Levels of Faecal Calprotectin and Magnetic Resonance Enterocolonography Correlate with Severity of Small Bowel Crohn’s Disease: A Retrospective Cohort Study

Abstract

Few studies have evaluated the usefulness of fecal calprotectin (FC) or magnetic resonance enterography (MRE) in diagnosing active Crohn’s disease (CD) of the small bowel. In the study, we investigated the reliability of FC and MRE in assessing the activity of ileal CD and further explored the relationship between levels of FC and MRE scores. A total of 221 patients were diagnosed with ileal or ileo-colitis CD in our department between July 2012 and October 2016. The global magnetic resonance index of activity (MaRIA) correlated with the simple endoscopic score for CD (SES-CD) (r = 0.527, P = 0.005). When analysed segment-by-segment, a significant correlation was still observed (r = 0.590, P < 0.001). The SES-CD correlated closest with FC (r = 0.503), followed by CRP (r = 0.461), ESR (0.377) and the CDAI (r = 0.320). In receiver operating characteristic (ROC) analyses, the FC cut-off value of mucosal healing was 213.1 μg/g, with 76.1% sensitivity and 66.7% specificity. As for MaRIA, a cut-off value of 6.8 for each segment provided a sensitivity of 100% and a specificity of 79.2%. No agreement between MaRIA and FC levels was found. In conclusion, a combination of FC levels and MaRIA could be effective in monitoring mucosal activity in patients with small bowel CD.

Magnetic Resonance Enterography, Colonoscopy, and Fecal Calprotectin correlate in colonic Crohn’s Disease

“…Multiple investigators have explored the range of FCP levels which most accurately reflects mucosal inflammation that range from 50 to 250 ug/mL [7][8][9][10][11][12]. While several prior studies have used FCP levels below 250 ug/mL [7][8][9][10][11], we confirmed that the FCP cutoff value of 250 ug/mL significantly correlated with the presence of active disease and severity of inflammation confirmed by both MRE and colonoscopy, respectively. This FCP cutoff value, which is in line with the Colombel et al…”

“…The median CDEIS was 22 with a range of 6 to 38; median MaRIA was 22.5 with a range of 5 to 30. FCP, MRE, and Crohn's Disease activity but in the small bowel, not the colon, as in this study [10][11][12].…”

“…Another limitation is the lack of validation of the results of our study in different clinical settings or different cohorts. It has been established that the diagnostic accuracies of FCP in colonic CD are generally considered to be different than those of small bowel CD; mucosal inflammation in the colon elevates FCP levels higher than mucosal inflammation in the small bowel [8][9][10][11][12][13][14][15].…”

“…The biomarker, FCP, is a heat stable granulocyte-derived protein that is released by activated neutrophils of the intestinal immune system in response to inflammation and then absorbed into feces [2]. Numerous studies have shown that FCP levels correlate well with intestinal inflammation with high levels of sensitivity and specificity [7][8][9][10][11][12]. Colombel et al, in one of the largest trials of tight control management of patients' with CD, established a FCP level of 250 mg/g or greater as abnormally elevated [13].…”

A review of magnetic resonance enterography-based indices for quantification of Crohn’s disease inflammation

“…Moy and colleagues 59 reassured previous results, however, their study differ in design and goals and did not assess MRE response to therapy but rather the ability to detect mucosal healing. Ye and colleagues 44 determined a cutoff value of 6.8 for detection of mucosal healing [area under the curve (AUC) 0.881, sensitivity 100%, specificity 79.2%] however they used a different value of SES-CD for mucosal healing as a standard reference.…”