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5 minutes! Join us! #AJRChat

Tonight we are joined by two authors of the article, Nadeen Abu Ata and Jonathan Dillman, as well as our #AJRChat moderators Christine Boone, MD, PhD and Cynthia Czawlytko, MD.

AJR Hi everyone, thanks for attending and thank you #AJR radiology #CBoonie_nanoIR and #DrCyncity for the invitation. #AJRChat

First time on an #AJRChat? Here's what you should know:

Q1. What aspect of the inflammatory process in Crohn disease do imaging-based blood flow measures most likely reflect? #AJRChat

AJR A1: We believe SMA / SMV blood flow measurements relate to histologic active inflammation in the bowel wall… sort of a quant measurement that likely correlates with enhancement / vasa recta engorgement, but NO IV contrast. #AJRChat

Q2. What imaging factors are included in the MR index of activity (MaRIA) score? Did any of these consistently improve with treatment?

Christine Boone, MD, PhD AJR Nadeen Abu Ata Yes... changes over cardiac cycle, especially SMA... cardiac cycle flow is then extrapolate to ml per min... blood flow decreases quickly w treatment in most #crohns pts

Cynthia Czawlytko, MD AJR The same preparation needed for MRE. #AJRChat

Q3. Was there any relationship between normalized flow at the SMA and SMV pre and post treatment in patients with Crohn disease? #AJRChat

AJR Both normalized (to abd aorta) SMA and SMV blood flow measurements decreased following biologic treatment, with decreases seen as early as 6 weeks in some patients! SMA and SMV measurements are correlated and both behaved pretty similarly and may well be interchangeable #AJRChat

Cynthia Czawlytko, MD AJR Nadeen Abu Ata Consistent npo status is likely critical... oral contrast prep is not necessary as not evaluating bowel directly

AJR A3: Both normalized (to abd aorta) SMA and SMV blood flow measurements decreased following biologic treatment, with decreases seen as early as 6 wks in some patients! SMA and SMV measurements are correlated and both behaved pretty similarly & may well be interchangeable #AJRChat

Q4. What are potential benefits of this technique as a noninvasive quantitative marker of inflammation? What are potential disadvantages? #AJRChat

AJR A4: Benefits: •Quantitative •No IV contrast material •Reproducible with near-perfect inter-operator agreement •Dynamic, changing over time #AJRChat

AJR Nadeen Abu Ata ???

AJR A4: Potential disadvantages: - Added time to MR exam (only 1 min 19 on average) - Increased blood flow not specific for CD - SMA/SMV measurements don’t capture changes in blood flow to colon /rectum, as these bowel segments are supplied /drained by different vasculature #AJRChat

AJR We think it is a promising method to quantify blood flow, reproducible with great inter reader agreement! #AJRchat

AJR Thank you both for participating in #AJRChat and discussing your innovative approach to evaluating inflammation in Crohns Disease—and potentially an approach to evaluate other inflammatory diseases of the GI tract.

Thank you! Tan-Lucien Mohammed, MD, FACR