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Sunday Poster Session

Category: IBD

P0944 - A Systematic Review and Methodological Assessment of Radiological Features and MRI-Based Activity Indices Used to Define Healing in Perianal Fistulizing Crohn’s Disease (pfCD) According to COSMIN Guidelines

Sunday, October 27, 2024
3:30 PM – 7:00 PM ET
Location: Exhibit Hall E
Has Audio

    Presenting Author(s)

  • Jalpa Devi, MD

    Washington University School of Medicine in St. Louis
    Saint Louis, MO

Jalpa Devi, MD1, Easan R. Anand, MBBS, MA, MRCS2, Ailsa Hart, PhD3, Philip Lung, MD4, Phil Tozer, MBBS, MD5, David Ballard, MD1, Parakkal Deepak, MBBS, MS6
1Washington University School of Medicine in St. Louis, St. Louis, MO; 2Fistula Research Unit, St. Mark’s National Bowel Hospital, London, England, United Kingdom; 3St. Mark’s Hospital and Imperial College, London, England, United Kingdom; 4St. Mark’s Academic Institute, London, England, United Kingdom; 5St. Mark’s Hospital, London, England, United Kingdom; 6Washington University in St. Louis, St. Louis, MO

Introduction: Clinical trials in pfCD increasingly use MRI criteria as a primary endpoint but there is heterogeneity in the radiological definition of a healed fistula. We aim to systematically review radiological variables used to define fistula healing in observational and interventional studies in pfCD.

Methods: The electronic bibliographic databases MEDLINE, Embase, and Scopus were searched using a comprehensive strategy to identify research in pfCD from 1990–2023. The review was conducted according to PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The protocol was prospectively registered on PROSPERO (CRD42024504334). MRI-based indices used to score fistula severity/healing were assessed for their methodological quality using the COSMIN checklist.

Results: 118 full-text studies were assessed for eligibility. There were 46 different definitions of healing used. The three most frequently used variables to define fistula healing on MRI were the absence of collections, the absence of T2 Hyperintensity, and fibrosis of the fistula tract. There were 5 MRI-based activity indices identified in the literature. Of these, the MAGNIFI-CD index in adults and the PEMPAC index for children displayed moderate quality evidence in the key domains of reliability, validity, and responsiveness.

Discussion: The healing of fistulas on MRI is contentious and poorly defined. In this systematic review, we identified the variables most frequently used to define the radiological healing of fistulas on MRI. Further work is required to determine the precise definition of healing and the most appropriate MRI-based activity index for use in pfCD. Our next step is the Delphi consensus. We have invited 105 participants from around the world for the first survey.

Figure: Summary of Results & Next Steps


Disclosures:
Jalpa Devi indicated no relevant financial relationships.
Easan Anand indicated no relevant financial relationships.
Ailsa Hart: AbbVie – Advisory Committee/Board Member, Consultant, Speakers Bureau. Atlantic Pharmaceuticals – Advisory Committee/Board Member, Consultant, Speakers Bureau. Bristol Myers Squibb – Advisory Committee/Board Member, Consultant, Speakers Bureau. Celltrion – Advisory Committee/Board Member, Consultant, Speakers Bureau. Dr. Falk Pharma – Advisory Committee/Board Member, Consultant, Speakers Bureau. Ferring – Advisory Committee/Board Member, Consultant, Speakers Bureau. Genentech – Global Steering Committee. Janssen – Advisory Committee/Board Member, Consultant, Speakers Bureau. MSD – Advisory Committee/Board Member, Consultant, Speakers Bureau. Napp Pharmaceuticals – Advisory Committee/Board Member, Consultant, Speakers Bureau. Pfizer – Advisory Committee/Board Member, Consultant, Speakers Bureau. Pharmacosmos – Advisory Committee/Board Member, Consultant, Speakers Bureau. Shire – Advisory Committee/Board Member, Consultant, Speakers Bureau. Takeda – Advisory Committee/Board Member, Consultant, Speakers Bureau.
Philip Lung indicated no relevant financial relationships.
Phil Tozer indicated no relevant financial relationships.
David Ballard: Merck – Consultant.
Parakkal Deepak: AbbVie – Consultant, Grant/Research Support. Alimentiv – Grant/Research Support. Arena Pharmaceuticals – Grant/Research Support. Boehringer Ingelheim – Grant/Research Support. Bristol Myers Squibb-Celgene – Advisory Committee/Board Member, Grant/Research Support. CorEvitas LLC – Consultant. Janssen – Grant/Research Support. Pfizer – Grant/Research Support. Prometheus Biosciences – Grant/Research Support. Roche/Genentech – Advisory Committee/Board Member. Scipher Medicine – Grant/Research Support. Takeda – Grant/Research Support.


Jalpa Devi, MD1, Easan R. Anand, MBBS, MA, MRCS2, Ailsa Hart, PhD3, Philip Lung, MD4, Phil Tozer, MBBS, MD5, David Ballard, MD1, Parakkal Deepak, MBBS, MS6. P0944 - A Systematic Review and Methodological Assessment of Radiological Features and MRI-Based Activity Indices Used to Define Healing in Perianal Fistulizing Crohn’s Disease (pfCD) According to COSMIN Guidelines, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.