A quantitative MRI-based measure of small bowel motility changed gastroenterologists' assessment of treatment response in nearly half of patients with small bowel Crohn's disease, according to a prospective, observational multicenter study published in Journal of Crohn's and Colitis.
In 120 of 253 patients (47%), treating gastroenterologists changed their impression of disease status by at least one category after reviewing the motility score; in 55 patients (22%), the added information reversed the overall assessment between improvement and deterioration.
The tool, GIQuant (Motilent), generates a numeric score of bowel-wall motion from cine magnetic resonance enterography (MRE). Reduced small bowel motility reflects inflammatory activity, and a return of peristalsis may serve as an objective marker of treatment response, the authors wrote. Objective motility assessment “may have a valuable role to play in personalised patient care,” wrote corresponding author Alex Menys, PhD, of Motilent and University College London, London, and colleagues.
The CONTEXT study enrolled 253 patients (61% male) with known or suspected small bowel Crohn's disease at six U.K. centers. Each underwent paired MRE scans a median of 10.4 months apart (range 2 to 36 months) while receiving or starting therapy. Twelve gastroenterologists first graded each patient's change in status on a six-point scale using standard clinical information — symptoms, blood tests, fecal calprotectin, endoscopy and conventional imaging reports — then repeated the assessment after being shown the GIQuant score and its change over time. The study was observational, with no randomization and no requirement that clinicians alter management.
The score tracked clinical response. Among the 147 patients judged responders on standard tests, the median GIQuant score rose from 123 to 163 — a 32% increase (P < .001). In the 106 non-responders, scores were essentially unchanged, decreasing by 2 units (P = .9).
“GIQuant as a measure of motility MRI demonstrated robust utility to track the response of small bowel Crohn's activity to therapeutic intervention across time points,” the authors wrote. They described the analysis as, to their knowledge, the first time such an approach had been used to evaluate an imaging biomarker.
Despite the frequent shifts in impression, there were no reported changes in treatment plans, because the protocol did not require management changes. “Treatment changes come from confidence, confidence comes from use and use from availability,” the authors wrote, adding that the findings support future interventional trials as part of a treat-to-target approach. Positioning the score against the growing use of intestinal ultrasound (IUS), they wrote that “GIQuant is a clinically available step that shows how MRI, as a tool, will differentiate itself and ideally complement tests like IUS.”
The authors noted several limitations. The study measured clinicians' impressions rather than patient outcomes, and gastroenterologists were not instructed to change management based on the score. The cohort was enriched for patients with small bowel disease undergoing treatment assessment, interobserver agreement among the participating gastroenterologists was not evaluated, and part of the study took place during the COVID-19 pandemic, which may have influenced clinical practice.
Menys reported employment by and share ownership in Motilent, which makes GIQuant, and served as the study's funding principal investigator; two coauthors are Motilent employees, and senior author Stuart Taylor reported holding Motilent shares. Senior author Gordon Moran reported consulting and speaker fees from multiple pharmaceutical companies. The study was funded by the U.K. National Institute for Health and Care Research.