Serial Magnetic Resonance Imaging for Monitoring Anti-TNF Treatment
Effects in Crohn’s Disease
Jeroen AW Tielbeek1, Mark Löwenberg2, Shandra Bipat1, Karin Horsthuis1, Cyriel Y
Ponsioen2, Geert R D’Haens2, Jaap Stoker1
1 Academic
Medical Center, Department of Radiology, Amsterdam, the Netherlands.
2 Academic
Medical Center, Department of Gastroenterology and Hepatology, Amsterdam,
the Netherlands.
Corresponding author:
Jeroen AW Tielbeek, MD
Academic Medical Center, University of Amsterdam
Department of Radiology (G1-229)
Meibergdreef 9
1105AZ Amsterdam, the Netherlands
Email: j.a.w.tielbeek@amc.uva.nl
Telephone: +31 20 566 2793
Fax: +31 20 5669119
Email addresses of co-authors:
Mark Löwenberg: m.lowenberg@amc.uva.nl
Karin Horsthuis: k.horsthuis@amc.uva.nl
Shandra Bipat: s.bipat@amc.uva.nl
Cyriel Ponsioen: c.y.ponsioen@amc.uva.nl
Geert D’Haens: g.dhaens@amc.uva.nl
Jaap Stoker: j.stoker@amc.uva.nl
ABSTRACT
Background
Tumor necrosis factor (TNF) antagonists can induce mucosal healing in patients with Crohn’s
disease (CD), but the effects on transmural inflammation and stenotic lesions are largely
unknown.
Aim
To assess the evolution of CD inflammation and stenosis in patients treated with anti-TNF
agents using serial Magnetic Resonance Imaging (MRI) scans.
Methods
We performed a retrospective study in 50 patients (54% female, median age 37 years) with
CD who had undergone serial MRI examinations while receiving infliximab or adalimumab.
Patients were grouped as clinical responders or non-responders based on physician’s
assessment, laboratory and endoscopic appearance. MRI scoring was performed by two
radiologists in consensus blinded to clinical data using a validated MRI scoring system. In
total 64 lesions on MRI were identified for analysis. Analyses were performed using paired ttest and Wilcoxon rank test.
Results
During anti-TNF treatment, MRI inflammation scores improved in 29 out of 50 patients
(45.3%), remained unchanged in 18 out of 50 (28.1%) or deteriorated in 17 out of 50 (26.6%)
over time. In the anti-TNF responder group, the mean intestinal inflammation score of all
lesions improved from 5.19 to 3.12 (p<0.0001). Mean inflammation scores in stenotic lesions
in anti-TNF responders improved also significantly, from 6.33 to 4.58 (p=0.01). In contrast,
inflammation scores deteriorated from 5.55 to 5.92 (p=0.49) in non-responders.
Conclusions
Improved inflammatory activity on serial MRI scans correlated with clinical response to
treatment with anti-TNF agents in luminal CD. MRI can be used as a complementary
approach to measure transmural inflammation in CD patients and guide the optimal use of
TNF antagonists in daily clinical practice.