Abstract

Background: Thanks to technical advances, imaging modalities are playing an increasingly important role both in the diagnosis and in the clinical management of chronic inflammatory bowel disease (IBD), especially with Crohn's disease. The diagnosis of inflammatory bowel disease (IBD) is based on laboratory tests and histological evidence. However, imaging methods have also become an important part of diagnosing and monitoring the progress. Fecal calprotectin (CP) is an established biomarker for evaluating inflammatory processes in the colon. It is used to detect neutrophils in inflammatory tissue and allows a differentiation between inflammatory and non-inflammatory diseases of the lower intestinal tract. Due to the high sensitivity, the analysis of the fecal CP provides reliable information about the intensity of the inflammatory lesion and adequately reflects the disease activity that can be detected endoscopically. This study aims to find the relationship between fecal CP and Magnetic Resonance Enterography (MRE), in the diagnosis and prognosis of Crohn's Disease.

Methods: In order to conduct the correlation between Fecal CP and MRE, a retrospective study was performed on 500 Crohn's-diagnosed patients from Gastroenterology and Radiology department at Al-Najah University hospital; from January 2017 to January 2020 who underwent MRE and Fecal CP (within a period of 30 days).

Results: The mean age of the study participants was 33.5 years, and 64.6% of them were males. The MRE score mean was 1.21, and the mean of Fecal CP levels was 324.44 mcg/g. Moreover, it was noticed that the mean of Fecal CP levels in the score "2" MRE group was 614.9 mcg/g, 103.68 mcg/g in the score "1" group, and 32.4 mcg/g in the score "0" group. The results of the regression model demonstrated that there was a statistically significant relationship between Fecal CP levels and MRE results (r²=0.363, P=0.000).

Conclusion: Fecal calprotectin correlates well with MRE activity, thus Fecal CP could be used as a predictor marker to select for MRE assessment.

Keywords: Fecal Calprotectin; MRE; Chron's Disease; IBD; Magnetic Resonance Imaging

References

1. Baumgart DC and Sandborn WJ. “Crohn’s disease”. Lancet9853 (2012): 1590-1605.
2. Erber WF and Erber JA. “Meta-Analysis of the Yield of Capsule Endoscopy in Patients with Crohn’s Disease”. Off J Am Coll Gastroenterol | ACG 11 (2006): 2669.
3. Kaushal P., et al. “MR Enterography of Inflammatory Bowel Disease with Endoscopic Correlation”. Radio Graphics 1 (2016): 116-131.
4. Kilcoyne A., et al. “Inflammatory bowel disease imaging: Current practice and future directions”. World Journal of Gastroenterology3 (2016): 917-932.
5. Maglinte DDT., et al. “Classification of small bowel Crohn’s subtypes based on multimodality imaging”. Clinical Radiology2 (2003): 285-303.
6. Van Assche G., et al. “The second European evidence-based Consensus on the diagnosis and management of Crohn’s disease: Definitions and diagnosis”. Journal of Crohn's and Colitis1 (2010): 7-27.
7. Panes J., et al. “Imaging techniques for assessment of inflammatory bowel disease: Joint ECCO and ESGAR evidence-based consensus guidelines”. Journal of Crohn's and Colitis7 (2013): 556-585.
8. Seidensticker M., et al. “Role of new sectional image techniques in the diagnosis and follow-up of chronic inflammatory bowel diseases”. Journal für Gastroenterologische und Hepatologische Erkrankungen veröffentlicht3 (2010): 12-18.
9. Liu W., et al. “A Diagnostic Accuracy Meta-analysis of CT and MRI for the Evaluation of Small Bowel Crohn Disease”. Academic Radiology10 (2017): 1216-1225.
10. Born C., et al. “[MRI with oral filling in patients with chronic inflammatory bowel diseases]”. Radiologe1 (2003): 34-42.
11. Negaard A., et al. “A prospective randomized comparison between two MRI studies of the small bowel in Crohn’s disease, the oral contrast method and MR enteroclysis”. European Radiology9 (2007): 2294-2301.
12. Scharitzer M and Ba-Ssalamah A. “[Modern MRI of the small bowell]”. Radiologe12 (2015): 1067-1076.
13. Mantarro A., et al. “Magnetic resonance enterography in Crohn’s disease: How we do it and common imaging findings”. World Journal of Radiology2 (2017): 46-54.
14. Laghi A., et al. “Polyethylene glycol solution as an oral contrast agent for MR imaging of the small bowel”. American Journal of Roentgenology6 (2001): 1333-1334.
15. Sood RR., et al. “Small bowel MRI: comparison of a polyethylene glycol preparation and water as oral contrast media”. Journal of Magnetic Resonance Imaging4 (2002): 40-48.
16. Masselli G and Gualdi G. “MR imaging of the small bowel”. Radiology2 (2012): 333-348.
17. Umschaden HW and Gasser J. “MR enteroclysis”. Radiologic Clinics of North America2 (2003): 231-248.
18. Ajaj W., et al. “Oral contrast agents for small bowel distension in MRI: influence of the osmolarity for small bowel distention”. European Radiology7 (2005): 1400-1406.
19. McKenna DA., et al. “Polyethylene glycol solution as an oral contrast agent for MRI of the small bowel in a patient population”. Clinical Radiology11 (2006): 966-970.
20. Taylor SA., et al. “The first joint ESGAR/ ESPR consensus statement on the technical performance of cross-sectional small bowel and colonic imaging”. European Radiology6 (2017): 2570-2582.
21. Pathirana WGW., et al. “Faecal Calprotectin”. The Clinical Biochemist Reviews3 (2018): 77-90.
22. Sipponen T and Kolho K-L. “Fecal calprotectin in diagnosis and clinical assessment of inflammatory bowel disease”. Scandinavian Journal of Gastroenterology1 (2015): 74-80.
23. Cerrillo E., et al. “Fecal Calprotectin in Ileal Crohn’s Disease: Relationship with Magnetic Resonance Enterography and a Pathology Score”. Inflammatory Bowel Diseases7 (2015): 1572-1579.
24. Jones GR., et al. “Faecal Calprotectin and Magnetic Resonance Enterography in Ileal Crohn’s Disease: Correlations Between Disease Activity and Long-Term Follow-Up”. Journal of Crohn's and Colitis4 (2019): 442-450.