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Diffusion-weighted magnetic resonance for assessing fibrosis in Crohn’s disease

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Abstract

Background

Intestinal fibrosis is a key feature of Crohn’s Disease lesions, and mucosal biopsies do not exactly represent transmural damage. Magnetic resonance enterography (MRE) allows for a panoramic study of the bowel loops. Diffusion-weighted imaging (DWI) through the restriction of the apparent diffusion coefficient (ADC) allows for an accurate evaluation of disease activity in Crohn’s Disease patients avoiding contrast agents. The aim of this study was to investigate whether DWI sequences were able to identify intestinal fibrosis in candidates for surgery, using histopathology as the gold standard.

Materials and methods

Thirty Crohn’s Disease patients undergoing surgery for stricturing ileo-colonic disease were consecutively enrolled from October 2010 to November 2015. All patients underwent MRE with DWI before surgery. Radiological parameters were calculated in the stenotic segment and in the ileum proximal to the stenosis. The histopathological examination was performed using a histological score for fibrosis and inflammation.

Results

ADC value correlated with the fibrosis score (r = −0.648; p < 0.0001), inflammation score (r = −0.763; p < 0.0001) and percentage of gain (r = −0.687; p < 0.0001). A correlation emerged between wall thickness and fibrosis score (r = 0.671; p < 0.0001). The threshold of wall thickness for fibrosis was > 6.3 mm (AUC 0.89, specificity 100% and sensitivity 69.23%). The cut-off of ADC value for fibrosis was < 1.1 × 10−3 mm2 s−1 with a sensitivity of 72% and specificity of 94% (AUC = 0.83).

Conclusions

The DWI sequence with ADC value could be useful to identify fibrosis in the intestinal wall of Crohn’s Disease patients.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Gastroenterology Unit of Castelfranco Veneto, Via dei Carpani 16/Z, 31033, Treviso, Italy

    Antonino Caruso

  2. General Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy

    Imerio Angriman & Marco Scarpa

  3. Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy

    Renata D’Incà & Giacomo Carlo Sturniolo

  4. Pathology Unit, Department of Medicine, University of Padova, Padua, Italy

    Claudia Mescoli

  5. Radiology I, Azienda Ospedaliera di Padova, Padua, Italy

    Massimo Rudatis, Giovanni Schifano & Carmelo Lacognata

Authors
  1. Antonino Caruso
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  2. Imerio Angriman
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  4. Renata D’Incà
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  6. Massimo Rudatis
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  7. Giacomo Carlo Sturniolo
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Correspondence to Antonino Caruso.

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Caruso, A., Angriman, I., Scarpa, M. et al. Diffusion-weighted magnetic resonance for assessing fibrosis in Crohn’s disease. Abdom Radiol 45, 2327–2335 (2020). https://doi.org/10.1007/s00261-019-02167-0

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  • DOI: https://doi.org/10.1007/s00261-019-02167-0

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