MRI and Blood Biomarkers Predict Surgery Risk in Ileal Crohn’s Disease

Elective ileal resection may be influenced by MRI findings and blood-based biomarkers, according to a multicenter study, published in Inflammatory Bowel Diseases, examining predictors for surgery in children and adults with ileal Crohn’s disease (CD). Researchers identified key MRI parameters and circulating biomarkers that could distinguish patients more likely to require surgery from those managed with medical therapy.

The prospective study involved 133 patients—50 who underwent ileal resection and 83 who remained on medical therapy. The average age was 23.9 years, and disease duration and treatment history were similar between both groups. MRI measures included normalized 3D magnetization transfer ratio (MTR), modified Look-Locker inversion recovery (MOLLI) T1 relaxation, and intravoxel incoherent motion (IVIM) metrics, while biomarkers like GM-CSF autoantibodies (Ab) and C-reactive protein were also assessed.

Univariate analysis showed that GM-CSF Ab (OR 2.87; P = 0.0009), normalized 3D MTR (OR 1.05; P = 0.002), and IVIM diffusion metrics were significantly associated with the need for surgery. In the multivariable model, luminal narrowing emerged as a strong predictor (OR 10.19; P = 0.003), alongside normalized 3D MTR (OR 1.07; P = 0.007) and GM-CSF Ab (OR 3.37; P = 0.01).

These findings underscore the potential role of MRI and blood biomarkers in tailoring management strategies for Crohn’s disease. " 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," the researchers noted.

Reference:

Dillman JR, Tkach JA, Fletcher JG, et al. MRI and blood-based biomarkers are associated with surgery in children and adults with ileal Crohn's disease. Inflamm Bowel Dis. 2024;30(11):2181-2190. doi:10.1093/ibd/izae101