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Commentary: diffusion-weighted magnetic resonance imaging - a novel way to assess disease activity in Crohn's disease? Authors' reply

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4. Oussalah A, Laurent V, Bruot O, et al. Diffusion-weighted magnetic resonance without bowel preparation for detecting colonic inflammation in inflammatory bowel disease. Gut 2010; 59: 1056–65.

5. Horsthuis K, Bipat S, Stokkers PCF, Stoker J. Magnetic resonance imaging for evaluation of disease activity in Crohn’s

disease: a systematic review. Eur Radiol 2009; 19: 1450–60.

6. Koh DM, Collins DJ. Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol 2007;188: 1622–35.

Commentary: diffusion-weighted magnetic

resonance imaging - a novel way to

assess disease activity in Crohn

’s

disease? Authors

’ reply

A. Buisson*

,†

& V. Petitcolin

*Department of Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Auvergne University, Clermont-Ferrand, France.

Microbes, Intestine, Inflammation and Susceptibility of the Host,

UMR Inserm/Auvergne University U1071, USC-INRA 2018, Clermont-Ferrand University, Clermont-Ferrand, France.

Department of Radiology, University Hospital Estaing of

Clermont-Ferrand, Clermont-Ferrand, France. E-mail: a_buisson@hotmail.fr

doi:10.1111/apt.12277

We thank Lambie and Tolan for their comment on our

article.

1, 2

As underscored by the authors, how to assess

Crohn’s disease (CD) activity or remission is a key point

in the era of biologics. To answer this question, the

emergence of new therapeutic goals, such as mucosal

healing or preventing digestive damage, have to be

con-sidered.

Although the CD Activity Index (CDAI) was the gold

standard to define clinical response or remission,

3

achieving these new goals warrant other tools for

moni-toring the therapeutic ef

ficacy. In this context,

biomar-kers and magnetic resonance imaging (MRI) appear as

very promising non-invasive tools. Contrary to

Hors-thuis’ meta-analysis,

4

the creators of the magnetic

reso-nance index of Activity (MaRIA) reported a very

high-diagnostic accuracy in differentiating active from inactive

segment

(

>0.8).

5

This

difference

could

be

partly

explained by the heterogeneity in de

fining disease

activ-ity or remission.

Although the performances of conventional or

diffu-sion weighted MRI are probably lower for the detection

of mild lesions,

4

we considered that it is not prejudicial

in monitoring therapeutic response. Is a patient with

persistent mild disease after treatment without ulceration

eligible for therapeutic optimisation? This is a key point

in the real-life setting. Though deep ulcers are correlated

with a more aggressive clinical course with an increased

rate of penetrating complications and surgery,

6

the

natu-ral history of mild lesions remains unknown.

As we focused on terminal ileal involvement, the

choice of the most active segment as endpoint seemed to

us appropriate. Though the apparent diffusion coefficient

(ADC) measurement could be improved by using

nor-malised measurements, polyethylene glycol in small

vol-ume is, in our experience, well-tolerated and DWI-MRI

seems an objective, reproducible, non time-consuming

and accurate tool in the assessment of CD activity.

ACKNOWLEDGEMENT

The authors

’ declarations of personal and financial

inter-ests are unchanged from those in the original article.

2

REFERENCES

1. Lambie H, Tolan D. Commentary: diffusion-weighted magnetic resonance imaging - a novel way to assess disease activity in Crohn’s disease? Aliment Pharmacol Ther 2013; 37: 833–4. 2. Buisson A, Joubert A, Montoriol P-F, et al. Diffusion-weighted

magnetic resonance imaging for detecting and assessing ileal inflammation in Crohn’s disease. Aliment Pharmacol Ther 2013; 37: 537–45.

3. Best WR, Becktel JM, Singleton JW, et al. Development of a Crohn’s disease activity index. National Cooperative Crohn’s Disease Study. Gastroenterology 1976;70: 439–44.

4. Horsthuis K, Bipat S, Stokkers PCF, et al. Magnetic resonance imaging for evaluation of disease activity in Crohn’s disease: a systematic review. Eur Radiol 2009;19: 1450–60.

5. Rimola J, Ordas I, Rodriguez S, et al. Magnetic resonance imaging for evaluation of Crohn’s disease: validation of parameters of severity and quantitative index of activity. Inflamm Bowel Dis 2011; 17: 1759–68.

6. Allez M, Lemann M, Bonnet J, et al. Long term outcome of patients with active Crohn’s disease exhibiting extensive and deep ulcerations at colonoscopy. Am J Gastroenterol 2002;97: 947–53.

834 Aliment Pharmacol Ther 2013; 37: 833-834

ª 2013 Blackwell Publishing Ltd

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