Optimizing patient management in crohn’s disease in a tertiary referral center: The impact of fast-track mri on patient management and outcomes

Akos Ilias, Barbara D. Lovasz, Lorant Gonczi, Zsuzsanna Kurti, Zsuzsanna Vegh, Liza D. Sumegi, Petra A. Golovics, Gabor Rudas, P. Lakatos

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background & Aims: Rapid optimization of treatment algorithms and disease outcomes requires an objective measurement of disease activity in patients with Crohn’s disease (CD). Our aim was to evaluate the impact of rapid-access to magnetic resonance imaging (MRI) on treatment optimization, clinical decision-making and outcomes for CD patients in a specialized tertiary care for inflammatory bowel disease (IBD) patients. Methods: A cohort of 75 referral CD patients (median age: 34, IQR: 25-43 years) who had underwent 90 fast-track MR enterography (MRE) scans between January 2014 and June 2016 were retrospectively enrolled. The MRI results were compared to clinical activity scores and biomarkers (C-reactive protein). The immediate impact of fast-track MRI on clinical decision-making, including changes in medical therapy, the need of hospitalization and surgery were evaluated. Results: The location of CD was ileo-colonic in 61% of the patients with perianal fistulas in 56% and previous surgeries in 55%. The indication for fast-track MRI scans was active disease (clinical or biomarker activity) in 55.6%. The radiological activity (including mild radiological signs to severe lesions) was detected in 94% of cases. Significant/severe MRI activity was depicted in 68% of these patients. Correlation between MRI radiological activity and clinical disease activity or colonoscopy was moderate (kappa: 0.609 and 0.652). A change in therapeutic strategy was made in 94.1% of cases with severe MRI radiological activity vs. 50% of patients without severe MRI radiological activity (p=0.001). Significant/severe MRI activity was followed by higher surgery rates among patients with clinical disease activity (50% vs. 12.5%; p=0.013). MRI performed on patients with clinical and biomarker remission identified disease activity in a significantly smaller proportion. Conclusions: Fast-track MRI had a great impact on patient management in CD patients with clinical or biomarker activity, leading to better patient stratification and faster optimization of the therapy (medical or surgical), while MRI revealed previously undiagnosed disease activity only in a small proportion of patients in clinical remission.

Original languageEnglish
Pages (from-to)391-397
Number of pages7
JournalJournal of Gastrointestinal and Liver Diseases
Volume27
Issue number4
DOIs
Publication statusPublished - Dec 1 2018

Fingerprint

Tertiary Care Centers
Crohn Disease
Magnetic Resonance Imaging
Biomarkers
Therapeutics
Tertiary Healthcare
Colonoscopy
Inflammatory Bowel Diseases
C-Reactive Protein
Fistula
Hospitalization
Referral and Consultation

Keywords

  • Clinical activity
  • Clinical outcom
  • Inflammatory bowel disease
  • Magnetic resonance imaging

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Optimizing patient management in crohn’s disease in a tertiary referral center : The impact of fast-track mri on patient management and outcomes. / Ilias, Akos; Lovasz, Barbara D.; Gonczi, Lorant; Kurti, Zsuzsanna; Vegh, Zsuzsanna; Sumegi, Liza D.; Golovics, Petra A.; Rudas, Gabor; Lakatos, P.

In: Journal of Gastrointestinal and Liver Diseases, Vol. 27, No. 4, 01.12.2018, p. 391-397.

Research output: Contribution to journalArticle

Ilias, Akos ; Lovasz, Barbara D. ; Gonczi, Lorant ; Kurti, Zsuzsanna ; Vegh, Zsuzsanna ; Sumegi, Liza D. ; Golovics, Petra A. ; Rudas, Gabor ; Lakatos, P. / Optimizing patient management in crohn’s disease in a tertiary referral center : The impact of fast-track mri on patient management and outcomes. In: Journal of Gastrointestinal and Liver Diseases. 2018 ; Vol. 27, No. 4. pp. 391-397.
@article{736f8a0e318f41f99d89170db5a99780,
title = "Optimizing patient management in crohn’s disease in a tertiary referral center: The impact of fast-track mri on patient management and outcomes",
abstract = "Background & Aims: Rapid optimization of treatment algorithms and disease outcomes requires an objective measurement of disease activity in patients with Crohn’s disease (CD). Our aim was to evaluate the impact of rapid-access to magnetic resonance imaging (MRI) on treatment optimization, clinical decision-making and outcomes for CD patients in a specialized tertiary care for inflammatory bowel disease (IBD) patients. Methods: A cohort of 75 referral CD patients (median age: 34, IQR: 25-43 years) who had underwent 90 fast-track MR enterography (MRE) scans between January 2014 and June 2016 were retrospectively enrolled. The MRI results were compared to clinical activity scores and biomarkers (C-reactive protein). The immediate impact of fast-track MRI on clinical decision-making, including changes in medical therapy, the need of hospitalization and surgery were evaluated. Results: The location of CD was ileo-colonic in 61{\%} of the patients with perianal fistulas in 56{\%} and previous surgeries in 55{\%}. The indication for fast-track MRI scans was active disease (clinical or biomarker activity) in 55.6{\%}. The radiological activity (including mild radiological signs to severe lesions) was detected in 94{\%} of cases. Significant/severe MRI activity was depicted in 68{\%} of these patients. Correlation between MRI radiological activity and clinical disease activity or colonoscopy was moderate (kappa: 0.609 and 0.652). A change in therapeutic strategy was made in 94.1{\%} of cases with severe MRI radiological activity vs. 50{\%} of patients without severe MRI radiological activity (p=0.001). Significant/severe MRI activity was followed by higher surgery rates among patients with clinical disease activity (50{\%} vs. 12.5{\%}; p=0.013). MRI performed on patients with clinical and biomarker remission identified disease activity in a significantly smaller proportion. Conclusions: Fast-track MRI had a great impact on patient management in CD patients with clinical or biomarker activity, leading to better patient stratification and faster optimization of the therapy (medical or surgical), while MRI revealed previously undiagnosed disease activity only in a small proportion of patients in clinical remission.",
keywords = "Clinical activity, Clinical outcom, Inflammatory bowel disease, Magnetic resonance imaging",
author = "Akos Ilias and Lovasz, {Barbara D.} and Lorant Gonczi and Zsuzsanna Kurti and Zsuzsanna Vegh and Sumegi, {Liza D.} and Golovics, {Petra A.} and Gabor Rudas and P. Lakatos",
year = "2018",
month = "12",
day = "1",
doi = "10.15403/jgld.2014.1121.274.ocm",
language = "English",
volume = "27",
pages = "391--397",
journal = "Journal of gastrointestinal and liver diseases : JGLD",
issn = "1841-8724",
publisher = "Romanian Society of Gastroenterology",
number = "4",

}

TY - JOUR

T1 - Optimizing patient management in crohn’s disease in a tertiary referral center

T2 - The impact of fast-track mri on patient management and outcomes

AU - Ilias, Akos

AU - Lovasz, Barbara D.

AU - Gonczi, Lorant

AU - Kurti, Zsuzsanna

AU - Vegh, Zsuzsanna

AU - Sumegi, Liza D.

AU - Golovics, Petra A.

AU - Rudas, Gabor

AU - Lakatos, P.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Background & Aims: Rapid optimization of treatment algorithms and disease outcomes requires an objective measurement of disease activity in patients with Crohn’s disease (CD). Our aim was to evaluate the impact of rapid-access to magnetic resonance imaging (MRI) on treatment optimization, clinical decision-making and outcomes for CD patients in a specialized tertiary care for inflammatory bowel disease (IBD) patients. Methods: A cohort of 75 referral CD patients (median age: 34, IQR: 25-43 years) who had underwent 90 fast-track MR enterography (MRE) scans between January 2014 and June 2016 were retrospectively enrolled. The MRI results were compared to clinical activity scores and biomarkers (C-reactive protein). The immediate impact of fast-track MRI on clinical decision-making, including changes in medical therapy, the need of hospitalization and surgery were evaluated. Results: The location of CD was ileo-colonic in 61% of the patients with perianal fistulas in 56% and previous surgeries in 55%. The indication for fast-track MRI scans was active disease (clinical or biomarker activity) in 55.6%. The radiological activity (including mild radiological signs to severe lesions) was detected in 94% of cases. Significant/severe MRI activity was depicted in 68% of these patients. Correlation between MRI radiological activity and clinical disease activity or colonoscopy was moderate (kappa: 0.609 and 0.652). A change in therapeutic strategy was made in 94.1% of cases with severe MRI radiological activity vs. 50% of patients without severe MRI radiological activity (p=0.001). Significant/severe MRI activity was followed by higher surgery rates among patients with clinical disease activity (50% vs. 12.5%; p=0.013). MRI performed on patients with clinical and biomarker remission identified disease activity in a significantly smaller proportion. Conclusions: Fast-track MRI had a great impact on patient management in CD patients with clinical or biomarker activity, leading to better patient stratification and faster optimization of the therapy (medical or surgical), while MRI revealed previously undiagnosed disease activity only in a small proportion of patients in clinical remission.

AB - Background & Aims: Rapid optimization of treatment algorithms and disease outcomes requires an objective measurement of disease activity in patients with Crohn’s disease (CD). Our aim was to evaluate the impact of rapid-access to magnetic resonance imaging (MRI) on treatment optimization, clinical decision-making and outcomes for CD patients in a specialized tertiary care for inflammatory bowel disease (IBD) patients. Methods: A cohort of 75 referral CD patients (median age: 34, IQR: 25-43 years) who had underwent 90 fast-track MR enterography (MRE) scans between January 2014 and June 2016 were retrospectively enrolled. The MRI results were compared to clinical activity scores and biomarkers (C-reactive protein). The immediate impact of fast-track MRI on clinical decision-making, including changes in medical therapy, the need of hospitalization and surgery were evaluated. Results: The location of CD was ileo-colonic in 61% of the patients with perianal fistulas in 56% and previous surgeries in 55%. The indication for fast-track MRI scans was active disease (clinical or biomarker activity) in 55.6%. The radiological activity (including mild radiological signs to severe lesions) was detected in 94% of cases. Significant/severe MRI activity was depicted in 68% of these patients. Correlation between MRI radiological activity and clinical disease activity or colonoscopy was moderate (kappa: 0.609 and 0.652). A change in therapeutic strategy was made in 94.1% of cases with severe MRI radiological activity vs. 50% of patients without severe MRI radiological activity (p=0.001). Significant/severe MRI activity was followed by higher surgery rates among patients with clinical disease activity (50% vs. 12.5%; p=0.013). MRI performed on patients with clinical and biomarker remission identified disease activity in a significantly smaller proportion. Conclusions: Fast-track MRI had a great impact on patient management in CD patients with clinical or biomarker activity, leading to better patient stratification and faster optimization of the therapy (medical or surgical), while MRI revealed previously undiagnosed disease activity only in a small proportion of patients in clinical remission.

KW - Clinical activity

KW - Clinical outcom

KW - Inflammatory bowel disease

KW - Magnetic resonance imaging

UR - http://www.scopus.com/inward/record.url?scp=85058836859&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85058836859&partnerID=8YFLogxK

U2 - 10.15403/jgld.2014.1121.274.ocm

DO - 10.15403/jgld.2014.1121.274.ocm

M3 - Article

C2 - 30574621

AN - SCOPUS:85058836859

VL - 27

SP - 391

EP - 397

JO - Journal of gastrointestinal and liver diseases : JGLD

JF - Journal of gastrointestinal and liver diseases : JGLD

SN - 1841-8724

IS - 4

ER -