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.
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Abbreviations
- ADC:
-
Apparent diffusion coefficient
- AUCs:
-
Areas under ROC curves
- CD:
-
Crohn’s disease
- CDAI:
-
Crohn’s disease activity index
- CE:
-
Contrast-enhanced
- CRP:
-
C-reactive protein
- DWI:
-
Diffusion-weighted imaging
- ESR:
-
Erythrocyte sedimentation rate
- FOV:
-
Field of view
- ICCs:
-
Intraclass correlation coefficients
- IVIM:
-
Intravoxel incoherent motion
- MRE:
-
Magnetic resonance enterography
- MRI:
-
Magnetic resonance imaging
- ROC:
-
Receiver operating characteristic
- ROI:
-
Region of interest
- SI:
-
Signal intensity
- WSIs:
-
Wall signal intensities
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Acknowledgements
The authors thank Professor Margaret H. Pui, a radiologist from Conde de S. Januario Central Hospital in Macau, for reading and commenting on the paper. We also thank Xiaolei Zhu, an MR collaboration scientist from Siemens Healthcare, for providing valuable suggestions regarding this paper.
Funding
This study has received funding by the National Natural Science Foundation of China (81770654, 81600508, 81571750, 81771908, 81500501).
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The scientific guarantors of this publication are Can-hui Sun and Shi-Ting Feng.
Conflict of interest
The authors of this manuscript declare relationships with the following companies: Author (Xu Yan) from a commercial company, Siemens Healthcare, was an MR collaboration scientist performing technical support in this study under the Siemens collaboration regulation without any payment and personal concern regarding to this study. All other authors declare no conflict of interest.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Informed consent
Written informed consent was obtained from all subjects (patients) in this study.
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Institutional Review Board approval was obtained.
Methodology
• Prospective
• Observational
• Performed at one institution
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Zhang, MC., Li, XH., Huang, SY. et al. IVIM with fractional perfusion as a novel biomarker for detecting and grading intestinal fibrosis in Crohn’s disease. Eur Radiol 29, 3069–3078 (2019). https://doi.org/10.1007/s00330-018-5848-6
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DOI: https://doi.org/10.1007/s00330-018-5848-6