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P220 Faecal calprotectin and ileal Crohn's disease: correlation with a small bowel MRI score for disease activity
S154 a cut off value of 244, FC had a 74% sensitivity and 52% specificity for predicting moderate/severe histological disease. The corresponding values for CRP >6 were 70% and 67%.
Poster presentations FC, studies where the radiologists reported upper GI or colonic inflammation were excluded (27/119). Results: 150 SBMRI scans were re-evaluated from 123 patients with purely ileal Crohn’s (Montreal L1, n = 109; L3 + previous panproctocolectomy, n = 14; 65% female; median age at MRI 45 years (IQR 32 56); median follow-up 34 months (IQR 25 44). The median (IQR) FC was 80 mg/g (20 142) where SBMRI demonstrated no active ileal disease (simple MRI score = 0, n = 38), 198 mg/g (120 444) for mild to moderate (1 6, n = 30) and 398 m/g (168 771) for severe disease (>6, n = 24) (p < 0.001). ROC analysis showed an AUC of 0.81 (0.72 0.90) for FC which was significantly higher than for CRP (0.65 [0.53 0.77], p = 0.020) (Figure 1).
Graph: Calprotectin vs histology score.
In 109 Crohn’s disease (CD) patients, the median FC for the histology scores; 0, 1, 2, 3 were; 85, 175, 644 and 4144, respectively (graph). The corresponding medians for CRP were; 8, 10, 14 and 100. There were highly significant FC differences between the different histology groups (c2 = 62.5, p < 0.0001), while CRP just reached significance (c2 = 9.5, p = 0.02). With a cut-off value of 250, FC had a 90% sensitivity and 82% specificity for predicting moderate/severe disease. The corresponding values for CRP >6 were 72% and 43%. Conclusions: In IBD, FC was strongly predictive of histological disease and with a FC cut off level of ~250 mg/g gave high levels of sensitivity and moderate specificity for predicting moderate to severe disease. FC showed greater accuracy in CD than in UC and also performed better than CRP. This study highlights the importance of FC as a valuable, non-invasive marker for measuring disease activity in IBD, and may be predictive of disease remission and relapse. P220 Faecal calprotectin and ileal Crohn’s disease: correlation with a small bowel MRI score for disease activity F. Fascì-Spurio1,2 *, N.A. Kennedy1,3 *, L. Wong4 , P. MacLean4 , J. Satsangi1,3 , S. Glancy4 , C.W. Lees1,3 . 1 Western General Hospital, Gastrointestinal Unit, Edinburgh, United Kingdom, 2 Sapienza University, Gastroenterology Unit, Rome, Italy, 3 University of Edinburgh, Gastrointestinal Unit, Centre for Genomic and Experimental Medicine, Edinburgh, United Kingdom, 4 Western General Hospital, Department of Radiology, Edinburgh, United Kingdom Background: Small bowel MRI (SBMRI) is the current standard for assessing ileal inflammation in Crohn’s disease. Faecal calprotectin (FC) is closely correlated with colonic inflammation, but is thought to be of less utility in ileal disease. Interpretation of existing data linking FC with SBMRI findings have been confounded by the presence of colonic inflammation. We therefore aimed to ascertain how FC best reflects MRI findings exclusively in the small bowel. Methods: 150 SBMRI studies with matched FC results (±30 days) were identified from the Edinburgh FC Register (2008 12; n = 18,138). Scans were entered into an anonymous ‘teaching’ list on PACS and each re-read independently by 2 expert GI radiologists blind to all clinical and lab data. Technical, quality and disease parameters were recorded onto standard proformas. Scans rated by one or other radiologist as being of poor quality were excluded (n = 31/150). 7/13 disease parameters were excluded due to poor inter-observer variability (Cohen’s kappa <0.5). A 6 item simple MRI score (range 0 10) was derived from assessment of the worst segment (bowel wall thickness, oedema, and relative enhancement, mesenteric oedema and pre-stenotic dilatation) plus total disease extent (overall kappa = 0.85). For comparisons with
Figure 1. ROC curves for abnormal ileum on small bowel MRI scan against various laboratory parameters.
Conclusions: FC correlates closely with SBMRI findings in ileal Crohn’s disease and outperforms other laboratory tests. In future, following validation, we will derive clinical useful MRI and FC cut-offs that predicate on important patient outcomes. P221 Faecal calprotectin concentrations in Crohn’s patients with ileal disease location: correlations with disease activity as seen by MRI enterography F. Fascì-Spurio1 *, A. Chiappini1 , V. Buonocore2 , S. Cannizzaro1 , Z. Maddalena1 , F. Maccioni2 , P. Vernia1 . 1 Sapienza University, Gastroenterology Unit, Policlinico Umberto I, Rome, Italy, 2 Sapienza University, Radiology Department, Policlinico Umberto I, Rome, Italy Background: Faecal Calprotectin (FC) is considered a reliable marker of disease activity in IBD. While its correlation with colonic inflammation has clearly been established, its correlation with ileal inflammation has never been thoroughly investigated and its clinical reliability in patients with ileal CD remains controversial. As MRI enterography is considered of prime importance for assessing disease activity in patients with ileal CD, aim of the present study has been to investigate the correlation between MRI findings and FC. Methods: A series of consecutive patients with known CD referred for MRI enterography at a single institution between December 2010 and June 2013 were prospectively recruited.
Poster presentations FC, studies where the radiologists reported upper GI or colonic inflammation were excluded (27/119). Results: 150 SBMRI scans were re-evaluated from 123 patients with purely ileal Crohn’s (Montreal L1, n = 109; L3 + previous panproctocolectomy, n = 14; 65% female; median age at MRI 45 years (IQR 32 56); median follow-up 34 months (IQR 25 44). The median (IQR) FC was 80 mg/g (20 142) where SBMRI demonstrated no active ileal disease (simple MRI score = 0, n = 38), 198 mg/g (120 444) for mild to moderate (1 6, n = 30) and 398 m/g (168 771) for severe disease (>6, n = 24) (p < 0.001). ROC analysis showed an AUC of 0.81 (0.72 0.90) for FC which was significantly higher than for CRP (0.65 [0.53 0.77], p = 0.020) (Figure 1).
Graph: Calprotectin vs histology score.
In 109 Crohn’s disease (CD) patients, the median FC for the histology scores; 0, 1, 2, 3 were; 85, 175, 644 and 4144, respectively (graph). The corresponding medians for CRP were; 8, 10, 14 and 100. There were highly significant FC differences between the different histology groups (c2 = 62.5, p < 0.0001), while CRP just reached significance (c2 = 9.5, p = 0.02). With a cut-off value of 250, FC had a 90% sensitivity and 82% specificity for predicting moderate/severe disease. The corresponding values for CRP >6 were 72% and 43%. Conclusions: In IBD, FC was strongly predictive of histological disease and with a FC cut off level of ~250 mg/g gave high levels of sensitivity and moderate specificity for predicting moderate to severe disease. FC showed greater accuracy in CD than in UC and also performed better than CRP. This study highlights the importance of FC as a valuable, non-invasive marker for measuring disease activity in IBD, and may be predictive of disease remission and relapse. P220 Faecal calprotectin and ileal Crohn’s disease: correlation with a small bowel MRI score for disease activity F. Fascì-Spurio1,2 *, N.A. Kennedy1,3 *, L. Wong4 , P. MacLean4 , J. Satsangi1,3 , S. Glancy4 , C.W. Lees1,3 . 1 Western General Hospital, Gastrointestinal Unit, Edinburgh, United Kingdom, 2 Sapienza University, Gastroenterology Unit, Rome, Italy, 3 University of Edinburgh, Gastrointestinal Unit, Centre for Genomic and Experimental Medicine, Edinburgh, United Kingdom, 4 Western General Hospital, Department of Radiology, Edinburgh, United Kingdom Background: Small bowel MRI (SBMRI) is the current standard for assessing ileal inflammation in Crohn’s disease. Faecal calprotectin (FC) is closely correlated with colonic inflammation, but is thought to be of less utility in ileal disease. Interpretation of existing data linking FC with SBMRI findings have been confounded by the presence of colonic inflammation. We therefore aimed to ascertain how FC best reflects MRI findings exclusively in the small bowel. Methods: 150 SBMRI studies with matched FC results (±30 days) were identified from the Edinburgh FC Register (2008 12; n = 18,138). Scans were entered into an anonymous ‘teaching’ list on PACS and each re-read independently by 2 expert GI radiologists blind to all clinical and lab data. Technical, quality and disease parameters were recorded onto standard proformas. Scans rated by one or other radiologist as being of poor quality were excluded (n = 31/150). 7/13 disease parameters were excluded due to poor inter-observer variability (Cohen’s kappa <0.5). A 6 item simple MRI score (range 0 10) was derived from assessment of the worst segment (bowel wall thickness, oedema, and relative enhancement, mesenteric oedema and pre-stenotic dilatation) plus total disease extent (overall kappa = 0.85). For comparisons with
Figure 1. ROC curves for abnormal ileum on small bowel MRI scan against various laboratory parameters.
Conclusions: FC correlates closely with SBMRI findings in ileal Crohn’s disease and outperforms other laboratory tests. In future, following validation, we will derive clinical useful MRI and FC cut-offs that predicate on important patient outcomes. P221 Faecal calprotectin concentrations in Crohn’s patients with ileal disease location: correlations with disease activity as seen by MRI enterography F. Fascì-Spurio1 *, A. Chiappini1 , V. Buonocore2 , S. Cannizzaro1 , Z. Maddalena1 , F. Maccioni2 , P. Vernia1 . 1 Sapienza University, Gastroenterology Unit, Policlinico Umberto I, Rome, Italy, 2 Sapienza University, Radiology Department, Policlinico Umberto I, Rome, Italy Background: Faecal Calprotectin (FC) is considered a reliable marker of disease activity in IBD. While its correlation with colonic inflammation has clearly been established, its correlation with ileal inflammation has never been thoroughly investigated and its clinical reliability in patients with ileal CD remains controversial. As MRI enterography is considered of prime importance for assessing disease activity in patients with ileal CD, aim of the present study has been to investigate the correlation between MRI findings and FC. Methods: A series of consecutive patients with known CD referred for MRI enterography at a single institution between December 2010 and June 2013 were prospectively recruited.