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P309 Impact of rapid access MR on clinical decision making and patient management in Crohn's disease in a tertiary referral center

Lovasz B.D.*1, Gonczi L.1, Kurti Z.1, Vegh Z.1, Golovics P.A.1, Rudas G.2, Gecse K.B.1, Lakatos P.L.1

1Semmelweis University, First Department of Medicine, Budapest, Hungary 2Semmelweis University, Magnetic Resonance Imaging Research Center, Budapest, Hungary

Background

Assessment of disease activity in CD patients should be based on the complex evaluation of clinical symptoms and objective measures including laboratory and imaging data. Our aim was to evaluate the impact of rapid access MR (within 2 weeks) on the clinical decision making in a specialized tertiary care center and analyze correlation between MR findings and laboratory findings, clinical activity and outcomes.

Methods

93 rapid access MRI/MRE scans were available in a cohort of 75 referral CD patients (male/female: 51/49%, median age: 34 IQR: 25–43 years) between January 2014 to June 2016. Active disease was the indication for MRI in 51%. Location of CD was ileocolonic in 61% and colonic in 28% with perianal fistulas in 39% and previous surgeries in 53% of CD patients. MRI results were compared to clinical activity scores, CRP and changes in medical management or surgery requirements. The MR Enterography was carried out by 3T MR Scanners (Philips Achieve and Insignia) on prone position after the administration of oral contrast agent (polyethylene glycol or methylcellulose), using the breath hold technic and coronal and axial single-shot T2-weighted turbo spin echo, axial 3D DWIBS sequences for the abdomen. We used the sagittal, coronal T2, axial T2 fs, axial 3D DWIBS and axial 3D Wave (T1 native and post contrast fs) sequences for the pelvis. We used 16-channel torso and multi coils.

Results

The indication for MRI was active disease in 51% of the patients. MRI confirmed any activity in 76% and significant activity based on the MRI result in 68% of the patients. Luminal activity, fistula, abscess and/or stenosis was confirmed in 45%, 36%, 25% and 16% of the patients. Agreement between clinical and MRI activity was weak for any MRI activity (kappa: 0.31) and moderate for significant MRI activity (kappa: 0.61, sensitivity: 68%, specificity: 92%, PPV: 90% and NPV: 74%). There was an association between activity on MRI and elevated CRP (p=0.01 for significant MRI activity, p=0.1 for any activity). The MRI results led to a change in medical therapy in 73% of the patients, while 31% of patients with significant MRI activity required surgery. Any MRI activity was detected in 46% of patient undergoing MRI for disease control/follow-up with significant MRI activity in 8% of these patients. The MRI result led to a change in the therapeutic strategy in 22% of these patients, while 1 patient with significant MRI activity required surgery.

Conclusion

Rapid access MR is an accurate imaging method with a great impact on the everyday clinical decision making in both patients with clinically active and quiescent disease, enabling rapid patient stratification and selecting patients for the appropriate therapeutic strategy.