Can Conventional and Diffusion-Weighted MR Enterography Biomarkers Differentiate Inflammatory from Fibrotic Strictures in Crohn’s Disease?
<i>Background and Objectives:</i> To retrospectively assess the value of magnetic resonance enterography (MRE) parameters derived from conventional and diffusion weighted imaging (DWI) sequences to differentiate fibrotic strictures from inflammatory ones in adult patients with Crohn’s di...
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| Format: | Article |
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MDPI AG
2021-03-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/57/3/265 |
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| author | Pietro Valerio Foti Mario Travali Renato Farina Stefano Palmucci Maria Coronella Corrado Spatola Lidia Puzzo Rossella Garro Gaetano Inserra Gaia Riguccio Luca Zanoli Antonio Basile |
| author_facet | Pietro Valerio Foti Mario Travali Renato Farina Stefano Palmucci Maria Coronella Corrado Spatola Lidia Puzzo Rossella Garro Gaetano Inserra Gaia Riguccio Luca Zanoli Antonio Basile |
| author_sort | Pietro Valerio Foti |
| collection | DOAJ |
| description | <i>Background and Objectives:</i> To retrospectively assess the value of magnetic resonance enterography (MRE) parameters derived from conventional and diffusion weighted imaging (DWI) sequences to differentiate fibrotic strictures from inflammatory ones in adult patients with Crohn’s disease (CD), using surgical specimens as the histopathological reference standard. <i>Material and Methods</i>: Twenty-three patients with CD who had undergone surgical resection of ileal strictures with full-thickness histopathologic analysis within 3 months from preoperative MRE were included. Two radiologists blinded to histopathology in consensus evaluated the following biomarkers on MRE images matched to resected pathological specimens: T1 ratio, T2 ratio, enhancement pattern, mural thickness, pre-stenotic luminal diameter, and apparent diffusion coefficient (ADC). A blinded pathologist graded stricture histological specimens with acute inflammation score (AIS) and fibrosis score (FS). MRE measurements were correlated with the reference standard. <i>Results:</i> Inflammation and fibrosis coexisted in 78.3% of patients. T2 ratio was reduced in patients with severe fibrosis (<i>p</i> = 0.01). Pre-stenotic bowel dilatation positively correlated with FS (<i>p</i> = 0.002). The ADC value negatively correlated with FS (<i>p</i> < 0.001) and was different between FS grades (<i>p</i> < 0.05). The area under the receiver operating characteristic curve for discriminating between none and mild/moderate–severe bowel wall fibrosis was 0.75 for pre-stenotic bowel dilatation (sensitivity 100%, specificity 44.4%) and 0.97 for ADC (sensitivity 80%, specificity 100%). <i>Conclusions:</i> Inflammation and fibrosis often coexist in CD bowel strictures needing surgery. The combination of parameters derived from conventional MR sequences (T2 ratio, pre-stenotic dilatation) and from DWI (ADC) may provide a contribution to detect and grade bowel fibrosis in adult CD patients. |
| first_indexed | 2024-03-10T13:14:27Z |
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| id | doaj.art-5ee067bb3a5e4b2dbf60048dac89fd68 |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-10T13:14:27Z |
| publishDate | 2021-03-01 |
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| record_format | Article |
| series | Medicina |
| spelling | doaj.art-5ee067bb3a5e4b2dbf60048dac89fd682023-11-21T10:30:07ZengMDPI AGMedicina1010-660X1648-91442021-03-0157326510.3390/medicina57030265Can Conventional and Diffusion-Weighted MR Enterography Biomarkers Differentiate Inflammatory from Fibrotic Strictures in Crohn’s Disease?Pietro Valerio Foti0Mario Travali1Renato Farina2Stefano Palmucci3Maria Coronella4Corrado Spatola5Lidia Puzzo6Rossella Garro7Gaetano Inserra8Gaia Riguccio9Luca Zanoli10Antonio Basile11Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia, 78-95123 Catania, ItalyDepartment of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia, 78-95123 Catania, ItalyDepartment of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia, 78-95123 Catania, ItalyDepartment of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia, 78-95123 Catania, ItalyDepartment of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia, 78-95123 Catania, ItalyDepartment of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia, 78-95123 Catania, ItalyDepartment of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Anatomic Pathology Section, University of Catania, Via Santa Sofia, 78-95123 Catania, ItalyDepartment of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Anatomic Pathology Section, University of Catania, Via Santa Sofia, 78-95123 Catania, ItalyDepartment of Clinical and Experimental Medicine, U.O. Medicina Interna, University of Catania, Via Santa Sofia, 78-95123 Catania, ItalyDepartment of Clinical and Experimental Medicine, U.O. Medicina Interna, University of Catania, Via Santa Sofia, 78-95123 Catania, ItalyDepartment of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia, 78-95123 Catania, ItalyDepartment of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia, 78-95123 Catania, Italy<i>Background and Objectives:</i> To retrospectively assess the value of magnetic resonance enterography (MRE) parameters derived from conventional and diffusion weighted imaging (DWI) sequences to differentiate fibrotic strictures from inflammatory ones in adult patients with Crohn’s disease (CD), using surgical specimens as the histopathological reference standard. <i>Material and Methods</i>: Twenty-three patients with CD who had undergone surgical resection of ileal strictures with full-thickness histopathologic analysis within 3 months from preoperative MRE were included. Two radiologists blinded to histopathology in consensus evaluated the following biomarkers on MRE images matched to resected pathological specimens: T1 ratio, T2 ratio, enhancement pattern, mural thickness, pre-stenotic luminal diameter, and apparent diffusion coefficient (ADC). A blinded pathologist graded stricture histological specimens with acute inflammation score (AIS) and fibrosis score (FS). MRE measurements were correlated with the reference standard. <i>Results:</i> Inflammation and fibrosis coexisted in 78.3% of patients. T2 ratio was reduced in patients with severe fibrosis (<i>p</i> = 0.01). Pre-stenotic bowel dilatation positively correlated with FS (<i>p</i> = 0.002). The ADC value negatively correlated with FS (<i>p</i> < 0.001) and was different between FS grades (<i>p</i> < 0.05). The area under the receiver operating characteristic curve for discriminating between none and mild/moderate–severe bowel wall fibrosis was 0.75 for pre-stenotic bowel dilatation (sensitivity 100%, specificity 44.4%) and 0.97 for ADC (sensitivity 80%, specificity 100%). <i>Conclusions:</i> Inflammation and fibrosis often coexist in CD bowel strictures needing surgery. The combination of parameters derived from conventional MR sequences (T2 ratio, pre-stenotic dilatation) and from DWI (ADC) may provide a contribution to detect and grade bowel fibrosis in adult CD patients.https://www.mdpi.com/1648-9144/57/3/265magnetic resonance imagingmagnetic resonance enterographydiffusion weighted imagingapparent diffusion coefficientCrohn’s diseasefibrosis |
| spellingShingle | Pietro Valerio Foti Mario Travali Renato Farina Stefano Palmucci Maria Coronella Corrado Spatola Lidia Puzzo Rossella Garro Gaetano Inserra Gaia Riguccio Luca Zanoli Antonio Basile Can Conventional and Diffusion-Weighted MR Enterography Biomarkers Differentiate Inflammatory from Fibrotic Strictures in Crohn’s Disease? Medicina magnetic resonance imaging magnetic resonance enterography diffusion weighted imaging apparent diffusion coefficient Crohn’s disease fibrosis |
| title | Can Conventional and Diffusion-Weighted MR Enterography Biomarkers Differentiate Inflammatory from Fibrotic Strictures in Crohn’s Disease? |
| title_full | Can Conventional and Diffusion-Weighted MR Enterography Biomarkers Differentiate Inflammatory from Fibrotic Strictures in Crohn’s Disease? |
| title_fullStr | Can Conventional and Diffusion-Weighted MR Enterography Biomarkers Differentiate Inflammatory from Fibrotic Strictures in Crohn’s Disease? |
| title_full_unstemmed | Can Conventional and Diffusion-Weighted MR Enterography Biomarkers Differentiate Inflammatory from Fibrotic Strictures in Crohn’s Disease? |
| title_short | Can Conventional and Diffusion-Weighted MR Enterography Biomarkers Differentiate Inflammatory from Fibrotic Strictures in Crohn’s Disease? |
| title_sort | can conventional and diffusion weighted mr enterography biomarkers differentiate inflammatory from fibrotic strictures in crohn s disease |
| topic | magnetic resonance imaging magnetic resonance enterography diffusion weighted imaging apparent diffusion coefficient Crohn’s disease fibrosis |
| url | https://www.mdpi.com/1648-9144/57/3/265 |
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