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Ability of DWI to characterize bowel fibrosis depends on the degree of bowel inflammation

  • Gastrointestinal
  • Published:
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Abstract

Objectives

Although diffusion-weighted imaging (DWI) is reported to be accurate in detecting bowel inflammation in Crohn’s disease (CD), its ability to assess bowel fibrosis remains unclear. This study assessed the role of DWI in the characterization of bowel fibrosis using surgical histopathology as the reference standard.

Methods

Abdominal DWI was performed before elective surgery in 30 consecutive patients with CD. The apparent diffusion coefficients (ADCs) in pathologic bowel walls were calculated. Region-by-region correlations between DWI and the surgical specimens were performed to determine the histologic degrees of bowel fibrosis and inflammation.

Results

ADCs correlated negatively with bowel inflammation (r = − 0.499, p < 0.001) and fibrosis (r = − 0.464, p < 0.001) in 90 specimens; the ADCs in regions of nonfibrosis and mild fibrosis were significantly higher than those in regions of moderate–severe fibrosis (p = 0.008). However, there was a significant correlation between the ADCs and bowel fibrosis (r = − 0.641, p = 0.001) in mildly inflamed segments but not in moderately (r = − 0.274, p = 0.255) or severely (r = − 0.225, p = 0.120) inflamed segments. In the mildly inflamed segments, the ADCs had good accuracy with an area under the receiver-operating characteristic curve of 0.867 (p = 0.004) for distinguishing nonfibrosis and mild fibrosis from moderate–severe fibrosis.

Conclusions

ADC can be used to assess bowel inflammation in patients with CD. However, it only enables the accurate detection of the degree of bowel fibrosis in mildly inflamed bowel walls. Therefore, caution is advised when using ADC to predict the degree of intestinal fibrosis.

Key Points

• Diffusion-weighted imaging was used to assess bowel inflammation in patients with Crohn’s disease.

• The ability of diffusion-weighted imaging to evaluate bowel fibrosis decreased with increasing bowel inflammation.

• Diffusion-weighted imaging enabled accurate detection of the degree of fibrosis only in mildly inflamed bowel walls.

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Abbreviations

ADC:

Apparent diffusion coefficient

CD:

Crohn’s disease

DWI:

Diffusion-weighted imaging

MRI:

Magnetic resonance imaging

TE:

Echo time

TR:

Repetition time

T2WI:

T2-weighted imaging

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Acknowledgements

The authors thank Zhongwei Zhang, a diagnostic medical physics doctor from the Radiology Department at the University of Florida, for reading and commenting on the paper. They are also grateful to Jian Zhang, a statistician from the Clinical Research Center at ZhongShan Ophthalmic Center, Sun Yat-Sen University, for valuable suggestion about statistical analysis.

Funding

The authors gratefully acknowledge the financial support by the National Natural Science Foundation of China (81600508, 81770654, 81500501, 81870451, 81771908, 81571750).

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Author notes

  1. Xue-hua Li and Ren Mao contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People’s Republic of China

    Xue-hua Li, Si-yun Huang, Zhuang-nian Fang, Bao-Lan Lu, Jin-jiang Lin, Zi-ping Li, Can-hui Sun & Shi-Ting Feng

  2. Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People’s Republic of China

    Ren Mao, Shan-shan Xiong & Min-hu Chen

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  1. Xue-hua Li
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Correspondence to Can-hui Sun or Shi-Ting Feng.

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The scientific guarantor of this publication is Shi-Ting Feng, Can-hui Sun.

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The authors declare that they have no conflicts of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

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Li, Xh., Mao, R., Huang, Sy. et al. Ability of DWI to characterize bowel fibrosis depends on the degree of bowel inflammation. Eur Radiol 29, 2465–2473 (2019). https://doi.org/10.1007/s00330-018-5860-x

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  • DOI: https://doi.org/10.1007/s00330-018-5860-x

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