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European Journal of Nuclear Medicine and Molecular Imaging

Erschienen in:

24.10.2019 | Original Article

¹⁸F-FDG PET-MR enterography in predicting histological active disease using the Nancy index in ulcerative colitis: a randomized controlled trial

verfasst von: Yan Li, Benedikt Schaarschmidt, Lale Umutlu, Michael Forsting, Aydin Demircioglu, Anna Katharina Koch, Ole Martin, Ken Herrmann, Hendrik Juette, Andrea Tannapfel, Jost Langhorst

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 4/2020

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Abstract

Purpose

To evaluate the diagnostic performance of PET-MR enterography in detecting histological active inflammation in patients with ulcerative colitis and the impact of bowel purgation on diagnostic accuracies of PET-MR parameters.

Methods

Fifty patients were enrolled in this randomized controlled trial (clinicaltrials.gov [NCT03781284]). Forty patients were randomized in two study arms, in which bowel purgation was performed either before or after PET-MR enterography. All patients underwent ileocolonoscopy with mucosal biopsies after PET-MR within 24 h. Diagnostic performance of MR morphological parameters (MRmorph), diffusion-weighted imaging (DWI), and PET in detecting histological inflammation determined by the Nancy index was compared with each other and between study arms. Correlation between PET and histological inflammatory severity was calculated.

Results

In study arm without previous bowel purgation, SUV_max ratio of bowel segment (relative to SUV_max of the liver) facilitated the highest specificity and diagnostic accuracy compared with MRmorph and DWI. Bowel cleansing led to markedly increased metabolic activity of bowel segments, resulting in significantly reduced specificity of PET compared with study arm without purgation (0.808 vs. 0.966, p = 0.007, respectively). Inter-observer concordance for assessing MRmorph was clearly increased after bowel cleansing (Cohen’s κ, 0.847 vs. 0.665; p = 0.013, respectively), though diagnostic performance of MRmorph was not significantly improved. Our findings suggested that the change of metabolic status was mainly associated with the grade of neutrophil infiltrate and less dependent on chronic infiltrate.

Conclusion

PET-MR enterography was an excellent non-invasive diagnostic method in the assessment of histological active inflammation in ulcerative colitis without the need of previous bowel purgation.

Trial registration

https://clinicaltrials.gov/ct2/show/NCT03781284

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Barakauskiene A, Warren BF, Hommes DW, Mantzaris GJ, Herfarth H, Fléjou JF, et al. European evidence-based consensus on the diagnosis and management of ulcerative colitis: definitions and diagnosis. J Crohn's Colitis. 2008;2(1):1–23. https://doi.org/10.1016/j.crohns.2007.11.001.CrossRef

Authors KT, Dignass AU, Atreya R, Bokemeyer B, Esters P, et al. Aktualisierte S3-Leitlinie Colitis ulcerosa der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS). Z Gastroenterol. 2018;56(09):1087–169. https://doi.org/10.1055/a-0651-8174.CrossRef

Peyrin-Biroulet L, Sandborn W, Sands BE, Reinisch W, Bemelman W, Bryant RV, et al. Selecting therapeutic targets in inflammatory bowel disease (STRIDE): determining therapeutic goals for treat-to-target. Am J Gastroenterol. 2015;110:1324. https://doi.org/10.1038/ajg.2015.233 https://www.nature.com/articles/ajg2015233#supplementary-information.CrossRefPubMed

Riley SA, Mani V, Goodman MJ, Dutt S, Herd ME. Microscopic activity in ulcerative colitis: what does it mean? Gut. 1991;32(2):174–8.CrossRef

Bessissow T, Lemmens B, Ferrante M, Bisschops R, Van Steen K, Geboes K, et al. Prognostic value of serologic and histologic markers on clinical relapse in ulcerative colitis patients with mucosal healing. Am J Gastroenterol. 2012;107:1684. https://doi.org/10.1038/ajg.2012.301.CrossRefPubMed

Bryant RV, Burger DC, Delo J, Walsh AJ, Thomas S, von Herbay A, et al. Beyond endoscopic mucosal healing in UC: histological remission better predicts corticosteroid use and hospitalisation over 6 years of follow-up. Gut. 2016;65(3):408–14. https://doi.org/10.1136/gutjnl-2015-309598.CrossRefPubMed

Lemmens B, Arijs I, Van Assche G, Sagaert X, Geboes K, Ferrante M, et al. Correlation between the endoscopic and histologic score in assessing the activity of ulcerative colitis. Inflamm Bowel Dis. 2013;19(6):1194–201. https://doi.org/10.1097/MIB.0b013e318280e75f.CrossRefPubMed

Zenlea T, Yee EU, Rosenberg L, Boyle M, Nanda KS, Wolf JL, et al. Histology grade is independently associated with relapse risk in patients with ulcerative colitis in clinical remission: a prospective study. Am J Gastroenterol. 2016;111:685. https://doi.org/10.1038/ajg.2016.50 https://www.nature.com/articles/ajg201650#supplementary-information.CrossRefPubMed

Geboes K, Riddell R, Öst A, Jensfelt B, Persson T, Löfberg R. A reproducible grading scale for histological assessment of inflammation in ulcerative colitis. Gut. 2000;47(3):404–9. https://doi.org/10.1136/gut.47.3.404.CrossRefPubMedPubMedCentral

10.

Marchal-Bressenot A, Salleron J, Boulagnon-Rombi C, Bastien C, Cahn V, Cadiot G, et al. Development and validation of the Nancy histological index for UC. Gut. 2017;66(1):43–9. https://doi.org/10.1136/gutjnl-2015-310187.CrossRefPubMed

11.

Mosli MH, Feagan BG, Zou G, Sandborn WJ, D’Haens G, Khanna R, et al. Development and validation of a histological index for UC. Gut. 2017;66(1):50–8. https://doi.org/10.1136/gutjnl-2015-310393.CrossRefPubMed

12.

Magro F, Langner C, Driessen A, Ensari A, Geboes K, Mantzaris GJ, et al. European consensus on the histopathology of inflammatory bowel disease. J Crohn's Colitis. 2013;7(10):827–51. https://doi.org/10.1016/j.crohns.2013.06.001.CrossRef

13.

Muthas D, Reznichenko A, Balendran CA, Böttcher G, Clausen IG, Kärrman Mårdh C, et al. Neutrophils in ulcerative colitis: a review of selected biomarkers and their potential therapeutic implications. Scand J Gastroenterol. 2017;52(2):125–35. https://doi.org/10.1080/00365521.2016.1235224.CrossRefPubMed

14.

Li Y, Beiderwellen K, Nensa F, Gruneisen J, Dobos G, Herrmann K, et al. [(18)F] FDG PET/MR enterography for the assessment of inflammatory activity in Crohn’s disease: comparison of different MRI and PET parameters. Eur J Nucl Med Mol Imaging. 2018. https://doi.org/10.1007/s00259-018-3962-y.CrossRef

15.

Catalano OA, Wu V, Mahmood U, Signore A, Vangel M, Soricelli A, et al. Diagnostic performance of PET/MR in the evaluation of active inflammation in Crohn disease. Am J Nucl Med Mol Imaging. 2018;8(1):62–9.PubMedPubMedCentral

16.

Li Y, Langhorst J, Koch AK, Demircioglu A, Nensa F, Kirchner J, et al. Assessment of ileocolonic inflammation in Crohn’s disease - which surrogate marker is better? MaRIA, Clermont or PET-MR index? Initial results of a feasibility trial. J Nucl Med. 2018. https://doi.org/10.2967/jnumed.118.216937.CrossRef

17.

Catalano OA, Gee MS, Nicolai E, Selvaggi F, Pellino G, Cuocolo A, et al. Evaluation of quantitative PET/MR enterography biomarkers for discrimination of inflammatory strictures from fibrotic strictures in Crohn disease. Radiology. 2016;278(3):792–800. https://doi.org/10.1148/radiol.2015150566.CrossRefPubMed

18.

Shih IL, Wei SC, Yen RF, Chang CC, Ko CL, Lin BR, et al. PET/MRI for evaluating subclinical inflammation of ulcerative colitis. J Magn Reson Imaging. 2018;47(3):737–45. https://doi.org/10.1002/jmri.25795.CrossRefPubMed

19.

Tu DG, Chen CR, Wang YW, Tu CW, Huang YC. Bowel-cleansing methods affecting PET-CT image interpretation. Nucl Med Commun. 2011;32(7):570–4. https://doi.org/10.1097/MNM.0b013e328345327b.CrossRefPubMed

20.

Soyka JD, Strobel K, Veit-Haibach P, Schaefer NG, Schmid DT, Tschopp A, et al. Influence of bowel preparation before 18F-FDG PET/CT on physiologic 18F-FDG activity in the intestine. J Nucl Med. 2010;51(4):507–10. https://doi.org/10.2967/jnumed.109.071001.CrossRefPubMed

21.

Marchal-Bressenot A, Scherl A, Salleron J, Peyrin-Biroulet L. A practical guide to assess the Nancy histological index for UC. Gut. 2016;65(11):1919–20. https://doi.org/10.1136/gutjnl-2016-312722.CrossRefPubMedPubMedCentral

22.

Grömping U. Estimators of relative importance in linear regression based on variance decomposition. Am Stat. 2007;61(2):139–47. https://doi.org/10.1198/000313007X188252.CrossRef

23.

Oussalah A, Laurent V, Bruot O, Bressenot A, Bigard M-A, Régent D, et al. Diffusion-weighted magnetic resonance without bowel preparation for detecting colonic inflammation in inflammatory bowel disease. Gut. 2010;59(8):1056–65. https://doi.org/10.1136/gut.2009.197665.CrossRefPubMed

24.

Zallot C, Peyrin-Biroulet L, Laurent V, Vuitton L, Girard-Gavanier M, Naudé S, et al. Accuracy of diffusion-weighted magnetic resonance colonography in assessing mucosal healing and the treatment response in patients with ulcerative colitis. J Crohn's Colitis. 2016;11(6):716–23. https://doi.org/10.1093/ecco-jcc/jjw211.CrossRef

25.

Savoye-Collet C, Roset JB, Koning E, Charpentier C, Hommel S, Lerebours E, et al. Magnetic resonance colonography in severe attacks of ulcerative colitis. Eur Radiol. 2012;22(9):1963–71. https://doi.org/10.1007/s00330-012-2456-8.CrossRefPubMed

26.

Rimola J, Rodriguez S, Garcia-Bosch O, Ricart E, Pages M, Pellise M, et al. Role of 3.0-T MR colonography in the evaluation of inflammatory bowel disease. Radiographics. 2009;29(3):701–19. https://doi.org/10.1148/rg.293085115.CrossRefPubMed

27.

Bettenworth D, Reuter S, Hermann S, Weckesser M, Kerstiens L, Stratis A, et al. Translational 18F-FDG PET/CT imaging to monitor lesion activity in intestinal inflammation. J Nucl Med. 2013;54(5):748–55. https://doi.org/10.2967/jnumed.112.112623.CrossRefPubMed

28.

Hindryckx P, Devisscher L, Laukens D, Peeters H, De Vos M, Deleye S, et al. Longitudinal quantification of inflammation in the murine dextran sodium sulfate-induced colitis model using μPET/CT1. Inflamm Bowel Dis. 2010;17(10):2058–64. https://doi.org/10.1002/ibd.21578. CrossRefPubMed

29.

Spier BJ, Perlman SB, Jaskowiak CJ, Reichelderfer M. PET/CT in the evaluation of inflammatory bowel disease: studies in patients before and after treatment. Mol Imaging Biol. 2010;12(1):85–8. https://doi.org/10.1007/s11307-009-0232-1.CrossRefPubMed

30.

group ftAs, Sollellis E, Bommelaer G, Buisson A, Bonnaud G, Mathieu S, et al. Comparative acceptability and perceived clinical utility of monitoring tools: a nationwide survey of patients with inflammatory bowel disease. Inflamm Bowel Dis. 2017;23(8):1425–33. https://doi.org/10.1097/mib.0000000000001140. CrossRef

31.

Langhorst J, Kuhle CA, Ajaj W, Nufer M, Barkhausen J, Michalsen A, et al. MR colonography without bowel purgation for the assessment of inflammatory bowel diseases: diagnostic accuracy and patient acceptance. Inflamm Bowel Dis. 2007;13(8):1001–8. https://doi.org/10.1002/ibd.20140.CrossRefPubMed

Titel: 18F-FDG PET-MR enterography in predicting histological active disease using the Nancy index in ulcerative colitis: a randomized controlled trial
verfasst von: Yan Li
Benedikt Schaarschmidt
Lale Umutlu
Michael Forsting
Aydin Demircioglu
Anna Katharina Koch
Ole Martin
Ken Herrmann
Hendrik Juette
Andrea Tannapfel
Jost Langhorst
Publikationsdatum: 24.10.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 4/2020
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-019-04535-w

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Trial registration

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