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

  • Gastrointestinal
  • Published:
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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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Correspondence to Can-Hui Sun or Shi-Ting Feng.

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Guarantor

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.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Prospective

• Observational

• Performed at one institution

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Cite this article

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

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