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Reinisch W, Colombel JF, D’Haens GR, Rimola J, DeHaas-Amatsaleh A, McKevitt M, Ren X, Serone A, Schwartz DA, Gecse KB. OP18 Efficacy and safety of filgotinib for the treatment of perianal fistulizing Crohn’s Disease: Results from the phase 2 DIVERGENCE 2 study. J Crohns Colitis 2022; 16. [PMCID: PMC9383240 DOI: 10.1093/ecco-jcc/jjab232.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Treatment of perianal fistulizing Crohn’s disease (PFCD) is a major unmet need. Filgotinib (FIL) is a once-daily, oral, preferential Janus kinase 1 inhibitor in development for the treatment of inflammatory bowel diseases. The efficacy and safety of FIL for the treatment of PFCD was evaluated in the phase 2, double-blind, randomized, placebo (PBO)-controlled DIVERGENCE 2 study (NCT03077412). Methods Patients (18–75 years old) with PFCD (documented diagnosis of CD for at least 3 months and 1–3 external openings [EOs] with drainage [spontaneous or on compression] for ≥ 4 weeks before screening) previously treated with antibiotics, immunomodulators and/or tumour necrosis factor inhibitors (TNFi) were randomized (2:2:1) to receive FIL 200 mg, FIL 100 mg or PBO once daily for up to 24 weeks. Active luminal CD was permitted providing that the Crohn’s Disease Activity Index score was ≤ 300 at screening. The primary endpoint was combined fistula response (reduction of ≥ 1 from baseline in the number of draining EOs determined by investigator assessment and no fluid collections > 1 cm on centrally read pelvic magnetic resonance imaging [MRI]) at Week 24. Combined fistula remission (closure of all draining EOs present at baseline and no fluid collections > 1 cm) at Week 24 was a key secondary endpoint. The study was not powered for statistical comparisons and was prematurely terminated owing to low recruitment rates during the COVID-19 pandemic. Results Baseline characteristics were broadly similar across the treatment groups (Table 1). Overall, 91.2% of patients had complex perianal fistulae and TNFi treatment had previously failed in 64.9% of patients. A lower proportion of patients randomized to receive FIL 200 mg discontinued the study compared with those who received PBO (Table 2). The proportion of patients who achieved a combined fistula response at Week 24 was numerically higher in the FIL 200 mg group (47.1%; 90% confidence interval [CI]: 26.0–68.9) than in the PBO group (25.0%; 90% CI: 7.2–52.7) (Figure 1), with similar results observed for combined fistula remission (FIL 200 mg [47.1%; CI: 26.0–68.9] versus PBO [16.7%; CI: 3.0–43.8]) (Figure 2). Treatment-emergent severe adverse events were highest in the FIL 200 mg group (Table 2). Adverse event rates were otherwise similar across treatment groups. ![]()
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Conclusion In this phase 2 study, numerically higher fistula response and remission rates were observed after 24 weeks of treatment with FIL 200 mg versus PBO in patients with active PFCD and a history of multiple medical treatment failures. FIL was well tolerated overall. Further studies of FIL for the treatment of PFCD are warranted.
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Affiliation(s)
- W Reinisch
- Medical University of Vienna, Department of Internal Medicine and Gastroenterology, Vienna, Austria
| | - J F Colombel
- Icahn School of Medicine at Mount Sinai, The Dr. Henry D. Janowitz Division of Gastroenterology, New York, United States
| | - G R D’Haens
- Amsterdam University Medical Centre, Department of Gastroenterology and Hepatology, Amsterdam, The Netherlands
| | - J Rimola
- Hospital Clinic of Barcelona, Inflammatory Bowel Disease Unit, Department of Radiology, Barcelona, Spain
| | | | - M McKevitt
- Gilead Sciences, Inc, Foster City, United States
| | - X Ren
- Gilead Sciences, Inc, Foster City, United States
| | - A Serone
- Gilead Sciences, Inc, Foster City, United States
| | - D A Schwartz
- Vanderbilt University Medical Center, Division of Gastroenterology, Hepatology and Nutrition, Nashville, United States
| | - K B Gecse
- Amsterdam University Medical Centre, Department of Gastroenterology and Hepatology, Amsterdam, The Netherlands
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Halligan S, Tolan D, Amitai MM, Hoeffel C, Kim SH, Maccioni F, Morrin MM, Mortele KJ, Rafaelsen SR, Rimola J, Schmidt S, Stoker J, Yang J. ESGAR consensus statement on the imaging of fistula-in-ano and other causes of anal sepsis. Eur Radiol 2020; 30:4734-4740. [PMID: 32307564 PMCID: PMC7431441 DOI: 10.1007/s00330-020-06826-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 03/19/2020] [Indexed: 12/15/2022]
Abstract
Objectives To develop imaging guidelines for patients with fistula-in-ano and other causes of anal sepsis. Methods An expert group of 13 members of the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) used a modified Delphi process to vote on a series of consensus statements relating to the imaging of patients with potential anal sepsis. Participants first completed a questionnaire to gather practice information and to help frame the statements posed. Results In the first round of voting, the expert group scored 51 statements of which 45 (88%) achieved immediate consensus. The remaining 6 statements were redrafted following input from the expert group and consensus achieved for all during a second round of voting, including an additional statement drafted. No statement was rejected due to a lack of consensus. After redrafting to improve clarity, 53 individual statements were presented. Conclusion These expert consensus statements can be used to guide appropriate indication, acquisition, interpretation and reporting of medical imaging for patients with potential fistula-in-ano and other causes of anal sepsis. Key Points • Medical imaging, notably magnetic resonance imaging, is used widely for the diagnosis and monitoring of fistula-in-ano and other causes of anal and perianal sepsis. • While the indexed medical literature is clear that diagnostic accuracy is potentially excellent, this depends on competent image acquisition and interpretation. • In order to facilitate this, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) has produced expert consensus guidelines regarding the imaging of fistula-in-ano and related conditions. Electronic supplementary material The online version of this article (10.1007/s00330-020-06826-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Halligan
- Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK.
| | - D Tolan
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals Trust, Leeds, UK
| | - M M Amitai
- Department of Radiology, Sackler Faculty of Medicine, Tel Aviv University, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - C Hoeffel
- Department of Radiology, Hôpital Robert-Debré, Reims, France
| | - S H Kim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, South Korea
| | - F Maccioni
- Department of Radiological Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - M M Morrin
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - K J Mortele
- Division of Abdominal Imaging, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - S R Rafaelsen
- Colorectal Centre of Excellence, University Hospital of Southern Denmark, Vejle, Denmark
| | - J Rimola
- Radiology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - S Schmidt
- Department of Radiology, University Hospital, CHUV, Lausanne, Switzerland
| | - J Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J Yang
- Department of Radiology, Concord Hospital, Sydney, Australia
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Samaan MA, Puylaert CAJ, Levesque BG, Zou GY, Stitt L, Taylor SA, Shackelton LM, Vandervoort MK, Khanna R, Santillan C, Rimola J, Hindryckx P, Nio CY, Sandborn WJ, D'Haens G, Feagan BG, Jairath V, Stoker J. The development of a magnetic resonance imaging index for fistulising Crohn's disease. Aliment Pharmacol Ther 2017; 46:516-528. [PMID: 28653753 DOI: 10.1111/apt.14190] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 10/29/2016] [Accepted: 05/24/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is the gold standard for assessment of perianal fistulising Crohn's disease (CD). The Van Assche index is the most commonly used MRI fistula index. AIMS To assess the reliability of the Van Assche index, and to modify the instrument to improve reliability and create a novel index for fistulising CD. METHODS A consensus process developed scoring conventions for existing Van Assche index component items and new items. Four experienced radiologists evaluated 50 MRI images in random order on three occasions. Reliability was assessed by estimates of intraclass correlation coefficients (ICCs). Common sources of disagreement were identified and recommendations made to minimise disagreement. A mixed effects model used a 100 mm visual anologue scale (VAS) for global severity as outcome and component items as predictors to create a modified Van Assche index. RESULTS Intraclass correlation coefficients (95% confidence intervals) for intra-rater reliability of the original and modified Van Assche indices and the VAS were 0.86 (0.81-0.90), 0.90 (0.86-0.93) and 0.86 (0.82-0.89). Corresponding ICCs for inter-rater reliability were 0.66 (0.52-0.76), 0.67 (0.55-0.75) and 0.58 (0.47-0.66). Sources of disagreement included number, location, and extension of fistula tracts, and rectal wall involvement. A modified Van Assche index (range 0-24) was created that included seven component items. CONCLUSIONS Although "almost perfect" intra-rater reliability was observed for the assessment of MRI images for fistulising CD using the Van Assche index, inter-rater reliability was considerably lower. Our modification of this index should result in a more optimal instrument.
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Affiliation(s)
- M A Samaan
- Department of Gastroenterology, Guy's & St Thomas' Hospital, London, UK.,Robarts Clinical Trials, Inc, London, Canada
| | - C A J Puylaert
- Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - B G Levesque
- Department of Gastroenterology, University of California San Diego, La Jolla, CA, USA.,Robarts Clinical Trials, Inc, San Diego, CA, USA
| | - G Y Zou
- Robarts Clinical Trials, Inc, London, Canada.,Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada
| | - L Stitt
- Robarts Clinical Trials, Inc, London, Canada
| | - S A Taylor
- Department of Medical Imaging, University College London, London, UK
| | | | | | - R Khanna
- Robarts Clinical Trials, Inc, London, Canada.,Department of Medicine, University of Western Ontario, London, Canada
| | - C Santillan
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - J Rimola
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - P Hindryckx
- Robarts Clinical Trials, Inc, London, Canada.,Department of Gastroenterology, University Hospital of Ghent, Ghent, Belgium
| | - C Y Nio
- Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - W J Sandborn
- Department of Gastroenterology, University of California San Diego, La Jolla, CA, USA.,Robarts Clinical Trials, Inc, San Diego, CA, USA
| | - G D'Haens
- Department of Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands.,Robarts Clinical Trials, BV, Amsterdam, The Netherlands
| | - B G Feagan
- Robarts Clinical Trials, Inc, London, Canada.,Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada.,Department of Medicine, University of Western Ontario, London, Canada
| | - V Jairath
- Robarts Clinical Trials, Inc, London, Canada.,Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada.,Department of Medicine, University of Western Ontario, London, Canada
| | - J Stoker
- Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands
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4
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García-Bosch O, Ordás I, Aceituno M, Rodríguez S, Ramírez AM, Gallego M, Ricart E, Rimola J, Panes J. Comparison of Diagnostic Accuracy and Impact of Magnetic Resonance Imaging and Colonoscopy for the Management of Crohn's Disease. J Crohns Colitis 2016; 10:663-9. [PMID: 26783346 DOI: 10.1093/ecco-jcc/jjw015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/14/2015] [Indexed: 12/14/2022]
Abstract
AIMS The objective of the current study was to compare two patient assessment strategies using colonoscopy and MRI alternatively as first- and second-line examinations. METHODS Clinical data, endoscopy and magnetic resonance imaging (MRI) examinations of 100 patients diagnosed with ileocolonic Crohn's disease (CD) performed within 1 week were blindly reviewed by 4 clinical investigators. Two investigators evaluated MRI followed by colonoscopy for 50 cases and the same examinations in reverse order for another 50 cases; the other 2 investigators evaluated the same cases switching the order of examinations. The assessments included the likelihood of the presence of inflammation, stenosis, fistula and abscess, and therapeutic recommendations. RESULTS Information from the first examination was considered sufficient for management in 80% of cases for MRI and only 34% of cases for colonoscopy (p < 0.001). Adding MRI to the information from colonoscopy changed the clinicians' confidence grade in a higher proportion of patients than adding colonoscopy to information from MRI for the diagnosis of disease activity (10 vs 4%, p = 0.03), stenosis (25 vs 9%, p < 0.001), fistula (31 vs 0%, p < 0.001) and internal abscess (27 vs 0%, p < 0.001). Indications for anti-tumour necrosis factor (TNF) therapy (51 vs 37%, F = 0.006), and surgery (12 vs 5%, F = 0.019) were more frequent after MRI than after colonoscopy as first examination. As a second examination, MRI led to change in therapy in a higher proportion of patients than colonoscopy (28 vs 8%, p < 0.001). CONCLUSIONS In CD, information provided by MRI has a higher impact on patient management than colonoscopy and may be considered as a first-line examination for CD assessment.
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Affiliation(s)
- O García-Bosch
- Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain Department of Digestive Diseases, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain
| | - I Ordás
- Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - M Aceituno
- Department of Digestive Diseases, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - S Rodríguez
- Department of Radiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - A M Ramírez
- Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - M Gallego
- Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - E Ricart
- Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - J Rimola
- Department of Radiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - J Panes
- Department of Gastroenterology, Hospital Clinic of Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
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5
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de Buck van Overstraeten A, Vermeire S, Vanbeckevoort D, Rimola J, Ferrante M, Van Assche G, Wolthuis A, D’Hoore A. Modified Side-To-Side Isoperistaltic Strictureplasty over the Ileocaecal Valve: An Alternative to Ileocaecal Resection in Extensive Terminal Ileal Crohn's Disease. J Crohns Colitis 2016; 10:437-42. [PMID: 26674959 PMCID: PMC4946765 DOI: 10.1093/ecco-jcc/jjv230] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/11/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND A modified Michelassi strictureplasty over the ileocaecal valve or ileocolic anastomosis could be an alternative to ileocaecal resection. This study assessed the outcome of the modified Michelassi strictureplasty in patients with extensive stenotic terminal ileal Crohn's disease [CD]. METHODS This type of strictureplasty was proposed to all patients with an extensive strictured [neo-] terminal ileal segment [> 20 cm]. Short- and long-term outcome data were retrieved from a prospectively maintained database. Safety and medium-term efficacy were studied, using both postoperative magnetic resonance enterography [MRE] and ileocolonoscopy at 6 months. RESULTS Between June 2009 and September 2014, 29 CD patients had a modified strictureplasty [male 9/29, median age 38 [range: 16-64] years]. The median length of strictureplasty was 50 [27-110] cm. Twelve patients underwent a total of 30 additional procedures during surgery, mainly additional short strictureplasties, but also segmental resections. The majority had a laparoscopic-assisted procedure. Median length of hospital stay was 9 [6-17] days. Two patients had an early rescue procedure to oversew a small anastomotic leak. MRE and ileocolonoscopy at follow-up showed a remarkable regression of inflammation and bowel wall thickness. Clinical recurrence, necessitating initiation or modification of medical therapy, and surgical recurrence were reported in 11 and 1 patient after a median follow-up of 21 [1-54] months, respectively. CONCLUSION A modified long Michelassi strictureplasty appears to be safe in patients with extensive stricturing Crohn's ileitis. Significant mucosal and bowel wall healing is observed and suggests that clearance of microbial stasis may play a role in this process.
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Affiliation(s)
| | - S. Vermeire
- University Hospitals Leuven, Department of Gastroenterology, KU Leuven, Belgium
| | - D. Vanbeckevoort
- University Hospitals Leuven, Department of Radiology, KU Leuven, Belgium
| | - J. Rimola
- Hospital Clinic de Barcelona, Department of Radiology, Barcelona, Spain
| | - M. Ferrante
- University Hospitals Leuven, Department of Gastroenterology, KU Leuven, Belgium
| | - G. Van Assche
- University Hospitals Leuven, Department of Gastroenterology, KU Leuven, Belgium
| | - A. Wolthuis
- University Hospitals Leuven, Department of Abdominal Surgery, KU Leuven, Belgium
| | - A. D’Hoore
- University Hospitals Leuven, Department of Abdominal Surgery, KU Leuven, Belgium
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6
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Coimbra AJF, Rimola J, O'Byrne S, Lu TT, Bengtsson T, de Crespigny A, Luca D, Rutgeerts P, Bruining DH, Fidler JL, Sandborn WJ, Santillan CS, Higgins PDR, Al-Hawary MM, Vermeire S, Vanbeckevoort D, Vanslembrouck R, Peyrin-Biroulet L, Laurent V, Herrmann KA, Panes J. Magnetic resonance enterography is feasible and reliable in multicenter clinical trials in patients with Crohn's disease, and may help select subjects with active inflammation. Aliment Pharmacol Ther 2016; 43:61-72. [PMID: 26548868 DOI: 10.1111/apt.13453] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 07/23/2015] [Accepted: 10/09/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Reliable tools for patient selection are critical for clinical drug trials. AIM To evaluate a consensus-based, standardised magnetic resonance enterography (MRE) protocol for selecting patients for inclusion in Crohn's disease (CD) multicenter clinical trials. METHODS This study recruited 20 patients [Crohn's Disease Activity Index (CDAI) scores: <150 (n = 8); 150-220 (n = 4); 220-450 (n = 8)], to undergo ileocolonoscopy and two MREs (with and without colonic contrast) within a 14-day period. Procedures were scored centrally using, Magnetic Resonance Index of Activity (MaRIA), and both Crohn's Disease Endoscopic Index of Severity (CDEIS) and Simplified Endoscopic Score (SES-CD). RESULTS 37 MREs were acquired. Both MREs were evaluable in 16 patients for calculation of test-retest and inter-reader reliability scores. The MaRIA scores for the terminal ileum had excellent test-retest and inter-reader reliability, with correlations >0.9. The proximal ileum showed strong within-reader agreement (0.90-0.96), and fair between-reader agreement (0.59-0.72). MRE procedures were tolerable. MaRIA scores correlated with CDEIS and SES-CD (0.63 and 0.71), but not with CDAI (0.34). MRE identified 3 patients with intra-abdominal complications, who would otherwise have been included in clinical trials. Furthermore, both MRE and ileocolonoscopy identified active bowel wall inflammation in 2 patients with CDAI <150, and none in 1 patient with CDAI > 220. Data quality was good/excellent in 85% of scans, and fair or better in 96%. CONCLUSIONS Magnetic resonance enterography of high-quality and reproducibility was feasible in a global multi- centre setting, with evidence for improved selectivity over CDAI and ileocolonoscopy in identifying appropriate CD patients for inclusion in therapeutic intervention trials.
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Affiliation(s)
| | - J Rimola
- Hospital Clínic de Barcelona, Catalonia, Spain
| | - S O'Byrne
- Genentech, Inc., South San Francisco, CA, USA
| | - T T Lu
- Genentech, Inc., South San Francisco, CA, USA
| | - T Bengtsson
- Genentech, Inc., South San Francisco, CA, USA
| | | | - D Luca
- Genentech, Inc., South San Francisco, CA, USA
| | - P Rutgeerts
- University Hospitals Leuven, Leuven, Belgium
| | | | | | - W J Sandborn
- University of California San Diego, La Jolla, CA, USA
| | - C S Santillan
- University of California San Diego, La Jolla, CA, USA
| | | | | | | | | | | | - L Peyrin-Biroulet
- University Hospital of Nancy-Brabois, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - V Laurent
- Adults University, Nancy University, Vandoeuvre-lès-Nancy, France
| | - K A Herrmann
- University Hospitals Case Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | - J Panes
- Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
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Jauregui-Amezaga A, Rimola J, Ordás I, Rodríguez S, Ramírez-Morros A, Gallego M, Masamunt MC, Llach J, González-Suárez B, Ricart E, Panés J. Value of endoscopy and MRI for predicting intestinal surgery in patients with Crohn's disease in the era of biologics. Gut 2015; 64:1397-402. [PMID: 25516418 DOI: 10.1136/gutjnl-2014-308101] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 11/27/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Severe endoscopic lesions (SEL) in patients with colonic Crohn's disease (CD) have been linked to higher risk of colectomy. The aims of this study were to reassess the predictive value of colonoscopy compared against MRI for requirement of resection surgery in patients with CD and determine the influence of current therapeutic options. DESIGN In this single-centre, observational, prospective, longitudinal study, patients with an established diagnosis of CD and suspected activity were included. After baseline assessment, including colonoscopy and MRI, patients were followed until resection surgery or the end of study. RESULTS 112 patients were eligible for analysis. Ulcers were present in 94/112 (84%) of patients at colonoscopy (SELs in 51/112 (46%)) and stenosis in 38/112 (34%). MRI identified ulcers in 79/112 (71%) of patients, stenosis in 36/112 (32%) and intra-abdominal fistulae in 20/112 (18%). Surgical resection requirements (29/112 (26%)) were not associated with the presence of SELs at colonoscopy. The presence of stenosis (p<0.001) or intra-abdominal fistulae (p<0.001) at MRI correlated with a higher risk of surgery. In the multivariate analysis, perianal disease (OR 9 (2 to 39), p=0.003), stenosis (OR 3.4 (1 to 11), p=0.04) and fistulae at MRI (OR 10.6 (2 to 46), p=0.002) increased the risk of abdominal resection surgery, while months under immunomodulators (OR 0.94 (0.90 to 0.98), p=0.002) and/or antitumor necrosis factor (anti-TNF) therapy (OR 0.97 (0.94 to 1), p=0.04) during follow-up decreased this risk. CONCLUSIONS Perianal disease, stenosis and/or intra-abdominal fistulae at MRI independently predict an increased risk of resection surgery in patients with CD, whereas immunosuppressants and/or anti-TNF therapy reduce such risk. Under current therapeutic strategies, the presence of SELs is not a predictor of resection surgery in patients with CD.
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Affiliation(s)
- A Jauregui-Amezaga
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - J Rimola
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - I Ordás
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - S Rodríguez
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - A Ramírez-Morros
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - M Gallego
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - M C Masamunt
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - J Llach
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - B González-Suárez
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - E Ricart
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - J Panés
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
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8
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Panes J, Bouhnik Y, Reinisch W, Stoker J, Taylor SA, Baumgart DC, Danese S, Halligan S, Marincek B, Matos C, Peyrin-Biroulet L, Rimola J, Rogler G, van Assche G, Ardizzone S, Ba-Ssalamah A, Bali MA, Bellini D, Biancone L, Castiglione F, Ehehalt R, Grassi R, Kucharzik T, Maccioni F, Maconi G, Magro F, Martín-Comín J, Morana G, Pendsé D, Sebastian S, Signore A, Tolan D, Tielbeek JA, Weishaupt D, Wiarda B, Laghi A. Imaging techniques for assessment of inflammatory bowel disease: joint ECCO and ESGAR evidence-based consensus guidelines. J Crohns Colitis 2013; 7:556-85. [PMID: 23583097 DOI: 10.1016/j.crohns.2013.02.020] [Citation(s) in RCA: 478] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 02/20/2013] [Indexed: 12/12/2022]
Abstract
The management of patients with IBD requires evaluation with objective tools, both at the time of diagnosis and throughout the course of the disease, to determine the location, extension, activity and severity of inflammatory lesions, as well as, the potential existence of complications. Whereas endoscopy is a well-established and uniformly performed diagnostic examination, the implementation of radiologic techniques for assessment of IBD is still heterogeneous; variations in technical aspects and the degrees of experience and preferences exist across countries in Europe. ECCO and ESGAR scientific societies jointly elaborated a consensus to establish standards for imaging in IBD using magnetic resonance imaging, computed tomography, ultrasonography, and including also other radiologic procedures such as conventional radiology or nuclear medicine examinations for different clinical situations that include general principles, upper GI tract, colon and rectum, perineum, liver and biliary tract, emergency situation, and the postoperative setting. The statements and general recommendations of this consensus are based on the highest level of evidence available, but significant gaps remain in certain areas such as the comparison of diagnostic accuracy between different techniques, the value for therapeutic monitoring, and the prognostic implications of particular findings.
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Affiliation(s)
- J Panes
- Gastroenterology Department, Hospital Clinic Barcelona, CIBERehd, IDIBAPS, Barcelona, Spain.
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Panés J, Bouzas R, Chaparro M, García-Sánchez V, Gisbert JP, Martínez de Guereñu B, Mendoza JL, Paredes JM, Quiroga S, Ripollés T, Rimola J. Systematic review: the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn's disease. Aliment Pharmacol Ther 2011; 34:125-45. [PMID: 21615440 DOI: 10.1111/j.1365-2036.2011.04710.x] [Citation(s) in RCA: 423] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cross-sectional imaging techniques, including ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI), are increasingly used for evaluation of Crohn's disease (CD). Aim To perform an assessment of the diagnostic accuracy of cross-sectional imaging techniques for diagnosis of CD, evaluation of disease extension and activity and diagnosis of complications, and to provide recommendations for their optimal use. METHODS Relevant publications were identified by literature search and selected based on predefined quality parameters, including a prospective design, sample size and reference standard. A total of 68 publications were chosen. RESULTS Ultrasonography is an accurate technique for diagnosis of suspected CD and for evaluation of disease activity (sensitivity 0.84, specificity 0.92), is widely available and non-invasive, but its accuracy is lower for disease proximal to the terminal ileum. MRI has a high diagnostic accuracy for the diagnosis of suspected CD and for evaluation of disease extension and activity (sensitivity 0.93, specificity 0.90), and is less dependent on the examiner and disease location compared with US. CT has a similar accuracy to MRI for assessment of disease extension and activity. The three techniques have a high accuracy for identification of fistulas, abscesses and stenosis (sensitivities and specificities >0.80), although US has false positive results for abscesses. As a result of the lack of radiation, US or MRI should be preferred over CT, particularly in young patients. CONCLUSIONS Cross-sectional imaging techniques have a high accuracy for evaluation of suspected and established CD, reliably measure disease severity and complications; they may offer the possibility to monitor disease progression.
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Affiliation(s)
- J Panés
- Hospital Clínic of Barcelona, IDIBAPS, Barcelona, Spain.
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10
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Rimola J, Rodriguez S, García-Bosch O, Ordás I, Ayala E, Aceituno M, Pellisé M, Ayuso C, Ricart E, Donoso L, Panés J. Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn's disease. Gut 2009; 58:1113-20. [PMID: 19136510 DOI: 10.1136/gut.2008.167957] [Citation(s) in RCA: 478] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Assessment of disease extension and activity is crucial to guide treatment in Crohn's disease. The objective of the current cross-sectional study was to determine the accuracy of MR for this assessment. DESIGN 50 patients with clinically active (n = 35) or inactive (n = 15) Crohn's disease underwent ileocolonoscopy (reference standard) and MR. T2-weighted and precontrast and postcontrast-enhanced T1-weighted sequences were acquired. Endoscopic activity was evaluated by CDEIS (Crohn's Disease Endoscopic Index of Severity); in addition endoscopic lesions were classified as absent, mild (inflammation without ulcers) or severe (presence of ulceration). RESULTS The comparison of intestinal segments with absent, mild and severe inflammation demonstrated a progressive and significant (p<0.001) increase in the following MR parameters: wall thickness, postcontrast wall signal intensity, relative contrast enhancement, presence of oedema, ulcers, pseudopolyps and lymph node enlargement. Independent predictors for CDEIS in a segment were wall thickness (p = 0.007), relative contrast enhancement (p = 0.01), presence of oedema (p = 0.02) and presence of ulcers at MR (p = 0.003). There was a significant correlation (r = 0.82, p<0.001) between the CDEIS of the segment and the MR index calculated according to the logistic regression analysis coefficients. The MR index had a high accuracy for the detection of disease activity (area under the receiver operating characteristic (ROC) curve 0.891, sensitivity 0.81, specificity 0.89) and for the detection of ulcerative lesions (area under the ROC curve 0.978, sensitivity 0.95, specificity 0.91) in the colon and terminal ileum. CONCLUSION The accuracy of MR for detecting disease activity and assessing severity brings about the possibility of using MR as an alternative to endoscopy in the evaluation of ileocolonic Crohn's disease.
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Affiliation(s)
- J Rimola
- Department of Radiology, Hospital Clínic de Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
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Forner A, Rodríguez de Lope C, Reig M, Rimola J, Varela M. Diagnóstico precoz del cáncer primario de hígado: imagen versus genética. Rev esp enferm dig 2008; 100:423-9. [DOI: 10.4321/s1130-01082008000700008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Massuet A, Fernández S, Rimola J, Andreu FJ, Tortajada L, Sentís M. [Metaplastic carcinoma of the breast: magnetic resonance and radiophatologic correlation]. Radiologia 2006; 48:155-63. [PMID: 17058637 DOI: 10.1016/s0033-8338(06)73146-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To review our radiological experience in metaplastic carcinoma together with the clinical and histopathologic findings. METHODS AND MATERIALS Eight cases of histologically confirmed metaplastic carcinoma of breast were reviewed. Imaging findings from US, mammography and MRI, and immunohistochemistry results from preoperative biopsy were assessed. Conventional prognostic factors, chondral differentiation markers, striated and straight muscle markers, neural markers, cytokeratin, vimentin and intermediate filaments were determined. RESULTS Eight patients aged ranged from 41-72 years. Metaplastic carcinoma presented as a palpable nodule in five cases, as a nipple retraction in ones case, and was discovered as an incidental mammographic finding in two. Mammographic appearance was a round, high-density nodule, measuring 10-50 mm, with variable margins in seven patients. One had architectural distortion. In three there were calcifications. Skin and nipple retraction appeared in one. On sonographic examination nodules were ill defined and showed low heterogeneous echogenicity. On MRI, T2-weighted images showed a relatively well-defined mass with high signal intensity. In the dynamic study, all showed contrast uptake, with signal-time intensity curves similar to those of infiltrating carcinoma of the breast. Histopathologic study found one squamous-cell, one sarcomatous, three chondroid, one giant-cell, one spindle-cell, and one acantholytic carcinoma, all of which were of high histologic grade. CONCLUSIONS Metaplastic carcinoma should be included in the differential diagnosis of a nodule presenting with high density and variable margins on mammography, low heterogeneous echogenicity and ill defined margins on sonography, and hyperintense at T2 with malignant enhancement at MR. Immunohistochemical assessment is mandatory for the final diagnosis. The radiologist can suggest this particular subtype of tumour.
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Affiliation(s)
- A Massuet
- UDIAT, Centro Diagnóstico, Servicio de Radiodiagnóstico, Corporación Sanitaria del Parc Taulí, Sabadell, Barcelona, España.
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Abstract
Paroxysmal nocturnal haemoglobinuria (PNH) is a rare, acquired stem-cell disorder characterized by defective haematopoiesis, which results in an increased sensitivity of the erythrocytes to complement-mediated intravascular haemolysis. Renal damage is infrequent but can produce chronic renal failure due cortical deposits of haemosiderin and microvascular thrombosis. MRI provides characteristic images of the kidneys that enable haemosiderin deposition to be diagnosed; in PNH, MRI typically shows reversed renal cortex-medulla differentiation on T(1) weighted images and substantial loss of cortical signal intensity on both T(1) and T(2) weighted images. We describe the MRI findings of renal cortical haemosiderosis occurring in four patients with PNH.
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Affiliation(s)
- J Rimola
- Unitat de Diagnòstic per la Imatge d'Alta Tecnologia, Corporació Sanitària del Parc Taulí, 08208 Sabadell, Spain
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Abstract
We report on 8 years of imaging and clinical follow-up of a confirmed hepatic angiomyolipoma (AML) undergoing notable growth over this period. The tumor grew considerably in the first 5 years, and its growth especially affected the fatty component; in the last 3 years, growth occurred more slowly. Radiologists should be aware that tumor growth of a hepatic AML can occur.
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Affiliation(s)
- J Rimola
- Unitat de Diagnòstic per la Imatge d'Alta Tecnología, Corporació Sanitaria del Parc Taulf, Parc-Tauli s/n, 08208 Sabadell, Spain
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