title: Diffusion-weighted magnetic resonance enterocolonography in predicting remission after anti-TNF induction therapy in Crohn's disease.
abstract: BACKGROUND
  Diffusion-weighted magnetic resonance entero-colonography (DW-MREC) with no rectal distension and with no bowel cleansing is accurate to assess inflammatory activity in ileocolonic Crohn's disease (CD).
  
  
  OBJECTIVE
  To study DW-MREC parameters as predictors of remission (CDAI < 150 and CRP < 5mg/L) after anti-TNF induction therapy.
  
  
  METHODS
  Forty consecutive CD patients were prospectively and consecutively included. All the patients underwent DW-MREC with apparent diffusion coefficient (ADC) and MaRIA calculation before starting anti-TNF. Mean ADC was defined as the mean of the segmental ADC.
  
  
  RESULTS
  Twenty patients (50.0%) experienced remission at W12. Low mean ADC (2.05 ± 0.22 vs 1.89 ± 0.25, p = 0.03) and high total MaRIA (39.2 ± 16.6 vs 51.7 ± 18.2, p = 0.03) were predictive of remission at W12. Using a ROC curve, we determined a mean ADC of 1.96 as predictive cut-off of remission at W12 (AUC = 0.703 [0.535-0.872]) with sensitivity, specificity, positive predictive value and negative predictive value of 70.0%, 65.0%, 66.7% and 68.4%, respectively. In multivariate analysis, mean ADC < 1.96 (OR = 4.87, 95% CI [1.04-22.64]) and total MaRIA > 42.5 (OR = 5.11, 95% CI [1.03-25.37]), reflecting high inflammatory activity, were predictive of remission at week 12.
  
  
  CONCLUSIONS
  DW-MREC using quantitative parameters i.e. ADC, is useful in detecting and assessing inflammatory activity but also to predict efficacy of anti-TNF induction therapy in CD.
authors.affiliation: University Hospital Estaing, Gastroenterology Department, Clermont-Ferrand, France; UMR 1071 Inserm/Université d'Auvergne, USC-INRA 2018, Microbes, Intestine, Inflammation et Susceptibility of the Host, Clermont-Ferrand, France. Electronic address: a_buisson@hotmail.fr.
authors.forename: Anthony
authors.initials: A
authors.lastname: Buisson
authors.affiliation: University Hospital Estaing, Radiology Department, Clermont-Ferrand, France.
authors.forename: Constance
authors.initials: C
authors.lastname: Hordonneau
authors.affiliation: University Hospital Estaing, Gastroenterology Department, Clermont-Ferrand, France; UMR 1071 Inserm/Université d'Auvergne, USC-INRA 2018, Microbes, Intestine, Inflammation et Susceptibility of the Host, Clermont-Ferrand, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Goutte
authors.affiliation: University Hospital Estaing, Gastroenterology Department, Clermont-Ferrand, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Scanzi
authors.affiliation: University Hospital Estaing, Gastroenterology Department, Clermont-Ferrand, France.
authors.forename: Felix
authors.initials: F
authors.lastname: Goutorbe
authors.affiliation: University Hospital Estaing, Radiology Department, Clermont-Ferrand, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Klotz
authors.affiliation: University Hospital Estaing, Radiology Department, Clermont-Ferrand, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Boyer
authors.affiliation: GM Clermont-Ferrand University and Medical Center, DRCI, Biostatistics Unit, Clermont-Ferrand, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.affiliation: University Hospital Estaing, Gastroenterology Department, Clermont-Ferrand, France; UMR 1071 Inserm/Université d'Auvergne, USC-INRA 2018, Microbes, Intestine, Inflammation et Susceptibility of the Host, Clermont-Ferrand, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Bommelaer
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000328:Adult; D002097:C-Reactive Protein / Q000276:immunology; D015331:Cohort Studies; D003106:Colon / Q000000981:diagnostic imaging*; D003424:Crohn Disease / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000276:immunology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use*; D007421:Intestine, Small / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012074:Remission Induction; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D055815:Young Adult
chemical_list: D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D000069285:Infliximab; D000068879:Adalimumab
keywords: Anti-TNF; Crohn's disease; Diffusion-weighted MRI; Predictive factor