Diffusion-weighted imaging to predict longer-term response in Crohn's disease patients commencing biological therapy: results from the MOTILITY trial.

Hameed, M.; Taylor, SA.; Ahmed, N.; Chowdhury, K.; Patel, A.; Helbren, E.; Bhagwanani, A.; Hyland, R.; Bhatnagar, G.; Sidhu, H.; Lambie, H.; Franklin, J.; Mohsin, M.; Thomson, E.; Boone, D.; Tolan, D.; Rahman, S.; Sakai, NS.; Moran, GW.; Hart, A.; Bloom, S.; Menys, A.; Jacobs, I.; Halligan, S.; Plumb, AA.

Diffusion-weighted imaging to predict longer-term response in Crohn's disease patients commencing biological therapy: results from the MOTILITY trial.

All Authors

Hameed, M.

Taylor, SA.

Ahmed, N.

Chowdhury, K.

Patel, A.

Helbren, E.

Bhagwanani, A.

Hyland, R.

Bhatnagar, G.

Sidhu, H.

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LTHT Author

Hyland, Rachel
Lambie, Hannah
Thomson, Elen
Tolan, Damian

LTHT Department

Radiology

Publication Date

2025

Item Type

Journal Article
Multicenter Study

Abstract

OBJECTIVES: Predicting longer-term response to biological therapy for small bowel Crohn's disease (SBCD) is an unmet clinical need. Diffusion-weighted magnetic resonance (MR) imaging (DWI) may indicate disease activity, but its predictive ability, if any, is unknown. We investigated the prognostic value of DWI for 1 year response or remission (RoR) in SBCD patients commencing biologic therapy, including incremental value over C-reactive protein (CRP) and faecal calprotectin (FC). METHODS: A subset of participants in a prospective, multicentre study investigating the predictive ability of motility MRI for 1-year RoR in patients starting biologic therapy for active SBCD, underwent additional DWI at baseline and post-induction (12-30 weeks). CRP and FC were collected in a subgroup. RoR at 1 year was evaluated using clinical and morphological MR enterography (MRE) parameters. We calculated sensitivity and specificity to predict RoR and quality of life (QoL) at 1 year, comparing apparent diffusion coefficient (ADC) value, Clermont score, and CRP using multivariable logistic regression. RESULTS: A total of 25 participants were included (mean 36.9 years, 32% female). ADC changes and Clermont score had poor sensitivity (30.0% [95% CI, 6.7-65.2] and 40.0% [95% CI, 12.2-73.8], respectively) and poor-to-modest specificity (50.0 [95% CI, 27.2-72.8] and 65.0% [95% CI, 40.8-84.6]) for RoR. None of Clermont score, CRP, or FC predicted QoL. CONCLUSIONS: DWI has inadequate sensitivity and specificity for RoR at 1 year. There is no significant incremental prognostic value of DWI over CRP and FC to predict RoR and/or QoL at 1 year. ADVANCES IN KNOWLEDGE: Early post-induction DWI has no prognostic value for RoR at 1 year.