Yu Lin, Hu Shun, Huang Fu-Chen, Wu Yin-Chen, Zheng Xian-Ying
Department of Radiology, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Fuzhou, 350005, Fujian Province, China.
Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian Province, China.
Abdom Radiol (NY). 2022 May;47(5):1714-1724. doi: 10.1007/s00261-022-03422-7. Epub 2022 Mar 4.
The existence of smooth muscle alteration in Crohn's disease (CD) is often neglected. It has been found that muscular hyperplasia/hypertrophy rather than fibrosis was the primary component of bowel wall thickening. This study aimed to assess the value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion weighted imaging for the characterization of histopathologic tissue composition of CD, particularly smooth muscle hypertrophy, as well as inflammation and fibrosis.
The study included patients diagnosed with CD who received MRI examination 30 days before resection from August 2016 to December 2020. A semiquantitative histological grading scheme was employed to evaluate the pathological tissues. Resected sections were matched with MRI according to pathological marks. Parameters evaluated included: mural thickness, T2 ratio, apparent diffusion coefficient value; and maximum enhancement, initial slope of increase, perfusion parameters of DCE-MRI and enhancement pattern. These parameters were compared with location-matched histopathological grade.
Ninety-one sections were enrolled in this retrospective study. When active inflammation is moderate or severe, volume transfer coefficient (K), maximum enhancement (ME) and initial slope of increase (ISI) are lower, mural thickness is higher when a certain degree of smooth muscle alteration is present. When active inflammation is absent or mild, ME, mural thickness and ISI can differentiate the presence of predominant muscular alteration. By combining ME and thickness comparisons against their cutoff values to create a combined ordinal parameter, the area under the curve value for whether significant muscular alteration coexists with moderate or severe active inflammation was found to be 0.953.
MRI predicts the degree of inflammation, and can distinguish the degree of muscular alteration coexists with moderate or severe active inflammation with reasonable accuracy.
克罗恩病（CD）中平滑肌改变的存在常被忽视。已发现肌肉增生/肥大而非纤维化是肠壁增厚的主要成分。本研究旨在评估动态对比增强磁共振成像（DCE-MRI）和扩散加权成像在表征CD组织病理学组成方面的价值，特别是平滑肌肥大以及炎症和纤维化。
本研究纳入了2016年8月至2020年12月期间在切除术前30天接受MRI检查的CD患者。采用半定量组织学分级方案评估病理组织。根据病理标记将切除的切片与MRI进行匹配。评估的参数包括：壁厚度、T2比值、表观扩散系数值；以及最大强化、强化增加的初始斜率、DCE-MRI的灌注参数和强化模式。将这些参数与位置匹配的组织病理学分级进行比较。
本回顾性研究共纳入91个切片。当活动性炎症为中度或重度时，容积转移系数（K）、最大强化（ME）和强化增加的初始斜率（ISI）较低，当存在一定程度的平滑肌改变时壁厚度较高。当无活动性炎症或炎症轻微时，ME、壁厚度和ISI可区分主要肌肉改变的存在。通过将ME和厚度与它们的临界值进行比较以创建一个组合序数参数，发现显著肌肉改变与中度或重度活动性炎症共存的曲线下面积值为0.953。
MRI可预测炎症程度，并能以合理的准确性区分与中度或重度活动性炎症共存的肌肉改变程度。
