only predictor for persistence of creeping fat (OR = 36.43, P < 0.001). Persistence of strictures at MRE is associated with earlier recurrence (P = 0.014). Conclusions Persistent MRE abnormalities are frequent in patients with Crohn's disease despite achieving endoscopic remission. Significant wall thickening, intestinal fat deposition, strictures, and creeping fat at baseline MRE are signs of established damage.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Persistent damage on magnetic resonance enterography in patients with Crohn’s disease in endoscopic remission

Rimola

Alfaro

Fernández-Clotet

et al. 2018

Aliment Pharmacol Ther

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“…Most studies have been reported retrospectively, and routine BAE's feasibility and diagnostic utility in clinical practice for CD have yet to be established [37,38]. However, several studies on BAE's utility for evaluating SB CD, and endoscopic treatment for strictures, have been reported in a prospective series from Japan [39][40][41][42].…”

Section: Balloon-assisted Endoscopymentioning

confidence: 99%

Objective evaluation for treat to target in Crohn’s disease

et al. 2020

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Background Crohn's disease (CD) is a chronic and destructive bowel disease; continued disease activity can lead to penetrating complications. With the recent advent of effective medications, the importance of using a treat-totarget approach to guide therapy is becoming important. Methods In this review, we reviewed the previous evidence for evaluating CD lesions. Results We describe ileocolonoscopy's role in assessing disease activity, as well as recent progress in modalities, such as balloon-assisted endoscopy, capsule endoscopy, magnetic resonance enterography, computed tomography enterography, and ultrasonography. Advances in modalities have changed CD assessment, with small-bowel involvement becoming more important. Conclusions Proper optimization is necessary in clinical practice.

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Evaluating the inflammatory activity in Crohn’s disease using magnetic resonance diffusion kurtosis imaging

et al. 2019

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Objectives To explore the feasibility of diffusion kurtosis imaging (DKI) for evaluating inflammatory activity in Crohn's disease (CD). Materials and methods In all, 51 CD patients were included, who were performed with consecutive enteroscopy, MR and DKI (b values = 0-2000 mm 2 /s). The lesions of bowel segments were graded as inactive (0-2), mild (3-6), and moderatesevere group (> 6) based on simplified endoscopic activity score for Crohn's disease (SES-CD), The abilities of the parameters of DKI and DWI in grading different activity lesions were compared. Results One hundred and twenty-seven bowel segments including inactive (15), mild (45) and moderate-severe (67) were analyzed. ADC (r = − 0.627, p < 0.001), D app (r = − 0.381, p < 0.001) and K app (r = 0.641, p < 0.001) were correlated with SES-CD. These parameters were significantly different among the three groups (all p < 0.001). ROC analysis found ADC had the highest accuracy (AUC = 0.884, p < 0.001) to differentiate inactive from active group with the threshold at 0.865 × 10 −3 mm 2 /s, which was slightly higher than K app (AUC = 0.867, p < 0.001) with the threshold at 0.645, and was obviously higher than D app (AUC = 0.726, p = 0.005). Similarly, ADC also had the highest accuracy (AUC = 0.846, p < 0.001) to differentiate inactive-mild from moderate-severe group with the threshold at 0.825 × 10 −3 mm 2 /s, and minimally higher than K app (AUC = 0.843, p < 0.001) with the threshold at 0.695, and obviously higher than D app (AUC = 0.690, p < 0.001). Conclusion DKI is feasible and comparable to conventional DWI for the evaluation of inflammatory activity in CD.

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Utility of Magnetic Resonance Enterography For Small Bowel Endoscopic Healing in Patients With Crohn's Disease

Abstract: SB inflammation was associated with a poor prognosis in patients with clinical-serological remission. MRE is a valid and reliable examination for SB inflammatory activity both for cross-sectional evaluations and prognostic prediction.

Cited by 61 publications

References 28 publications

Persistent damage on magnetic resonance enterography in patients with Crohn’s disease in endoscopic remission

Persistent damage on magnetic resonance enterography in patients with Crohn’s disease in endoscopic remission

Objective evaluation for treat to target in Crohn’s disease

Evaluating the inflammatory activity in Crohn’s disease using magnetic resonance diffusion kurtosis imaging

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