Quantified terminal ileal motility during MR enterography as a potential biomarker of Crohn's disease activity: a preliminary study.
OBJECTIVE
To compare quantified terminal ileal (TI) motility during MR enterography (MRE) with histopathological severity of acute inflammation in Crohn's disease.


METHODS
A total of 28 Crohn's patients underwent MRE and endoscopic TI biopsy. Axial and coronal TrueFISP, HASTE and post-gadolinium VIBE images were supplemented by multiple coronal TrueFISP cine motility sequences through the small bowel volume. TI motility index (MI) was quantified using validated software; an acute inflammation score (eAIS; 0-6) was assigned to the biopsy. Two observers qualitatively scored mural thickness, T2 signal, contrast enhancement and perimural oedema (0-3) to produce an activity score (aMRIs) based on anatomical MRI. The association among the MI, eAIS and aMRIs was tested using Spearman's rank correlation. Wilcoxon rank sum test compared motility in subjects with and without histopathological inflammation.


RESULTS
Mean MI and mean eAIS were 0.27 (range 0.06-0.55) and 1.5 (range 0-5), respectively. There was a significant difference in MI between non-inflamed (mean 0.37, range 0.13-0.55) and inflamed (mean 0.19, range 0.06-0.44) TI, P = 0.002, and a significant negative correlation between MI and both eAIS (Rho = -0.52, P = 0.005) and aMRIs (R = -0.7, P < 0.001).


CONCLUSIONS
Quantified TI motility negatively correlates with histopathological measures of disease activity and existing anatomical MRI activity biomarkers.


CONCLUSIONS
• Magnetic resonance imaging is increasingly used to assess Crohn's disease.                                  • MRI measurements can provide a quantitative assessment of small bowel motility.                                  • MR enterography can grade Crohn's disease.                                  • Small bowel motility can be used as a marker of inflammatory activity.
Centre for Medical Imaging, University College London, London, UK.
Alex
A
Menys
David
D
Atkinson
Freddy
F
Odille
Asia
A
Ahmed
Marco
M
Novelli
Manuel
M
Rodriguez-Justo
Ian
I
Proctor
Shonit
S
Punwani
Steve
S
Halligan
Stuart A
SA
Taylor
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D015415:Biomarkers / Q000378:metabolism; D015331:Cohort Studies; D003424:Crohn Disease / Q000175:diagnosis* / Q000378:metabolism*; D003952:Diagnostic Imaging / Q000379:methods; D004724:Endoscopy / Q000379:methods; D005260:Female; D005769:Gastrointestinal Motility; D006801:Humans; D007249:Inflammation; D007422:Intestines / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012984:Software
D015415:Biomarkers