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

Zhang, Meng Chen; Li, Xue Hua; Huang, Shaobin; Mao, Ren; Fang, Zhuang Nian; Cao, Qin; Zhang, Zhong Wei; Xu, Yan; Chen, Min Hu; Li, Zi Ping; Sun, Can Hui; Feng, Shi Ting

doi:10.1007/s00330-018-5848-6

Cited by 30 publications

(27 citation statements)

References 31 publications

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“…This may reflect some partial volume effects of the luminal content from the thin bowel wall in healhty volunteers, along with differences in b-values used to calculate the parameters. The range and median PF values measured in the different studies [6,34] were similar when compared to this study (median/mean values around 0.4). To date, there have been no previous publications of measuring T1 in the bowel wall.…”

Section: Discussionsupporting

confidence: 82%

Test–retest assessment of non-contrast MRI sequences to characterise and quantify the small bowel wall in healthy participants

Alyami

Williams

Argyriou

et al. 2021

Magn Reson Mater Phy

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Objective Quantitative Magnetic Resonance Imaging sequences have been investigated as objective imaging biomarkers of fibrosis and inflammation in Crohn’s disease. Aim To determine the repeatability and inter- and intra-observer agreement of these measures in the prepared small bowel wall. Methods Ten healthy participants were scanned at 3 T on 2 separate occasions using T1 and T2 relaxometry, IVIM-DWI and MT sequences. Test–retest repeatability was assessed using the coefficient of variation (CoV) and intra-class correlation coefficients (ICCs) were used to evaluate the intra- and inter-observer agreement Results Test–retest repeatability in the bowel wall was excellent for apparent diffusion coefficient (ADC), magnetisation transfer ratio (MTR), T1, and diffusion coefficient D (CoV 5%, 7%, 8%, and 10%, respectively), good for perfusion fraction (PF) (CoV 20%) and acceptable for T2 (CoV 21%). Inter-observer agreement was good for the T2, D and ADC (ICC = 0.89, 0.86, 0.76, respectively) and moderate for T1 (ICC = 0.55). Intra-observer agreement was similar to inter-observer agreement. Discussion This study showed variable results between the different parameters measured. Test–retest repeatability was at least acceptable for all parameters except pseudo-diffusion coefficient D*. Good inter- and intra-observer agreement was obtained for T2, ADC and D, with these parameters performing best in this technical validation study.

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Section: Discussionsupporting

confidence: 82%

Test–retest assessment of non-contrast MRI sequences to characterise and quantify the small bowel wall in healthy participants

Alyami

Williams

Argyriou

et al. 2021

Magn Reson Mater Phy

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“…The subsequent denser cellularity and abundant accumulation of extracellular matrix (ECM), especially fibrillary collagens, could inhibit the random motion of water molecules, which might result in the reduction of ADC and D values 3 , 10 , 16 . Similar to other organ fibrosis, due to the presence of endometrium perfusion rather than pure diffusion restrictions, ADC values were greater than the corresponding D values 10 , 15 , 17 . Thus, compared with the biexponential model, a monoexponential model could overestimate the water diffusion in the fibrotic tissue.…”

Section: Discussionmentioning

confidence: 61%

“…According to previous studies, it is widely held that blood perfusion decreases in fibrotic tissue due to concomitant alterations in tissue microcirculation, including damage to capillary networks, proliferation of connective tissue and increased resistance to blood flow 10 , 15 . This might explain the lower f value in fibrotic endometrium compared with normal endometrium in this study.…”

Section: Discussionmentioning

confidence: 99%

“…As a quantitative imaging technique, intravoxel incoherent motion (IVIM) MR imaging can be used to noninvasively investigate diffusivity and microcapillary perfusion in biological tissues 9 , 10 . In recent years, it has been successfully used to stage liver fibrosis, to evaluate the degree of fibrosis of the kidney and pancreas, and to detect parotid gland and intestinal fibrosis 11 – 15 . Based on those studies and the histopathology of endometrial fibrosis, it is presumable that IVIM MR imaging might serve as a potential imaging biomarker for evaluating endometrial fibrosis.…”

Section: Introductionmentioning

confidence: 99%

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Noninvasive assessment of endometrial fibrosis in patients with intravoxel incoherent motion MR imaging

Jiang

Feng

et al. 2021

Sci Rep

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Recently, few noninvasive methods have been reported to evaluate endometrial fibrosis. Our study was to investigate the feasibility of intravoxel incoherent motion (IVIM) MR imaging in the detection of endometrial fibrosis in patients with intrauterine injury. 30 patients with hysteroscopy-confirmed endometrial fibrosis and 28 healthy women were enrolled to undergo MR examination including the IVIM sequence. Endometrial thickness (ET); apparent diffusion coefficient (ADC); and IVIM parameters, including pure diffusion coefficient (D), pseudodiffusion coefficient (D*) and vascular fraction (f) were evaluated. A multivariable model combing ADC, D, and f values using binary logistic regression analysis was built to diagnose endometrial fibrosis. Endometrial fibrosis patients demonstrated lower endometrial ADC, D, f values and ET (all p < 0.05). The multivariable model, ADC, D, f values and ET performed well in diagnosing endometrial fibrosis with AUC of 0.979, 0.965, 0.920, 0.901 and 0.833, respectively. The multivariable model revealed a better diagnostic accuracy than D, f and ET (all p < 0.05). Although ADC achieved a better diagnostic value than ET (z = 2.082, p < 0.05), no difference in AUC was shown among ADC, D, and f (all p > 0.05); between ET and D (p > 0.05); and between ET and f (p > 0.05). The reproducibility of ADC, D, f and D* values in patients with endometrial fibrosis and healthy women were good to excellent (ICC: 0.614–0.951). IVIM parameters exhibit promising potential to serve as imaging biomarkers in the noninvasive assessment of endometrial fibrosis.

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“…Stenoses with an inflammatory component should undergo conservative medical management (antiinflammatory, immunosuppressant, biological drugs). On the other hand, fibrostenotic strictures need a mechanical approach (endoscopic balloon dilation, strictureplasty or intestinal resection, on the basis of specific indications) [3,11], since currently, no specific anti-fibrotic medical therapy exists [10,12], especially for late fibrotic stages [13]. In this regard, it is important to remember that the prevalence of bowel strictures in CD patients has not significantly modified in the last two decades [10].…”

Section: Introductionmentioning

confidence: 99%

Can Conventional and Diffusion-Weighted MR Enterography Biomarkers Differentiate Inflammatory from Fibrotic Strictures in Crohn’s Disease?

Foti¹,

Travali²,

Farina³

et al. 2021

Medicina

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Background and Objectives: To retrospectively assess the value of magnetic resonance enterography (MRE) parameters derived from conventional and diffusion weighted imaging (DWI) sequences to differentiate fibrotic strictures from inflammatory ones in adult patients with Crohn’s disease (CD), using surgical specimens as the histopathological reference standard. Material and Methods: Twenty-three patients with CD who had undergone surgical resection of ileal strictures with full-thickness histopathologic analysis within 3 months from preoperative MRE were included. Two radiologists blinded to histopathology in consensus evaluated the following biomarkers on MRE images matched to resected pathological specimens: T1 ratio, T2 ratio, enhancement pattern, mural thickness, pre-stenotic luminal diameter, and apparent diffusion coefficient (ADC). A blinded pathologist graded stricture histological specimens with acute inflammation score (AIS) and fibrosis score (FS). MRE measurements were correlated with the reference standard. Results: Inflammation and fibrosis coexisted in 78.3% of patients. T2 ratio was reduced in patients with severe fibrosis (p = 0.01). Pre-stenotic bowel dilatation positively correlated with FS (p = 0.002). The ADC value negatively correlated with FS (p < 0.001) and was different between FS grades (p < 0.05). The area under the receiver operating characteristic curve for discriminating between none and mild/moderate–severe bowel wall fibrosis was 0.75 for pre-stenotic bowel dilatation (sensitivity 100%, specificity 44.4%) and 0.97 for ADC (sensitivity 80%, specificity 100%). Conclusions: Inflammation and fibrosis often coexist in CD bowel strictures needing surgery. The combination of parameters derived from conventional MR sequences (T2 ratio, pre-stenotic dilatation) and from DWI (ADC) may provide a contribution to detect and grade bowel fibrosis in adult CD patients.

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

Cited by 30 publications

References 31 publications

Test–retest assessment of non-contrast MRI sequences to characterise and quantify the small bowel wall in healthy participants

Test–retest assessment of non-contrast MRI sequences to characterise and quantify the small bowel wall in healthy participants

Noninvasive assessment of endometrial fibrosis in patients with intravoxel incoherent motion MR imaging

Can Conventional and Diffusion-Weighted MR Enterography Biomarkers Differentiate Inflammatory from Fibrotic Strictures in Crohn’s Disease?

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