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Monitoring Crohn’s disease during anti-TNF-α therapy: validation of the magnetic resonance enterography global score (MEGS) against a combined clinical reference standard

  • Gastrointestinal
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Abstract

Objectives

To assess the ability of magnetic resonance enterography global score (MEGS) to characterise Crohn’s disease (CD) response to anti-TNF-α therapy.

Methods

Thirty-six CD patients (median age 26 years, 20 males) commencing anti-TNF-α therapy with concomitant baseline MRI enterography (MRE) were identified retrospectively. Patients’ clinical course was followed and correlated with subsequent MREs. Scan order was randomised and MEGS (a global activity score) was applied by two blinded radiologists. A physician’s global assessment of the disease activity (remission, mild, moderate or severe) at the time of MRE was assigned. The cohort was divided into clinical responders and non-responders and MEGS compared according to activity status and treatment response. Interobserver agreement was assessed.

Results

Median MEGS decreased significantly between baseline and first follow-up in responders (28 versus 6, P < 0.001) but was unchanged in non-responders (26 versus 18, P = 0.28). The median MEGS was significantly lower in clinical remission (9) than in moderate (14) or severe (29) activity (P < 0.001). MEGS correlated significantly with clinical activity (r = 0.53; P < 0.001). Interobserver Bland-Altman limits of agreement (BA LoA) were -19.7 to 18.5.

Conclusions

MEGS decreases significantly in clinical responders to anti-TNF-α therapy but not in non-responders, demonstrates good interobserver agreement and moderate correlation with clinical disease activity.

Key Points

• MRI scores of Crohn’s activity are used increasingly in clinical practice and therapeutic trials.

• Such scores have been advocated as biomarkers of therapeutic response.

• MEGS reflects clinical response to anti-TNF-α therapy and the clinical classification of disease activity.

• MEGS demonstrates good interobserver agreement.

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Abbreviations

ANOVA:

Analysis of variance

BA LoA:

Bland-Altman limits of agreement

CD:

Crohn’s disease

CRP:

C-reactive protein

fC:

Faecal calprotectin

ICC:

Intra-class correlation coefficient

IQR:

Interquartile range

IBD:

Inflammatory bowel disease

MEGS:

Magnetic resonance enterography global score

MRE:

Magnetic resonance enterography

MRI:

Magnetic resonance imaging

TNF-α:

tumour necrosis factor α

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Acknowledgments

Stuart Taylor and Steve Halligan are senior investigators at the National Institute for Health Research (NIHR). The views expressed in this paper are those of the authors and not necessarily those of the UK National Health Service (NHS), the NIHR or the Department of Health.

The scientific guarantor of this publication is Professor Stuart Taylor. Stuart Taylor is a research consultant for Robarts. The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding by the University College London / University College London Hospital (UCL/UCLH) National Institute for Health Research (NIHR) Biomedical Research Centre. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Centre for Medical Imaging, University College London, 3rd floor east, 250 Euston Rd, London, NW1 2PG, UK

    Davide Prezzi, Gauraang Bhatnagar, Jesica Makanyanga, Steve Halligan & Stuart Andrew Taylor

  2. Gastrointestinal Services, University College Hospital, Ground floor west, 250 Euston Road, London, NW1 2PG, UK

    Roser Vega

  3. Department of Cancer Imaging, King’s College London, St Thomas’ Hospital, 4th floor Lambeth Wing, London, SE1 7EH, UK

    Davide Prezzi

Authors
  1. Davide Prezzi
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  2. Gauraang Bhatnagar
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  3. Roser Vega
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  4. Jesica Makanyanga
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  5. Steve Halligan
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  6. Stuart Andrew Taylor
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Corresponding author

Correspondence to Stuart Andrew Taylor.

Appendices

Appendix 1

Table 3 MRI parameters at 1.5 Tesla. SSTSE = single shot turbo spin echo; True FISP = true fast imaging with steady-state precision. Dynamic contrast-enhanced MRI commenced at the start of contrast medium injection and the final time point was used to assess contrast enhancement
Full size table

Appendix 2

Table 4 MRI parameters at 3 Tesla. SSTSE = single shot turbo spin echo; True FISP = true fast imaging with steady-state precision. Dynamic contrast-enhanced MRI commenced at the start of contrast medium injection and the final time point was used to assess contrast enhancement
Full size table

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Prezzi, D., Bhatnagar, G., Vega, R. et al. Monitoring Crohn’s disease during anti-TNF-α therapy: validation of the magnetic resonance enterography global score (MEGS) against a combined clinical reference standard. Eur Radiol 26, 2107–2117 (2016). https://doi.org/10.1007/s00330-015-4036-1

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  • DOI: https://doi.org/10.1007/s00330-015-4036-1

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