Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China.
Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China.
Eur Radiol. 2019 May;29(5):2465-2473. doi: 10.1007/s00330-018-5860-x. Epub 2019 Jan 11.
Although diffusion-weighted imaging (DWI) is reported to be accurate in detecting bowel inflammation in Crohn's disease (CD), its ability to assess bowel fibrosis remains unclear. This study assessed the role of DWI in the characterization of bowel fibrosis using surgical histopathology as the reference standard.
Abdominal DWI was performed before elective surgery in 30 consecutive patients with CD. The apparent diffusion coefficients (ADCs) in pathologic bowel walls were calculated. Region-by-region correlations between DWI and the surgical specimens were performed to determine the histologic degrees of bowel fibrosis and inflammation.
ADCs correlated negatively with bowel inflammation (r = - 0.499, p < 0.001) and fibrosis (r = - 0.464, p < 0.001) in 90 specimens; the ADCs in regions of nonfibrosis and mild fibrosis were significantly higher than those in regions of moderate-severe fibrosis (p = 0.008). However, there was a significant correlation between the ADCs and bowel fibrosis (r = - 0.641, p = 0.001) in mildly inflamed segments but not in moderately (r = - 0.274, p = 0.255) or severely (r = - 0.225, p = 0.120) inflamed segments. In the mildly inflamed segments, the ADCs had good accuracy with an area under the receiver-operating characteristic curve of 0.867 (p = 0.004) for distinguishing nonfibrosis and mild fibrosis from moderate-severe fibrosis.
ADC can be used to assess bowel inflammation in patients with CD. However, it only enables the accurate detection of the degree of bowel fibrosis in mildly inflamed bowel walls. Therefore, caution is advised when using ADC to predict the degree of intestinal fibrosis.
• Diffusion-weighted imaging was used to assess bowel inflammation in patients with Crohn's disease. • The ability of diffusion-weighted imaging to evaluate bowel fibrosis decreased with increasing bowel inflammation. • Diffusion-weighted imaging enabled accurate detection of the degree of fibrosis only in mildly inflamed bowel walls.
尽管弥散加权成像（DWI）已被报道可准确检测克罗恩病（CD）中的肠道炎症，但它评估肠道纤维化的能力仍不清楚。本研究使用手术组织病理学作为参考标准，评估 DWI 在肠道纤维化特征描述中的作用。
对 30 例连续的 CD 患者进行择期手术前的腹部 DWI。计算病变肠壁的表观扩散系数（ADC）。对 DWI 与手术标本的区域相关性进行分析，以确定肠道纤维化和炎症的组织学程度。
90 个标本中 ADC 与肠道炎症（r=-0.499，p<0.001）和纤维化（r=-0.464，p<0.001）呈负相关；无纤维化和轻度纤维化区域的 ADC 明显高于中度-重度纤维化区域（p=0.008）。然而，在轻度炎症节段中，ADC 与肠道纤维化之间存在显著相关性（r=-0.641，p=0.001），而在中度（r=-0.274，p=0.255）或重度（r=-0.225，p=0.120）炎症节段中则无显著相关性。在轻度炎症节段中，ADC 的准确性较高，ROC 曲线下面积为 0.867（p=0.004），可用于区分无纤维化和轻度纤维化与中-重度纤维化。
ADC 可用于评估 CD 患者的肠道炎症。然而，它仅能准确检测轻度炎症肠壁的纤维化程度。因此，在使用 ADC 预测肠道纤维化程度时应谨慎。
弥散加权成像用于评估克罗恩病患者的肠道炎症。
弥散加权成像评估肠道纤维化的能力随肠道炎症的增加而降低。
弥散加权成像仅能准确检测轻度炎症肠壁的纤维化程度。
