Crohn Disease
Conditions
Brief summary
Chronic inflammatory bowel disease (IBD) is a disabling, incurable condition that affects 250,000 people in France, and Crohn's disease (CD) is the most common form. CD progresses, in one-quarter of the cases, towards the appearance of intestinal stenosis, most often on the terminal ileum, sometimes with obstructive symptoms and requiring an optimization of medical treatment (biotherapies) and/or surgery The hypothesis of this study is \[18F\]FDG PET /CT, (Positron emission tomography with the tracer fluorine-18 (18F) fluorodeoxyglucose (FDG), called \[18F\]FDG PET coupled to a dedicated CT scanner) could help quantify intestinal inflammation in patients with abnormal entero-MRI, and differentiate inflammation and fibrosis on a joint PET /CT and MRI , in patients with complicated Crohn Disease intestinal stenosis
Detailed description
Intestinal inflammation could be quantified by the PET/CT due to the tropism of a PET tracer, \[18F\]FDG for activated inflammatory cells. \[18F\]FDG PET/CTperformed on latest digital PET/CT cameras and recordings focused on the abdomen could help quantify intestinal inflammation in patients with abnormal entero-MRI, and differentiate inflammation and fibrosis on a joint PET/CT and MRI , in patients with complicated Crohn Disease intestinal stenosis. Magnetic resonance imaging (MRI) indices are used to assess the upgradability and activity of CD and try to predict response to treatment, in particular Nancy's MRI score for digestive inflammation. An inflammation index (FILM-i) and a fibrosis index (FILM-f), based on this MRI/PET analysis, will be developed and validated to develop personalized medicine in patients with stenosing CD. Indeed, these indices will guide the therapeutic choice, in particular for the biotherapies prescription or the need to operate these patients.
Interventions
DIAGNOSTIC_TESTabdominal [18F]FDG PET/CT
Patients will have within a maximum period of 15 days before the surgery (resection of intestinal stenosis), records by MRI and by digital PET/CT with low injected activity of \[18F\]FDG, focused on the abdomen, the MRI will be performed maximum 30 days before the intervention (if available and performed according to the procedure for the study, it will not be repeated for the study).
Sponsors
Central Hospital, Nancy, France
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Intervention model description
Patient with stenosing CD and for which the surgical resection of one or more stenosis (s) of the terminal ileum is programmed as part of the treatment.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Major subject having received complete information of the clinical research and having signed their informed consent * Subject with a stenosing CD (objectified on MRI, CT and / or endoscopy). * Subject for which surgical resection of one or more stenosis (s) of the terminal ileum is programmed as part of the treatment. * Subject with a social security scheme
Exclusion criteria
* Subject having a contraindication to performing MRI and / or PET / CT at 18F-FDG. * Subject with an ostomy * Diabetic subject treated by metformin. * Subject referred to in articles L. 1121-5, L. 1121-7 and L1121-8 of the public health code. * Pregnant woman, parturient or nursing mother. * Subject with a legal protection measure (guardianship, curatorship, safeguard of justice). * Subject unable to express consent. * Subject deprived of their liberty by a judicial or administrative decision, persons subject to psychiatric care under articles L. 3212-1 and L.3213-1.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Index FILM-i | Day 45 | Index FILM-i will be developed using histological scores determined according to the extent and the diffusion in the thickness of the intestinal wall: cellular infiltration and edema These histological scores both include 4 grades: * 0 = no damage (fibrosis or inflammation), * 1 = slight damage, * 2 = average achievement, * 3 = severe damage. The FILM-i indice is developed in order to predict these same 4 grades. |
| Index FILM-f | Day 45 | Index FILM-f will be developed using histological scores determined according to the extent and the diffusion in the thickness of the intestinal wall : collagen fibrosis These histological scores both include 4 grades: * 0 = no damage (fibrosis or inflammation), * 1 = slight damage, * 2 = average achievement, * 3 = severe damage. The FILM-i indice is developed in order to predict these same 4 grades. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Contribution of [18F]FDG PET/CT with index NET (Net Reclassification Index) | Day 45 | Quantify the contribution of \[18F\]FDG PET/CT, in addition to MRI, for the characterization of the fibrotic and inflammatory components of stenosis of the terminal ileum with the index NET. This index will be calculated to quantify the contribution of PET items to the model including only MRI items. |
| To compare the performance of the inflammation index (FILM-i) with that of a baseline MRI score, the Nancy score, for the detection of significant colonic inflammation (moderate to severe in histopathology). | Day 45 | The performance of the FILM-i index and Nancy's score will be evaluated by the of correctly classified segments. |
| Inter- and intra-observer reproducibility | Day 45 | To estimate the inter- and intra-observer reproducibility of the 4 grade classifications obtained by the FILM-i and FILM-f indices with the intra-class correlation coefficients. |
| Degree of correlation between FILM-i and FILM-f index and the modified histological activity score of the Global Histologic Activity Score (GHAS). | Day 45 | Compare the results of index and modified GHAS score |
Contacts
Primary ContactMarine CLAUDIN, MD
Backup ContactVeronique ROCH, MSc
Outcome results
None listed