Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China.
Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China.
Eur Radiol. 2020 Apr;30(4):1938-1947. doi: 10.1007/s00330-019-06594-x. Epub 2020 Jan 3.
Identifying inflammation- or fibrosis-predominant strictures in Crohn's disease (CD) is crucial for treatment strategies. We evaluated the additive value of magnetisation transfer (MT) to conventional MRI for differentiating CD strictures using surgical histopathology as a reference standard.
Twenty-eight consecutive CD patients who underwent MRI preoperatively were recruited. MRI parameters included T2-weighted imaging (T2WI) hyperintensity, bowel wall thickness, enhancement pattern changes over time, enhancement pattern and gain ratio in dynamic contrast-enhanced phases, and MT ratio. Correlation analysis was performed using Spearman's rank test. Receiver operating characteristic curve analysis and Cohen's κ were used. A model with combined MRI variables characterising intestinal strictures was proposed and validated in 14 additional CD patients.
Significant correlations with histological inflammation scores were shown for wall thickness (r = 0.361, p = 0.001) and T2WI hyperintensity (r = 0.396, p < 0.001), whereas histological fibrosis scores were significantly correlated with MT ratio (r = 0.681, p < 0.001) and wall thickness (r = 0.461, p < 0.001). T2WI hyperintensity could differentiate mild from moderate-to-severe inflammation with a sensitivity of 0.871 and a specificity of 0.800. MT ratio could discriminate mild from moderate-to-severe fibrosis with a sensitivity and a specificity of 0.913 and 0.923, respectively. Combining MT ratio and T2WI hyperintensity, the MRI classification moderately agreed with the pathological stricture classification (p < 0.01, κ = 0.549). In the validation set, the diagnostic accuracy of T2WI hyperintensity and MT ratio were 86% and 89%, with good agreement between MRI and histopathological classification (p < 0.01, κ = 0.665).
MT ratio combined with conventional MRI improves the differentiation of fibrotic from inflammatory components of small-bowel strictures in CD patients.
• MT ratio from magnetisation transfer imaging combined with T2WI from conventional MRI can simultaneously characterise bowel fibrosis and inflammation in adult Crohn's disease.
识别克罗恩病（CD）中的炎症或纤维化为主的狭窄对于治疗策略至关重要。我们评估了磁化传递（MT）对常规 MRI 的附加价值，以手术组织病理学为参考标准来区分 CD 狭窄。
招募了 28 例接受术前 MRI 的连续 CD 患者。MRI 参数包括 T2 加权成像（T2WI）高信号、肠壁厚度、随时间变化的增强模式变化、动态对比增强期的增强模式和增益比以及 MT 比。使用 Spearman 秩检验进行相关性分析。使用受试者工作特征曲线分析和 Cohen's κ 进行分析。提出并验证了一种具有描述肠道狭窄的组合 MRI 变量的模型。
与组织学炎症评分显著相关的是壁厚度（r=0.361，p=0.001）和 T2WI 高信号（r=0.396，p<0.001），而组织学纤维化评分与 MT 比（r=0.681，p<0.001）和壁厚度（r=0.461，p<0.001）显著相关。T2WI 高信号可区分轻度与中度至重度炎症，其敏感性为 0.871，特异性为 0.800。MT 比可分别以 0.913 和 0.923 的敏感性和特异性区分轻度与中度至重度纤维化。结合 MT 比和 T2WI 高信号，MRI 分类与病理狭窄分类中度一致（p<0.01，κ=0.549）。在验证集中，T2WI 高信号和 MT 比的诊断准确性分别为 86%和 89%，MRI 和组织病理学分类之间具有良好的一致性（p<0.01，κ=0.665）。
MT 比与常规 MRI 相结合可改善 CD 患者小肠狭窄纤维化和炎症成分的区分。
• 磁化传递成像的 MT 比与常规 MRI 的 T2WI 相结合，可同时描述成人克罗恩病的肠纤维化和炎症。
