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P271. Correlations between MR findings and disease activity in Crohn's disease

P. Vernia1, S. Cannizzaro1, V. Buonocore2, A. Chiappini1, F. Maccioni2, 1“Sapienza”, Department of Internal Medicine and Medical Specialties, Rome, Italy, 2Sapienza University of Rome, Dep. Radiological Sciences, Oncology and Pathology, Rome, Italy

Background

The assessment of disease activity in Crohn's disease (CD) is challenging and results from integrated clinical, laboratory and imaging data. Aim of the study was to analyze correlations between magnetic resonance imaging (MRI) signs and lab inflammatory markers (WBC count, CRP and ESR) and clinical activity scores (CDAI and HB index) in a large series of CD patients.

Methods

MRI signs, including ileal wall enhancement, perivisceral inflammation, mesenteric fat hypertrophy, mesenteric hyperaemia and complications (adherences, abscesses, fistulas) were independently evaluated by 2 radiologists, blind to clinical and laboratory data, in 127 CD patients. Each MR parameter was graded as: 0 - absent to 3 - severe. The ileal maximum wall thickness and the length of involved segments were also considered. Statistics: Spearman and Pearson coefficients.

Results

The length of involved ileum correlated with leukocyte count (r = 0.325, p < 0.0005) and ESR (r = 0.323, p < 0.005). Good correlation was found between maximum ileal wall thickness and leucocyte count (r = 0.356 p < 0.0005), and a less strict correlation with CRP levels (r = 0.182 p < 0.05). The ileal enhancement showed correlation with leukocyte count (r = 0.228, p < 0.02), CRP (r = 0.211, p < 0.04), ESR (r = 0.255, p < 0.01), HBI (r = 0.255, p < 0.01), CDAI (r = 0.263, p < 0.01). Perivisceral inflammation correlated with both CRP and ESR (r = 0.307 and 0.322 p < 0.001, respectively). ESR levels correlated with mesenteric fat hypertrophy (r = 0.278, p < 0.004) and lymphoadenopaties (r = 0.194, p < 0.02). A negative correlation was found between mesenteric hyperemia and clinical activity scores (CDAI and HBI, r = −0.274, p < 0.01; r = −0.238, p < 0.05). The presence of complications correlated both with CRP and ESR levels (r = 0.310, p < 0.0007 and r = 0.257, p < 0.005, respectively).

Conclusion

A number of statistically significant correlations were found between MRI findings and clinical and laboratory data, nonetheless, the low correlation coefficients indicate that their clinical reliability in the assessment of activity individual patients is less than optimal. Thus, MRI findings are not adequate, alone, for this purpose. It is suggested that new tools/MRI sequences should be identified for improving the effectiveness of MRI in the assessment of inflammatory activity in CD patients.