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P204. Layered pattern of enhancement and retrodilation at Magnetic Resonance Enterography predict the outcome of anti-TNF α therapy in patients with moderate-to-severe ileal Crohn's disease

M.L. Annunziata1, P. Balestrieri1, I. Sansoni2, C. Coluccio1, R. Del Vescovo2, A. Tullio1, B. Beomonte Zobel2, A. Armuzzi3, M. Cicala1, 1Campus Bio-Medico University, Digestive Disease Department, Rome, Italy, 2Campus Bio-Medico University, Diagnostic Imaging Department, Rome, Italy, 3Complesso Integrato Columbus, Unit of Internal Medicine and Gastroenterology, Rome, Italy

Background

Monoclonal antibodies targeting tumor necrosis factor (TNF-α) have proven to be highly effective in the management of moderate to severe Crohn's disease (CD), although the costs and side-effects still represent the major concerns. Magnetic Resonance Enterography (MRE) is a non-invasive technique which avoids ionizing radiation and demonstrates to correlate with clinical disease activity. Aim of the present study was to prospectively evaluate the accuracy of MRE parameters in predicting the clinical outcome of therapy with Infliximab (IFX) or Adalimumab (ADA) in active ileal CD patients.

Methods

From January 2009 to May 2012, 31 patients with moderate-to-severe active ileal CD (mean age 44 yrs; M 14) were enrolled. Of these, 20 patients were treated with IFX and 11 with ADA with scheduled induction and maintenance. All patients, before and after 54 weeks of therapy, underwent MRE with oral administration of 1.5L of poly­ethylene­glycol solution and ileo-colonoscopy, being classified according to the Simple Endoscopic Score for Crohn's Disease (SES-CD). Clinical activity was measured by the Harvey Bradshaw Index (HBI) and C-reactive protein (CRP). A specialized radiologist analyzed MRE images in T2-weighted and pre- and post-contrast-enhanced T1-weighted sequences. Wall thickness (WT), T2-ratio mural signal intensity (SI), T1-ratio Relative Contrast Enhancement (RCE), layered or homogenous Pattern of Enhancement (PE) and presence of retrodilation were assessed. WT, T2-ratio mural SI and T1-ratio RCE were expressed as mean and 95% confidence interval (CI).

Results

WT, layered PE and mural SI directly correlated with HBI, CRP and endoscopic parameters. 17 patients were classified as responders and 14 non responders (increase of HBI ≥3 and CRP >5 or SES-CD sub-score ≥5 or occlusive symptoms requiring surgery or endoscopic dilation). Mean SI and WT values before therapy were significantly higher than those observed after therapy (20.3±4.1 vs 12.3±1.7, p < 0.01 and 8.6±1.3 vs 6.9±0.9, p < 0.05, respectively). RCE values didn't differ before and after therapy. Layered PE as well as the presence of retrodilation were significantly associated with failure of biological therapy (OR, 95% CI: 4.52, 0.70–29.3 and 2.19, 0.95–5.03, respectively).

Conclusion

MRE is confirmed to be a non-invasive, useful, tool to monitor the disease course. Of the MRE parameters, layered PE and retrodilation demonstrate to be reliable in predicting clinical outcome of anti-TNFα therapy in patients with moderate-to-severe ileal CD.