Transmural Disease, Biomarkers, and Correlation between MRI and Endoscopy

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A recent study (I Weinstein-Nakar et al. Clin Gastroenterol Hepatol 2018; 16: 1089-97, editorial 1037-39)) provide data from 151 children who underwent multiple modalities to assess their Crohn’s disease (CD) (ImageKids Study group).

Key findings:

  • MRE and ileocolonoscopy had concordance in 69% of cases.  55% had neither transmural nor mucosal healing, 14% had both transmural and mucosal healing.
  • MRE did not show features of active disease in 25% that was identified on ileocolonoscopy.  This is an expected finding given the ability of endoscopy (& capsule endoscopy) to identify milder mucosal lesions more precisely.
  • MRE did show evidence of disease in 6% who had unremarkable ileocolonoscopy (mucosal healing)
  • Calprotectin at a cut-off of 100 mcg/mL had 71% sensitivity and 92% specificity for diagnosing mucosal and transmural healing whereas a level of 300 mcg/mL had a sensitivity of 80% and specificity of 81%.

My take: This study confirms the complementary nature of cross-sectional imaging with endoscopy to determine healing.  In addition, in children with CD, calprotectin levels of more than 100 mcg/mL could indicate the need for further assessment (if this would affect management).

This is in agreement with another recent post: IBD Reviews: Antibiotics and Biomarkers:  “a calprotectin has a high level of excluding active inflammation/IBD. In populations with IBD, levels more than 250 mcg/g indicate a high likelihood of active inflammation whereas levels between 100-250 are indeterminate.”

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