P0572 Impact of objective motility MRI scoring of ileal Crohn’s disease on gastroenterologists treatment assessment: The CONTEXT Trial
Authors: Moran G , Naim I , Barber J , Patel K , Patel N , Ocholi A , Khodabakhshi D , Baillie S , Onyeador N , Jennings V , Vuyyuru S , Clarke C , Munya R , Bhatnagar G , Shepherd T , Upponi S , De la Revilla Negro J , Sethi-Arora K , Kuzhiyanjal A , Limdi J , Win A , Ghodekar P , Siddiuqui A M , Tolan D , Lambie H , Fitzke H , Weston W , Harrow P , Yeo J , Hameed M , Taylor S , Menys A 
Published: January 2025

Abstract

Background
Assessing small bowel (SB) Crohn’s Disease (CD) is challenging due to finite accuracy of Faecal Calprotectin and the invasive nature of ileocolonoscopy. While SB motility is a validated biomarker, its impact on clinical decision-making remains unstudied. This study aims to evaluate the influence of GIQuant lesion-specific motility score on clinical assessments in real-world settings.

Methods
10 practising NHS gastroenterologists in 6 UK sites participated with each site identifying eligible CD patients. All patients had baseline and 1y follow up MRE as part of their clinical care including SB motility sequences. For both timepoints, a GIQuant score was derived by the reporting radiologist via an ROI placed in the most active SB segment (matched, if more than one), to which the gastroenterologist was initially blinded. After the second timepoint, gastroenterologists completed an eCRF grading treatment response, 12-month prognosis and surgical likelihood on a 6-point scale: much worse, somewhat worse, slightly worse, slightly better, somewhat better, or much better based on all available clinical information including imaging, but not the GIQuant scores. GIQuant scores from each scan timepoint were then revealed, and gastroenterologists updated their clinical impressions guided by the quantitative change in SB motility scores.

Results
170 CD patients scanned between Nov 2017 and Dec 2023 (61% male, mean age 36±12yrs) were included. Disease was characterised as ileal (61%) or ileocolonic (39%), with behaviour classified as inflammatory (36%), stenosing (42%), or penetrating (21%). 59% of patients had a disease duration of &gt;4yrs. (25,17%) patients had a single CD-related operation, and another 29 had multiple surgeries. Most patients (84%) were on biologics: 33% Adalimumab, 19% Ustekinumab, 16% Infliximab, and 9% Vedolizumab.
GIQuant led to changes in clinical opinion in 43% of cases for disease status, 38% for 12-month prognosis, and 25% for surgical referral likelihood. Most adjustments were 1-step (e.g.,'somewhat worse' to 'slightly worse'), with fewer 2-step and 3-step changes (e.g.,'slightly worse' to much better') reflecting more substantial re-evaluations (Figure1). There was a change in direction of impression, e.g. slightly better to slightly worse or vice versa in (36,21%) cases for disease status, (31,18%) for 12-month prognosis and (15/143,10%) for surgical referral likelihood indicating that GIQuant scores may aid clinical evaluation.

Conclusion
Objective markers are urgently needed for effective management of SBCD. Scoring with GIQuant fundamentally changed the clinical impression in 21% of our cohort, supporting its role as an objective marker in CD management.