Su1174 The Use of Magnetic Resonance Enterography for Diagnosis and Monitoring of Inflammatory Bowel Disease in Clinical Practice

Abstract

end points were time to surgery and time to tx failure (defined as either need for surgery, biologic therapy stopped or switched due to lack of efficacy or adverse events).Specific MRE findings ; 1. penetrating complications e.g fistulae, 2. Small bowel stenosis (SBS) +/dilatation, 3. Small bowel wall thickening (SBWT) and 4. Relative contrast enhancement (RCE) were then correlated to primary and secondary end points. RESULTS: In total,353 patients were commenced on aTNFtx for CD(182 adalimumab and 171 infliximab).Of these 54 patients had an MRE prior to commencing aTNFtx(23 infliximab;31 adalimumab).The median time from MRE to aTNFtx was 66.2 days (+/58.4). 13/54(24.1%) had surgery within the following year due to tx failure.The proportion of patients with SBS on MRE was significantly greater in those who went on to have surgery within 1 year;10/13 (76.9%) vs 3/ 41(7.3%)respectively (chi-square p,0.001).The frequency of penetrating complications, SBWT and RCE was not significantly different in the group who required early surgery.Time to surgery was significantly shorter in patients with SBS on MRE (log rank p=0.001).34 patients were defined as tx responders vs 20 who experienced tx failure. In a multivariate analysis using cox proportional hazards model, the MRE variables independently associated with time to tx failure were SBS (p ,0.001, hazard ratio 17.9, 95% CI 4.5-71.4) and penetrating complications (p,0.027, hazard ratio 14.5 95% CI 1.4-155.3) . CONCLUSION: The presence of SBS on MRE can help predict need for early surgery and is associated with tx failure in patients who commence aTNFtx. These findings demonstrate the utility of MRE in planning tx and suggest that aTNFtx may be more effective when commenced early in disease course, prior to onset of fibrostenotic or penetrating complications.