Magnetic Resonance Enterography (MRE) Changes after Antibody to Tumor Necrosis Factor (anti-TNF) Alpha Therapy in Crohn’s Disease

Abstract Purpose. To determine the changes over time in MRE parameters during treatment with anti-TNF in patients with Crohn’s disease (CD), and to verify the correlation between MRE score, endoscopic appearance and clinical-biological markers. Materials and methods. We performed a prospective single centre study of 27 patients with active CD. All patients underwent ileocolonoscopy and MRE at baseline and 26 weeks after anti TNF therapy. Endoscopic severity was graded according to the SES-CD and Magnetic Resonance Index of Activity (MaRIA) was calculated. Patients underwent clinical evaluation (CDAI) and the C-reactive protein (CRP) level was measured. The associations between variables were assessed with Pearson’s bivariate correlation analysis. Results. A total of 135 intestinal segments were studied. The median patient age was 27,4 years, 67% were male and the mean disease duration was 6,1 years. For induction of remission, 18 patients were treated with infliximab and 9 with adalimumab. The mean SES-CD and MaRIA scores significantly changed at week 26 (SES-CD: 14,7 ± 8,9 at baseline vs. 4,4 ± 4,6 at 26 weeks - p < 0.001; MaRIA: 41,1 ± 14,8 at baseline vs. 32,8 ± 11,7 at 26 weeks - p < 0.001). Also the CDAI and serum levels of CRP decreased significantly following treatment (p < 0.001). The overall MaRIA correlated with endoscopic score and with clinical activity (CDAI) both at baseline and at week 26 (p < 0.05). The correlation between overall MaRIA and CRP was significant only at week 26 (p < 0.001). Conclusion. The MaRIA has a high accuracy for prediction of endoscopic mucosal healing and is a eliable indicator to monitor the use of TNF antagonists in patients with CD.