Faecal calprotectin and magnetic resonance imaging in detecting Crohn’s disease endoscopic postoperative recurrence

Abstract

AIMTo assess magnetic resonance imaging (MRI) and faecal calprotectin to detect endoscopic postoperative recurrence in patients with Crohn’s disease (CD).METHODSFrom two tertiary centers, all patients with CD who underwent ileocolonic resection were consecutively and prospectively included. All the patients underwent MRI and endoscopy within the first year after surgery or after the restoration of intestinal continuity [median = 6 mo (5.0-9.3)]. The stools were collected the day before the colonoscopy to evaluate faecal calprotectin level. Endoscopic postoperative recurrence (POR) was defined as Rutgeerts’ index ≥ i2b. The MRI was analyzed independently by two radiologists blinded from clinical data.RESULTSApparent diffusion coefficient (ADC) was lower in patients with endoscopic POR compared to those with no recurrence (2.03 ± 0.32 vs 2.27 ± 0.38 × 10-3 mm²/s, P = 0.032). Clermont score (10.4 ± 5.8 vs 7.4 ± 4.5, P = 0.038) and relative contrast enhancement (RCE) (129.4% ± 62.8% vs 76.4% ± 32.6%, P = 0.007) were significantly associated with endoscopic POR contrary to the magnetic resonance index of activity (MaRIA) (7.3 ± 4.5 vs 4.8 ± 3.7; P = 0.15) and MR scoring system (P = 0.056). ADC < 2.35 × 10-3 mm²/s [sensitivity = 0.85, specificity = 0.65, positive predictive value (PPV) = 0.85, negative predictive value (NPV) = 0.65] and RCE > 100% (sensitivity = 0.75, specificity = 0.81, PPV = 0.75, NPV = 0.81) were the best cut-off values to identify endoscopic POR. Clermont score > 6.4 (sensitivity = 0.61, specificity = 0.82, PPV = 0.73, NPV = 0.74), MaRIA > 3.76 (sensitivity = 0.61, specificity = 0.82, PPV = 0.73, NPV = 0.74) and a MR scoring system ≥ MR1 (sensitivity = 0.54, specificity = 0.82, PPV = 0.70, and NPV = 0.70) demonstrated interesting performances to detect endoscopic POR. Faecal calprotectin values were significantly higher in patients with endoscopic POR (114 ± 54.5 μg/g vs 354.8 ± 432.5 μg/g; P = 0.0075). Faecal calprotectin > 100 μg/g demonstrated high performances to detect endoscopic POR (sensitivity = 0.67, specificity = 0.93, PPV = 0.89 and NPV = 0.77).CONCLUSIONFaecal calprotectin and MRI are two reliable tools to detect endoscopic POR in patients with CD.

Transmural healing and MRI healing are associated with lower risk of bowel damage progression than endoscopic mucosal healing in Crohn’s disease

“…As MRI is able to assess transmural inflammation and to detect CD‐related complications, our definition of MRI healing included no sign of active inflammation ( ie ulceration, oedema, diffusion‐weighted hyperintensity, increased contrast enhancement), no extra‐enteric sign ( ie fat creeping, enlarged lymph nodes, comb sign) and no CD‐related complications ( ie stricture, fistula or abscess). Of note, bowel wall thickness was not taken into account as it could be due to fibrotic phenomenon especially in patients with prior surgery 18 . As expected, most of endoscopic lesions that were not detected by MRI were superficial (80% in our study).…”

A Magnetic Resonance Imaging Index to Predict Crohn’s Disease Postoperative Recurrence: The MONITOR Index

“…To avoid iterative follow-up colonoscopies after CD-related surgery, a combination of a rapid, specifically designed MRI assessment tool and fecal calprotectin monitoring might be a useful way of predicting POR. 31 In our study, fecal calprotectin was available only in 6 cases, and the potential added value of combining fecal calprotectin monitoring and MRI above MRI monitoring alone could therefore not be analyzed. The NPV of the MONITOR index of 68% is not high enough to avoid every colonoscopy, but an associated negative calprotectin would be against a recurrence.…”

“…30 Furthermore, the index of Sailer et al does not take account diffusion-weighted sequences, which is a promising technique that should now always be implemented in MRI evaluations of CD. 11 The MaRIA score 12 and the Clermont score 13 have recently been studied with regard to POR, but they were not originally designed for this purpose and were less sensitive 31 than the MONITOR index. These 2 scores are rarely used in clinical practice because of their complexity and the time needed for scoring.…”

Is fecal calprotectin an accurate marker in the management of Crohn's disease?

“…Moreover, the quality of the studies is more uniform than in the other sections of this review. All but two studies 65,70 had a prospective design (Table S1), and in all cases but one, 61 the definition of POR was based on the Rutgeerts score, rendering conclusions more reliable despite the small sample size of most series (Table 6 [57][58][59][60][61][62][63][64][65][67][68][69][70][71][72][73] ).…”