Diffusion-weighted imaging to predict longer-term response in Crohn’s disease patients commencing biological therapy: results from the MOTILITY trial
Authors: Hameed Maira , Taylor Stuart A , Ahmed Norin , Chowdhury Kashfia , Patel Anisha , Helbren Emma , Bhagwanani Anisha , Hyland Rachel , Bhatnagar Gauraang , Sidhu Harbir , Lambie Hannah , Franklin James , Mohsin Maryam , Thomson Elen , Boone Darren , Tolan Damian , Rahman Safi , Sakai Naomi S , Moran Gordon W , Hart Alisa , Bloom Stuart , Menys Alex , Jacobs Ilan , Halligan Steve , Plumb Andrew A ,   MOTILITY Trial Investigators, Ahmad Tariq , Ahmed Saiam , Ahmed-Timms Fardowsa , Baldwin-Cleland Rachel , Chikkeragowda Uday Bannur , Barratt Nina , Beeston Teresita , Brezina Biljana , Cetroni Amanda , Choudhury Junaid , Cipriano Bessie , Dilawershah Maria , Fitzke Heather , Foster Tracy , Gangi Anmol , Gibbons Nicola , Godfrey Edmund , Gupta Arun , Higginson Anthony , Holmes Judith , Hosseini-Ardehali Faraz , Isaac Elizabeth , Jastrub Roman , Joseph Mayamol , Kaur Jaspreet , Kilic Yakup , Kok Klaartje Bel , Kpodo Felix , Kumar Shankar , Langlands Sarah , Loveday Eric , McCartney Sara , Mooney Peter , Onoviran Felicia , Parkes Miles , Patel Jaymin , Patel Kamal , Patel Kamini , Patodi Nishant , Philpott Sue , Pollok Richard , Przemiosolo Robert , Rafferty Helen , Ramsami Javen , Robinson Charlotte , Roffe Suzanne , Rogers Lindsay , Rosiou Konstantina , Seward Abi , Theis Belinda , Thoua Nora , Travis Simon , Wadke Anvi , Ward Lana , Wilce Annamaria , Williams Steven 
Published: January 2025

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.