P119 Evaluation of Crohn's disease: CRP in the midst of MRI and endoscopy
M. Serio*1, K. Efthymakis1, A. Pierro2, F. Laterza1, A. Milano1, G. Maselli2, A. Bonitatibus1, G. Sallustio2, M. Neri1
1Università "G. D'Annunzio", Medicine and Aging Sciences and CESI, Chieti, Italy, 2Fondazione di Ricerca e Cura "Giovanni Paolo II", Università Cattolica del Sacro Cuore, Radiology Department, Campobasso, Italy
Endoscopy is the gold standard for the assessment of activity in Crohn's disease (CD) however,due to the full thickness involvement of the bowel wall or presence of complications,evaluation of CD activity should be the result of an integration of endoscopical,clinical,laboratory,and radiological approach.In this context,it is still unclear when MRI should be performed.
Aim of this study was to evaluate the capability of endoscopy and MRI to assess disease activity and severity in a series of CD patients and when and how to perform them at their best.
50 consecutive patients with endoscopically proven CD underwent MRI enterography for the staging of disease at diagnosis and activity assessment.Endoscopic activity was measured by a quantitative score (SES-CD,range 0-40) with active mild, moderate ad severe disease defined as a scores 4-10,11-19 and >20 respectively.MRI activity was measured by a previously validated quantitative score which integrates both mural and extramural involvement (Magnetic Resonance Enterography global score,MEGS,range 0-296),with active disease being present for a ≥ 1 score.For all participants CDAI was completed and CRP and fecal calprotectin (FC) were also measured (positivity cut-off respectively >0,50 mg/dl and >150 μg/gr).
We enrolled 20 males and 30 females (diagnosis in 62%, follow-up in 38%),mean age 38 ± 15 ys,mean disease duration 5 ys.SES-CD and MEGS were well correlated (r=0,42,p=0.001);both SESCD and MEGS show correlation with clinical (CDAI r=0,51,r=0,59,p<0.001) and biological activity (CRP r=0,37,r=0,43 p<0.005,FC r=0.27,p=0.02 respectively).According to SES-CD,90% of patient had active disease (64% mild,20% moderate and 6% severe);at MEGS,86% of patients had active disease (sensibility 89%,specificity 40%,VPP 93%,VPN 29% vs. endoscopy).MEGS scoring did not showed ability to distinguish severity of disease as determined at endoscopy (p=0.14),but revealed trasmural/extramural signs of inflammation,indipendently from CD activity (60% of patients in remission,84% mild,and 100% with moderate and severe disease), mostly with CRP positivity.Increasing staging of grading at endoscopy was significantly correlated to the risk of trasmural/extramural involvement,only in CRP positive patients (p=0.007).CRP positivity was associated with the presence of extraintestinal involvement (p=0.006;lymph nodes p=0.009, combsign p=0.001 and abscess p=0.005),not of mural involment(p=0.4).
MRI does not discriminate luminal CD severity;however,transmural inflammation,which is more frequent in severe disease,may still be present regardless of endoscopical activity.The presence of positive CRP suggests the need of MRI for the staging of patients with CD independently from endoscopic severity.