Assessment of Ileocolonic Inflammation in Crohn’s Disease: Which Surrogate Marker Is Better—MaRIA, Clermont, or PET/MR Index? Initial Results of a Feasibility Trial

Li, Yan; Langhorst, Jost; Koch, Anna K.; Demircioğlu, Aydın; Nensa, Felix; Kirchner, Julian; Beiderwellen, Karsten; Catalano, Onofrio A.; Forsting, Michael; Herrmann, Ken; Umutlu, Lale

doi:10.2967/jnumed.118.216937

Cited by 24 publications

(4 citation statements)

References 19 publications

(29 reference statements)

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“…An analysis of 309 segments demonstrated that SUV max ratio (SUV max of bowel segment relative to SUV max of liver) was the most important parameter for detecting segments with severe ulcerative inflammation [69 ▪ ]. In another study, a hybrid PET/MR index based on wall thickness, edema, ulceration, and SUV max ratio yielded significantly improved specificity and diagnostic accuracy compared with conventional MR indices (MaRIA and the Clermont score) [70 ▪ ]. PET/MRE has also been used to differentiate fibrotic from inflammatory strictures [73–75].…”

Section: Nuclear Radiologymentioning

confidence: 99%

“…However, the clinical use of PET/CT in CD is limited by the inherent radiation exposure and reimbursement considerations [68]. Recently, integrated PET/MRE has been used for the assessment of disease activity in CD [69 ▪ ,70 ▪ ,71,72]. In one study, 50 patients with known CD and recurrent symptoms underwent ileocolonoscopy as well as PET/MRE.…”

Section: Nuclear Radiologymentioning

confidence: 99%

See 1 more Smart Citation

Small bowel radiology

Olson

Navin²,

Welle³

et al. 2021

Current Opinion in Gastroenterology

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Purpose of review Recent advances in computed tomography (CT), ultrasound (US), magnetic resonance imaging (MRI), and nuclear radiology have improved the diagnosis and characterization of small bowel pathology. Our purpose is to highlight the current status and recent advances in multimodality noninvasive imaging of the small bowel. Recent findings CT and MR enterography are established techniques for small bowel evaluation. Dual-energy CT is a novel technique that has shown promise for the mesenteric ischemia and small bowel bleeding. Advanced US techniques and MRI sequences are being investigated to improve assessment of bowel inflammation, treatment response assessment, motility, and mural fibrosis. Novel radiotracers and scanner technologies have made molecular imaging the new reference standard for small bowel neuroendocrine tumors. Computational image analysis and artificial intelligence (AI) have the potential to augment physician expertise, reduce errors and variability in assessment of the small bowel on imaging. Summary Advances in translational imaging research coupled with progress in imaging technology have led to a wider adoption of cross-sectional imaging for the evaluation and management of small bowel entities. Ongoing developments in image acquisition and postprocessing techniques, molecular imaging and AI have the strongest potential to transform the care and outcomes of patients with small bowel diseases.

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Section: Nuclear Radiologymentioning

confidence: 99%

Section: Nuclear Radiologymentioning

confidence: 99%

Small bowel radiology

Olson

Navin²,

Welle³

et al. 2021

Current Opinion in Gastroenterology

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show abstract

“…Combining the aforementioned metric with the combined faecal levels of calprotectin and C-reactive protein can effectively differentiate between active and quiescent CD with high sensitivity and specificity, 83% and 100%, respectively [ 48 ]. Moreover, PET/MR index has been observed to exhibit an equal correlation with the Simple Endoscopic Score for CD [ 49 ]. PET-compared to PET-CT, PET-MRI at detecting extraluminal disease and can be used to determine whether patients are more likely to require faecal diversion during surgery.…”

Section: The Role Of Molecular Imaging In Diagnosing CD In Generalmentioning

confidence: 99%

The role of molecular imaging in detecting fibrosis in Crohn’s disease

Alyami,

Madkhali,

Majrashi

et al. 2024

Annals of Medicine

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Fibrosis is a pathological process that occurs due to chronic inflammation, leading to the proliferation of fibroblasts and the excessive deposition of extracellular matrix (ECM). The process of long-term fibrosis initiates with tissue hypofunction and progressively culminates in the ultimate manifestation of organ failure. Intestinal fibrosis is a significant complication of Crohn’s disease (CD) that can result in persistent luminal narrowing and strictures, which are difficult to reverse. In recent years, there have been significant advances in our understanding of the cellular and molecular mechanisms underlying intestinal fibrosis in inflammatory bowel disease (IBD). Significant progress has been achieved in the fields of pathogenesis, diagnosis, and management of intestinal fibrosis in the last few years. A significant amount of research has also been conducted in the field of biomarkers for the prediction or detection of intestinal fibrosis, including novel cross-sectional imaging modalities such as positron emission tomography (PET) and single photon emission computed tomography (SPECT). Molecular imaging represents a promising biomedical approach that enables the non-invasive visualization of cellular and subcellular processes. Molecular imaging has the potential to be employed for early detection, disease staging, and prognostication in addition to assessing disease activity and treatment response in IBD. Molecular imaging methods also have a potential role to enabling minimally invasive assessment of intestinal fibrosis. This review discusses the role of molecular imaging in combination of AI in detecting CD fibrosis.

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“…Recently, superior diagnostic performance of simultaneous 18 F-fluoro-deoxyglucose ([ 18 F]-FDG) Positron Emission Tomography (PET)/MR have been demonstrated in the assessment of IBD [ 7 , 8 , 9 , 10 ]. Hybrid biomarkers comprised of PET and MR parameters facilitated higher diagnostic values than each modality alone not only in assessing disease activity but also in differentiating fibrotic strictures from mixed or inflammatory ones in Crohn’s disease [ 11 , 12 ]. Previously, in a randomized controlled trial (RCT), we have investigated the diagnostic accuracies of [ 18 F]-FDG PET/MR in predicting histologically active inflammation in 50 patients with UC [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Performance of Simultaneous [18F]-FDG PET/MR for Assessing Endoscopically Active Inflammation in Patients with Ulcerative Colitis: A Prospective Study

Langhorst

Umutlu

Schaarschmidt

et al. 2020

JCM

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Background: To investigate the diagnostic performance of simultaneous 18F-fluoro-deoxyglucose ([18F]-FDG) PET/MR enterography in assessing and grading endoscopically active inflammation in patients with ulcerative colitis. Methods: 50 patients underwent PET/MR 24 h before ileocolonoscopy. Inflammatory activities of bowel segments were evaluated with both Mayo endoscopic subscore and Nancy histologic index. MR, DWI (Diffusion-weighted imaging) and PET were utilized as qualitative parameters for detecting endoscopically active inflammation. SUVmaxQuot in each segment (maximum of standard uptake value relative to liver) was calculated to quantify inflammation. Results: In the study arm without bowel purgation, combined reading of PET and MR resulted in significantly increased specificity against each submodality alone (0.944 vs. 0.82 for MR and 0.843 for PET, p < 0.05) and highest overall accuracy. In the study arm with bowel purgation, the significantly lower specificity of PET (0.595) could be markedly improved by a combined reading of PET and MR. Metabolic conditions in bowel segments with both endoscopic and histological remission were significantly lower than in segments with endoscopic remission but persistent microscopic inflammation (SUVmaxQuot 0.719 vs. 0.947, p < 0.001). SUVmaxQuot correlated highly with Mayo endoscopic subscore (ρ = 0.718 and 0.606) and enabled grading of inflammatory activity. Conclusions: Simultaneous [18F]-FDG PET/MR may be considered as an alternative to endoscopy in clinical trials.

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Assessment of Ileocolonic Inflammation in Crohn’s Disease: Which Surrogate Marker Is Better—MaRIA, Clermont, or PET/MR Index? Initial Results of a Feasibility Trial

Cited by 24 publications

References 19 publications

Small bowel radiology

Small bowel radiology

The role of molecular imaging in detecting fibrosis in Crohn’s disease

Diagnostic Performance of Simultaneous [18F]-FDG PET/MR for Assessing Endoscopically Active Inflammation in Patients with Ulcerative Colitis: A Prospective Study

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