Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 6/2019

01-06-2019 | Gastrointestinal

IVIM with fractional perfusion as a novel biomarker for detecting and grading intestinal fibrosis in Crohn’s disease

Authors: Meng-Chen Zhang, Xue-Hua Li, Si-Yun Huang, Ren Mao, Zhuang-Nian Fang, Qing-Hua Cao, Zhong-Wei Zhang, Xu Yan, Min-Hu Chen, Zi-Ping Li, Can-Hui Sun, Shi-Ting Feng

Published in: European Radiology | Issue 6/2019

Login to get access

Abstract

Objectives

Intravoxel incoherent motion (IVIM) diffusion-weighted magnetic resonance imaging (MRI) provides information on both perfusion and diffusion and has been used to evaluate Crohn’s disease (CD) activity and fibrosis in children; however, there are no reports on its use in adults. We aimed to determine its value for detecting and grading intestinal fibrosis in adults with CD compared with contrast-enhanced imaging and traditional diffusion-weighted imaging using surgical histopathology as a reference standard.

Methods

Twenty-four adults with CD underwent preoperative IVIM, traditional diffusion-weighted, and contrast-enhanced imaging. Region-by-region correlations between MRI findings and histologic findings of the surgical specimens were performed. Imaging parameters including fractional perfusion, perfusion coefficient, and diffusion coefficient for IVIM and apparent diffusion coefficient value for traditional diffusion-weighted imaging and contrast-enhanced parameter of 95 bowel lesions were measured. Intestinal fibrosis was histologically scored from 0 to 3.

Results

The fractional perfusion (r = − 0.629, p < 0.001) and apparent diffusion coefficient values (r = − 0.495, p < 0.001) were significantly correlated with fibrosis scores. Fractional perfusion decreased following increases in fibrosis severity from mild, to moderate, to severe (p < 0.001). The area under the receiver operating characteristic curve for distinguishing moderate-severe from mild fibrosis was 0.876 (p < 0.001) for fractional perfusion, followed by 0.802 for apparent diffusion coefficient value (p < 0.001). Perfusion coefficient, diffusion coefficient, and contrast-enhanced parameter were uncorrelated with histological fibrosis.

Conclusions

IVIM diffusion-weighted magnetic resonance imaging outperforms traditional diffusion-weighted and contrast-enhanced imaging in grading bowel fibrosis, and fractional perfusion may be a promising biomarker for fibrosis severity in adults with CD.

Key Points

• Intravoxel incoherent motion diffusion-weighted MRI outperforms contrast-enhanced imaging and traditional diffusion-weighted MRI for detecting and grading intestinal fibrosis in adult Crohn’s disease.
• The parameter fractional perfusion, a promising biomarker for fibrosis severity, may be beneficial for treatment planning and monitoring of bowel fibrosis in adult Crohn’s disease.
• Perfusion coefficient, diffusion coefficient, and the percentage of enhancement gain between 70 s and 7 min were uncorrelated with histological fibrosis.
Literature
1.
Rieder F, Fiocchi C (2013) Mechanisms of tissue remodeling in inflammatory bowel disease. Dig Dis 31:186–193CrossRefPubMed
2.
Rieder F, de Bruyn JR, Bao TP et al (2014) Results of the 4th Scientific Workshop of the ECCO (Group II): markers of intestinal fibrosis in inflammatory bowel disease. J Crohns Colitis 8:1166–1178
3.
Latella G, Di Gregorio J, Flati V, Rieder F, Lawrance IC (2015) Mechanisms of initiation and progression of intestinal fibrosis in IBD. Scand J Gastroenterol 50:53–65
4.
Rieder F, Latella G, Magro F et al (2016) European Crohn’s and Colitis Organisation topical review on prediction, diagnosis and management of fibrostenosing Crohn’s disease. J Crohns Colitis 10:873CrossRefPubMed
5.
Taylor SA, Avni F, Cronin CG et al (2017) The first joint ESGAR/ESPR consensus statement on the technical performance of cross-sectional small bowel and colonic imaging. Eur Radiol 27(6):1–13CrossRef
6.
Rimola J, Planell N, Rodríguez S et al (2015) Characterization of inflammation and fibrosis in Crohn’s disease lesions by magnetic resonance imaging. Am J Gastroenterol 110:432–440CrossRefPubMed
7.
Wilkens R, Hagemann-Madsen RH, Peters DA et al (2018) Validity of contrast enhanced ultrasonography and dynamic contrast enhanced MR enterography in the assessment of transmural activity and fibrosis in Crohn’s disease. J Crohns Colitis 12:48–56CrossRefPubMed
8.
Punwani S, Rodriguez-Justo M, Bainbridge A et al(2009) Mural inflammation in Crohn disease: location-matched histologic validation of MR imaging features. Radiology 252:712–720
9.
Li XH, Sun CH, Mao R et al (2017) Diffusion-weighted MRI enables to accurately grade inflammatory activity in patients of ileocolonic Crohn’s disease: results from an observational study. Inflamm Bowel Dis 23:244–253CrossRefPubMed
10.
Seo N, Park SH, Kim KJ et al (2015) MR Enterography for the evaluation of small-bowel inflammation in Crohn disease by using diffusion-weighted imaging without intravenous contrast material: a prospective noninferiority study. Radiology 278:762CrossRefPubMed
11.
Li XH, Sun CH, Mao R et al (2015) Assessment of activity of Crohn disease by diffusion-weighted magnetic resonance imaging. Medicine (Baltimore) 94:e1819
12.
Hordonneau C, Buisson A, Scanzi J et al (2014) Diffusion-weighted magnetic resonance imaging in ileocolonic Crohn’s disease: validation of quantitative index of activity. Am J Gastroenterol 109:89–98CrossRefPubMed
13.
Tielbeek JA, Ziech ML, Li Z et al (2014) Evaluation of conventional, dynamic contrast enhanced and diffusion weighted MRI for quantitative Crohn’s disease assessment with histopathology of surgical specimens. Eur Radiol 24:619–629CrossRefPubMed
14.
Catalano OA, Gee MS, Nicolai E et al (2017) Evaluation of quantitative PET/MR enterography biomarkers for discrimination of inflammatory strictures from fibrotic strictures in Crohn disease. Radiology 278:150566
15.
Le Bihan D (2008) Intravoxel incoherent motion perfusion MR imaging: a wake-up call. Radiology 249:748–752CrossRefPubMed
16.
Luciani A, Vignaud A, Cavet M et al (2009) Liver cirrhosis: intravoxel incoherent motion MR imaging – pilot study. Radiology 249:891CrossRef
17.
Freiman M, Perez-Rossello JM, Callahan MJ et al (2013) Characterization of fast and slow diffusion from diffusion-weighted MRI of pediatric Crohn’s disease. J Magn Reson Imaging 37:156–163CrossRefPubMed
18.
Bairdain S, Freiman M, Pérez-Rosselló JM et al (2016) Incoherent-motion magnetic resonance imaging and pediatric Crohn disease. Arch Clin Exp Surg 5:116–120CrossRef
19.
20.
Gomollón F, Dignass A, Annese V et al (2016) 3rd EUROPEAN Evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 1: diagnosis and medical management. J Crohns Colitis. 2017 11(1):3–25
21.
Li XH, Mao R, Huang SY et al (2018) Characterization of degree of intestinal fibrosis in patients with Crohn disease by using magnetization transfer MR imaging. Radiology 287(2):494CrossRefPubMed
22.
23.
Adler J, Punglia DR, Dillman JR et al (2012) Computed tomography enterography findings correlate with tissue inflammation, not fibrosis in resected small bowel Crohn’s disease. Inflamm Bowel Dis 18:849–856CrossRefPubMed
24.
Latella G, Sferra R, Speca S, Vetuschi A, Gaudio E (2013) Can we prevent, reduce or reverse intestinal fibrosis in IBD? Eur Rev Med Pharmacol Sci 17:1283–1304
25.
Barkmeier DT, Dillman JR, Al-Hawary M et al (2016) MR enterography – histology comparison in resected pediatric small bowel Crohn disease strictures: can imaging predict fibrosis? Pediatr Radiol 46:498–507CrossRefPubMed
26.
Baumgart DC, Müller HP, Grittner U et al (2015) US-based real-time elastography for the detection of fibrotic gut tissue in patients with stricturing Crohn disease. Radiology 275:889–899
27.
Hultén L, Lindhagen J, Lundgren O, Fasth S, Ahrén C (1977) Regional intestinal blood flow in ulcerative colitis and Crohn’s disease. Gastroenterology 72:388–396
28.
Kruschewski M, Busch C, Dörner A, Lierse W (1995) Angio-architecture of the colon in Crohn disease and ulcerative colitis. Light microscopy and scanning electron microscopy studies with reference to the morphology of the healthy large intestine. Langenbecks Arch Chir 380:253
29.
Nylund K, Jirik R, Mezl M et al (2013) Quantitative contrast-enhanced ultrasound comparison between inflammatory and fibrotic lesions in patients with Crohn’s disease. Ultrasound Med Biol 39:1197–1206CrossRefPubMed
306.
França M, Martí-Bonmatí L, Alberich-Bayarri Á et al (2017) Evaluation of fibrosis and inflammation in diffuse liver diseases using intravoxel incoherent motion diffusion-weighted MR imaging. Abdom Radiol (NY) 42:468–477
31.
Dyvorne HA, Galea N, Nevers T et al (2013) Diffusion-weighted imaging of the liver with multiple b values: effect of diffusion gradient polarity and breathing acquisition on image quality and intravoxel incoherent motion parameters – a pilot study. Radiology 266:920CrossRefPubMedPubMedCentral
32.
Joo I, Lee JM, Yoon JH, Jang JJ, Han JK, Choi BI (2014) Nonalcoholic fatty liver disease: intravoxel incoherent motion diffusion-weighted MR imaging – an experimental study in a rabbit model. Radiology 270:131–140
Metadata
Title
IVIM with fractional perfusion as a novel biomarker for detecting and grading intestinal fibrosis in Crohn’s disease
Authors
Meng-Chen Zhang
Xue-Hua Li
Si-Yun Huang
Ren Mao
Zhuang-Nian Fang
Qing-Hua Cao
Zhong-Wei Zhang
Xu Yan
Min-Hu Chen
Zi-Ping Li
Can-Hui Sun
Shi-Ting Feng
Publication date
01-06-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 6/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5848-6

Other articles of this Issue 6/2019

European Radiology 6/2019 Go to the issue

Computed Tomography

Uncontrolled asthma phenotypes defined from parameters using quantitative CT analysis

Breast

Pre- and post-contrast versus post-contrast cone-beam breast CT: can we reduce radiation exposure while maintaining diagnostic accuracy?

Ultrasound

Ultrasound-based radiomics score: a potential biomarker for the prediction of microvascular invasion in hepatocellular carcinoma

Musculoskeletal

Muscle diffusion tensor imaging in glycogen storage disease V (McArdle disease)

Hepatobiliary-Pancreas

Non-hypervascular hepatobiliary phase hypointense nodules on gadoxetic acid-enhanced MR can help determine the treatment method for HCC

Musculoskeletal

Diffusion tensor imaging of the sciatic nerve in Charcot–Marie–Tooth disease type I patients: a prospective case–control study