Inflamm Bowel Dis. 2024 Nov 4;30(11):2181-2190.doi: 10.1093/ibd/izae101.

Jonathan R Dillman ¹, Jean A Tkach ¹, Joel G Fletcher ², David H Bruining ³, Aiming Lu ³, Subra Kugathasan ⁴, Adina L Alazraki ⁵, Jack Knight-Scott ⁵, Ryan W Stidham ⁶, Jeremy Adler ⁷, Bruce C Trapnell ⁸, Scott D Swanson ⁹, Lin Fei ¹⁰, Lucia Qian ¹¹, Alexander J Towbin ¹, Murat Kocaoglu ¹, Christopher G Anton ¹, Rebecca A Imbus ¹², Jonathan A Dudley ¹², Lee A Denson ¹³

Author information

¹Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.

²Department of Radiology, Mayo Clinic, Rochester, MN, USA.

³Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.

⁴Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA.

⁵Department of Radiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.

⁶Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA.

⁷Division of Pediatric Gastroenterology, Department of Pediatrics, C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, MI, USA.

⁸Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, and Departments of Medicine and Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.

⁹Department of Radiology, Michigan Medicine, Ann Arbor, MI, USA.

¹⁰Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.

¹¹University of Michigan, Ann Arbor, MI, USA.

¹²Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

¹³Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.

Abstract

Background: Despite advances in medical therapy, many children and adults with ileal Crohn's disease (CD) progress to fibrostenosis requiring surgery. We aimed to identify MRI and circulating biomarkers associated with the need for surgical management.

Methods: This prospective, multicenter study included pediatric and adult CD cases undergoing ileal resection and CD controls receiving medical therapy. Noncontrast research MRI examinations measured bowel wall 3-dimensional magnetization transfer ratio normalized to skeletal muscle (normalized 3D MTR), modified Look-Locker inversion recovery (MOLLI) T1 relaxation, intravoxel incoherent motion (IVIM) diffusion-weighted imaging metrics, and the simplified magnetic resonance index of activity (sMaRIA). Circulating biomarkers were measured on the same day as the research MRI and included CD64, extracellular matrix protein 1 (ECM1), and granulocyte-macrophage colony-stimulating factor (GM-CSF) autoantibodies (Ab). Associations between MRI and circulating biomarkers and need for ileal resection were tested using univariate and multivariable LASSO regression.

Results: Our study sample included 50 patients with CD undergoing ileal resection and 83 patients with CD receiving medical therapy; mean participant age was 23.9 ± 13.1 years. Disease duration and treatment exposures did not vary between the groups. Univariate biomarker associations with ileal resection included log GM-CSF Ab (odds ratio [OR], 2.87; P = .0009), normalized 3D MTR (OR, 1.05; P = .002), log MOLLI T1 (OR, 0.01; P = .02), log IVIM perfusion fraction (f; OR, 0.38; P = .04), and IVIM apparent diffusion coefficient (ADC; OR, 0.3; P = .001). The multivariable model for surgery based upon corrected Akaike information criterion included age (OR, 1.03; P = .29), BMI (OR, 0.91; P = .09), log GM-CSF Ab (OR, 3.37; P = .01), normalized 3D MTR (OR, 1.07; P = .007), sMaRIA (OR, 1.14; P = .61), luminal narrowing (OR, 10.19; P = .003), log C-reactive protein (normalized; OR, 2.75; P = .10), and hematocrit (OR, 0.90; P = .13).

Conclusion: After accounting for clinical and MRI measures of severity, normalized 3D MTR and GM-CSF Ab are associated with the need for surgery in ileal CD.