Faecal calprotectin and MRI Enterography in ileal Crohn’s disease: correlations between disease activity and long term follow up.
J Crohns Colitis. 2018 Nov 19;:
Authors: Jones GR, Fascì-Spurio F, Kennedy NA, Plevris N, Jenkinson P, Lyons M, Wong L, MacLean P, Glancy S, Lees CW
Background and Aims: Magnetic resonance enterography (MRE) is the gold standard for assessing ileal inflammation in Crohn’s disease. The aim of the present study was to correlate faecal calprotectin (FC) to MRE via a simple score in an exclusive ileal cohort with long term follow up for association with time to surgery or biologic therapy.
Methods: 150 MRE studies with matched FC (±30 days) were identified from the Edinburgh FC Register (2008-12; n=18,138). Scans were re-read blinded to clinical data, independently by 2 expert GI radiologists to generate a simple MRE score (range 0-10) from assessment of the worst segment plus total disease extent.
Results: 119 MRE scans were evaluated from 104 patients with ileal CD (L1 or L3 with panproctocolectomy). ROC analysis showed an AUC of 0.77(0.67-0.87, p<0.0001) for FC and MRE score>1 with an optimal cut-off of 145μg/g for severe inflammation on MRE with 69.3% (57.6-79.5) sensitivity and 71.4% (53.7-85.4) specificity. Long-term follow up over median (IQR) 2086 days (1786-2353) revealed FC145μg/g was associated with reduced biologic-free survival until 3years post-MRE, whereas MRE score (severe versus absent) was associated with reduced surgery- and biologic-free survival throughout follow-up. Backwards stepwise logistic regression revealed length of ileal disease (OR3.8, 1.1-13.2, p=0.034) and increased bowel wall thickness at MRE (OR4.2, 1.6-10.7, p<0.0001) or female sex (OR5.2, 1.5-18.7, p=0.011) at MRE increased risk of biologic use or surgery respectively.
Conclusions: FC correlates well to MRE assessment of ileal CD with MRE parameters associated with long term biologic and surgery free remission.
PMID: 30452618 [PubMed – as supplied by publisher]