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Avoiding contrast-enhanced sequences does not compromise the precision of the simplified MaRIA for the assessment of non-penetrating Crohn’s disease activity

  • Gastrointestinal
  • Published:
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Abstract

Objectives

Patients with Crohn’s disease (CD) require multiple assessments with magnetic resonance enterography (MRE) from a young age. Standard MRE protocols for CD include contrast-enhanced sequences. Gadolinium deposits in brain tissue suggest avoiding gadolinium could benefit patients with CD. This study aimed to compare the accuracy of the simplified Magnetic Resonance Index of Activity (sMaRIA) calculated with and without contrast-enhanced sequences in determining the response to biologic drugs in patients with CD.

Methods

This post hoc analysis of a prospective study included patients with CD with endoscopic ulceration in ≥ 1 intestinal segment starting biologic drug therapy. Two blinded radiologists used the sMaRIA to score images obtained at baseline and week 46 of treatment first using only unenhanced sequences (T2-sMaRIA) and 1 month later using both unenhanced and enhanced images (CE-sMaRIA). We calculated the rates of agreement between T2-sMaRIA, CE-sMaRIA, and ileocolonoscopy for different conceptualizations of therapeutic response.

Results

A total of 46 patients (median age, 36 years [IQR: 28–47]) were included. Agreement with ileocolonoscopy was similar for CE-sMaRIA and T2-sMaRIA in identifying ulcer healing (kappa = 0.74 [0.55–0.93] and 0.70 [0.5–0.9], respectively), treatment response (kappa = 0.53 [0.28–0.79] and 0.44 [0.17 – 0.71]), and remission (kappa = 0.48 [0.22–0.73] and 0.43 [0.17–0.69]). The standardized effect size was moderate for both CE-sMaRIA = 0.63 [0.41–0.85] p < 0.001 and T2-sMaRIA = 0.58 [0.36–0.80] p < 0.001.

Conclusions

sMaRIA with and without contrast-enhanced images accurately classified the response according to different therapeutic endpoints determined by ileocolonoscopy.

Key Points

• The simplified Magnetic Resonance Index of Activity is accurate for the assessment of Crohn’s disease activity, severity, and therapeutic response, using four dichotomic components that can be evaluated without the need of using contrast-enhanced sequences, representing a practical and safety advantage, but concerns have been expressed as to whether the lack of contrast sequences may compromise precision.

• The simplified Magnetic Resonance Index of Activity can assess the response to biologic therapy in patients with Crohn’s disease without the need for intravenous contrast agents obtaining comparable results without and with contrast-enhanced sequences.

• Avoiding intravenous contrast agents could reduce the duration of the MRE examination and its cost and would increase the acceptance and safety of MRE in clinical research in patients with Crohn’s disease.

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Abbreviations

CD:

Crohn’s disease

MaRIA:

Magnetic Resonance Index of Activity

MRE:

Magnetic resonance enterography

SES-CD:

Simplified Endoscopic Score for Crohn’s Disease

sMaRIA:

Simplified Magnetic Resonance Index of Activity

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Acknowledgements

We thank the patients and their families who took part in the study, as well as the staff, research coordinators, and investigators for your time and dedication. Medical English correction support was provided by John Giba.

Funding

This work has been financed by project PI16 / 00721, integrated into the National R & D & I Program and co-financed by the ISCIII-Subdirección General de Evaluación y el Fondo Europeo de Desarrollo Regional (FEDER).

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Author notes

  1. Jordi Rimola

    Present address: Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain

Authors and Affiliations

  1. Gastroenterology Department, IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain

    Agnès Fernàndez-Clotet, Maria-Carme Masamunt, Elena Ricart, Ingrid Ordás & Julian Panés

  2. Statistics Core, Institut d’Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Barcelona, Spain

    Víctor Sapena

  3. Radiology Department, IBD Unit, Hospital Clínic de Barcelona, C/Villarroel, 170, 08036, Barcelona, Catalonia, Spain

    Nunzia Capozzi, Sonia Rodríguez & Jordi Rimola

  4. Radiology Department, Policlinico Universitario Sant’Orsola-Malpighi, Bologna, Italy

    Nunzia Capozzi

  5. Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain

    Elena Ricart, Ingrid Ordás & Julian Panés

  6. Centro de Investigación Biomédica en Red Enfermedades Hepáticas Y Digestivas (CIBERehd), Barcelona, Spain

    Maria-Carme Masamunt, Elena Ricart, Ingrid Ordás & Julian Panés

  7. University of Barcelona, Barcelona, Spain

    Elena Ricart, Ingrid Ordás & Julian Panés

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Correspondence to Jordi Rimola.

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Guarantor

The scientific guarantor of this publication is Jordi Rimola.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:.

Nunzia Capozzi. received a research grant (BRACCO fellowship) from Bracco Imaging.

Elena Ricart has served as a speaker, has received research funding, or has participated in educational and advisory events for MSD, AbbVie, Takeda, Pfizer, Janssen, Frezenius Kabi, Chiesi, and Ferring.

Ingrid Ordas has received consulting fees from AbbVie, speaking fees from MSD, Abbvie, Jansen, Takeda, and unrestricted research grants from Faes Pharma and AbbVie.

Julian Panés has received research grants from Abbvie MSD and Pfizer and received consulting and/or speaking fees from AbbVie, Abbott, Arena Pharmaceuticals, Boehringer Ingelheim, Celgene, Celltrion, Genentech-Roche, Gilead, GoodGut, GSK, Janssen, MSD, Nestle, Oppilan, Pfizer, Progenity, Takeda, Theravance, Origo, and TiGenix.

Jordi Rimola has received research grants from Abbvie and Genentech and lecture or consultancy fees from Origo Biopharma, Gilead, Takeda, and Janssen; he is on the advisory board of Takeda, TiGenix, Gilead, and Alimentiv.

The rest of the authors have no competing interests to disclose.

Statistics and biometry

Victor Sapena kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in Capozzi N et al J Crohns Colitis. 2020 Sep 7;14(8):1074-1081

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Fernàndez-Clotet, A., Sapena, V., Capozzi, N. et al. Avoiding contrast-enhanced sequences does not compromise the precision of the simplified MaRIA for the assessment of non-penetrating Crohn’s disease activity. Eur Radiol 32, 3334–3345 (2022). https://doi.org/10.1007/s00330-021-08392-w

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