MR enterography and intestinal ultrasound improves patient care and management of Crohn’s disease
Each year in the UK at least 115,000 people are diagnosed with Crohn’s disease (CD). Radiological imaging is fundamental to managing CD but exposes patients to x-rays which increase cancer risk. UCL/UCLH research has improved how patients are diagnosed and monitored internationally. Professor Stuart Taylor’s work has changed NHS practice, and tests using x-rays are now being replaced by cost-effective, well-tolerated alternatives, potentially preventing around 25-30 radiation-induced cancers per year.
CD is a chronic inflammatory bowel disease, requiring lifelong medical and surgical therapy. Imaging tests such as CT scanning are used to diagnose and monitor patients but can expose patients to significant doses of x-rays, increasing cancer risk in these predominantly young patients.
To evaluate safer alternatives, the UCLH-BRC funded Taylor to lead a large multicentre trial testing the diagnostic accuracy and patient satisfaction of MR enterography (MRE - a specialised MRI of the bowel) and intestinal ultrasound (US), neither of which use x-rays(1).
The METRIC study (2013-2016), commissioned by the NIHR, was a formal collaboration between UCL and the NHS, involving almost 300 patients and running at 8 hospitals and 4 NIHR BRCs. METRIC found that both MRE and US achieve high accuracy for localising small bowel CD, were cost effective, and well tolerated by patients(2).
The findings led to changes in clinical guidelines by the British Society of Gastroenterology and European Crohns and Colitis Organisation, which both now recommend MRE and US as first line tests in CD. The charity IBD UK includes test access in their national service benchmarking tool. As a result, MRE use in the NHS has increased by 79% in the last 6 years and tests using x-rays have fallen by 63%, reducing the incidence of diagnostic radiation induced cancer.
The UCLH-BRC team, including Dr Alex Menys who completed a BRC funded PhD in 2014, has also developed imaging software using MRE to assess early treatment responses(3). The technology has now been rolled out via a spin-out company Motilent as an EU-approved product – GI Quant – across 7 NHS sites.
National and International clinical guidelines now recommend MRE to monitor response to treatment in people with CD, including in clinical trials.
References:
1. Taylor SA et al. Lancet Gastroenterolo & Hepatolo, 2018
2. Miles A et al. Eur radiol, 2019
3. Menys A et al. Radiology, 2018
