A novel identification system combining diffusion kurtosis imaging with conventional magnetic resonance imaging to assess intestinal strictures in patients with Crohn’s disease

Jin fang Du, Bao lan Lu, Si yun Huang, Ren Mao, Zhong wei Zhang, Qing hua Cao, Zhi hui Chen, Shuo yang Li, Qing lian Qin, Can hui Sun, Shi ting Feng, Zi ping Li, Li Huang, Xue hua Li

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Purpose: To determine the utility of diffusion kurtosis imaging (DKI) for assessing bowel fibrosis and to establish a new magnetic resonance imaging (MRI)-based classification based on DKI and conventional MRI parameters for characterizing intestinal strictures in Crohn’s disease (CD) using the histological evaluation of resected intestine samples as the reference standard. Methods: Thirty-one patients with CD undergoing preoperative conventional MRI and diffusion-weighted imaging (DWI) (b values = 0–2000 s/mm2) were consecutively enrolled. We classified the mural T2-weighted signal intensity and arterial-phase enhancement patterns on conventional MRI. We also measured DWI-derived apparent diffusion coefficients (ADCs) and DKI-derived apparent diffusion for non-Gaussian distribution (Dapp) and apparent diffusional kurtosis (Kapp). A new MRI-based classification was established to characterize intestinal strictures in CD. Its performance was validated in nine additional patients with CD. Results: Histological inflammation grades were significantly correlated to T2-weighted signal intensity (r = 0.477; P < 0.001) and ADC (r = − 0.226; P = 0.044). Histological fibrosis grades were moderately correlated to Kapp (r = 0.604, P < 0.001); they were also correlated to Dapp (r = − 0.491; P < 0.001) and ADC (r = − 0.270; P = 0.015). T2-weighted signal intensity could differentiate between no-to-mild and moderate-to-severe bowel inflammation (sensitivity, 0.970; specificity, 0.479). Kapp could differentiate between no-to-mild and moderate-to-severe bowel fibrosis (sensitivity, 0.959; specificity, 0.781). The agreement between the new MRI-based classification and the histological classification was moderate in the test (κ = 0.507; P < 0.001) and validation (κ = 0.530; P < 0.001) sets. Conclusions: DKI can be used to assess bowel fibrosis. The new MRI-based classification can help to distinguish between fibrotic and inflammatory intestinal strictures in patients with CD.

Original languageEnglish
Pages (from-to)936-947
Number of pages12
JournalAbdominal Radiology
Volume46
Issue number3
DOIs
StatePublished - Mar 2021

Keywords

  • Crohn’s disease
  • Diffusion kurtosis imaging
  • Magnetic resonance imaging
  • Stricture

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