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Alyami AS, Madkhali Y, Majrashi NA, Alwadani B, Elbashir M, Ali S, Ageeli W, El-Bahkiry HS, Althobity AA, Refaee T. The role of molecular imaging in detecting fibrosis in Crohn's disease. Ann Med 2024; 56:2313676. [PMID: 38346385 PMCID: PMC10863520 DOI: 10.1080/07853890.2024.2313676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024] Open
Abstract
Fibrosis is a pathological process that occurs due to chronic inflammation, leading to the proliferation of fibroblasts and the excessive deposition of extracellular matrix (ECM). The process of long-term fibrosis initiates with tissue hypofunction and progressively culminates in the ultimate manifestation of organ failure. Intestinal fibrosis is a significant complication of Crohn's disease (CD) that can result in persistent luminal narrowing and strictures, which are difficult to reverse. In recent years, there have been significant advances in our understanding of the cellular and molecular mechanisms underlying intestinal fibrosis in inflammatory bowel disease (IBD). Significant progress has been achieved in the fields of pathogenesis, diagnosis, and management of intestinal fibrosis in the last few years. A significant amount of research has also been conducted in the field of biomarkers for the prediction or detection of intestinal fibrosis, including novel cross-sectional imaging modalities such as positron emission tomography (PET) and single photon emission computed tomography (SPECT). Molecular imaging represents a promising biomedical approach that enables the non-invasive visualization of cellular and subcellular processes. Molecular imaging has the potential to be employed for early detection, disease staging, and prognostication in addition to assessing disease activity and treatment response in IBD. Molecular imaging methods also have a potential role to enabling minimally invasive assessment of intestinal fibrosis. This review discusses the role of molecular imaging in combination of AI in detecting CD fibrosis.
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Affiliation(s)
- Ali S. Alyami
- Department of Diagnostic Radiography Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Yahia Madkhali
- Department of Diagnostic Radiography Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Naif A. Majrashi
- Department of Diagnostic Radiography Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Bandar Alwadani
- Department of Diagnostic Radiography Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Meaad Elbashir
- Department of Diagnostic Radiography Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Sarra Ali
- Department of Diagnostic Radiography Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Wael Ageeli
- Department of Diagnostic Radiography Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Hesham S. El-Bahkiry
- Department of Diagnostic Radiography Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Abdullah A. Althobity
- Department of Radiological Sciences and Medical Imaging, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
| | - Turkey Refaee
- Department of Diagnostic Radiography Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
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Shen B, Bruining DH, YunMa H. Radiographic Evaluation of Ileal Pouch Disorders: A Systematic Review. Dis Colon Rectum 2024; 67:S70-S81. [PMID: 38441126 DOI: 10.1097/dcr.0000000000003181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
BACKGROUND Radiographic imaging of the abdomen and pelvis plays an important role in the diagnosis and management of ileal pouch disorders with modalities including CT, MRI, contrasted pouchography, and defecography. OBJECTIVES To perform a systematic review of the literature and describe applications of cross-sectional imaging, pouchography, defecography, and ultrasonography. DATA SOURCES PubMed, Google Scholar, and Cochrane database. STUDY SELECTION Relevant articles on endoscopy in ileal pouches published between January 2003 and June 2023 in English were included on the basis of Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. INTERVENTION Main abdominal and pelvic imaging modalities and their applications in the diagnosis of ileal pouch disorders were included. MAIN OUTCOME MEASURES Accuracy in characterization of ileal pouch disorders. RESULTS CT is the test of choice for the evaluation of acute anastomotic leaks, perforation, and abscess(es). MRI of the pelvis is suitable for the assessment of chronic anastomotic leaks and their associated fistulas and sinus tracts, as well as for the penetrating phenotype of Crohn's disease of the pouch. CT enterography and magnetic resonance enterography are useful in assessing intraluminal, intramural, and extraluminal disease processes of the pouch and prepouch ileum. Water-soluble contrast pouchography is particularly useful for evaluating acute or chronic anastomotic leaks and outlines the shape and configuration of the pouch. Defecography is the key modality to evaluate structural and functional pouch inlet and outlet obstructions. Ultrasonography can be performed to assess the pouch in experienced IBD centers. LIMITATIONS This is a qualitative, not quantitative, review of mainly case series and case reports. CONCLUSIONS Abdominopelvic imaging, along with clinical and endoscopic evaluation, is imperative for accurately assessing structural, inflammatory, functional, and neoplastic disorders. See video from symposium .
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Affiliation(s)
- Bo Shen
- The Global Center for Integrated Colorectal Surgery and IBD Interventional Endoscopy, Center for Inflammatory Bowel Disease, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, New York
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Hong YunMa
- Department of Radiology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York
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McKinley S, Garuba F, Itani M, Deepak P, Ballard DH. Inflammatory and Malignant Uptake Along Crohn Perianal Fistula on 18 F-FDG. Clin Nucl Med 2024; 49:554-556. [PMID: 38537214 DOI: 10.1097/rlu.0000000000005181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
ABSTRACT Inflammatory increased metabolic activity was discovered in the left anal canal on an 18 F-FDG PET/CT scan performed for initial staging of anal squamous cell carcinoma in a patient with history of perianal Crohn disease. This increased uptake was due to a complex intersphincteric perianal fistula with supralevator extension, with a secondary, contiguous, superficial focus of squamous cell carcinoma at the anal verge that was identified on an MRI performed on the same day.
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Affiliation(s)
| | - Favour Garuba
- From the Washington University School of Medicine in St Louis
| | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St Louis
| | - Parakkal Deepak
- Division of Gastroenterology, Washington University in Saint Louis, St Louis, MO
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St Louis
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Fernández-Clotet A, Ordás I, Masamunt MC, Caballol B, Rodríguez S, Gallego M, Barastegui R, Saavedra AC, Panés J, Ricart E, Rimola J. Magnetic resonance enterography findings 46 weeks after initiation of biological therapy predict long-term adverse outcomes in Crohn's disease. Aliment Pharmacol Ther 2024; 59:1435-1445. [PMID: 38650481 DOI: 10.1111/apt.17968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND AND AIMS Magnetic resonance enterography (MRE) depicts transmural changes in response to biological treatment for Crohn's disease (CD); however, the long-term prognostic significance of these findings is unknown. The primary objective of this study was to identify findings on MRE 46 weeks after initiating biological treatment that predict adverse long-term outcomes. METHODS Patients with CD underwent MRE 46 weeks after initiating biological treatment and were prospectively followed for 2 years. A logistic regression analysis was performed to assess the prognostic value of different radiologic findings for various predefined adverse outcomes. RESULTS Of the 89 patients included, 46 (51.7%) had ≥1 adverse outcome during follow-up: 40 (44.9%) had clinical recurrence; 18 (20.2%) required surgery, 8 (9%) endoscopic balloon dilation, 12 (13.5%) hospitalization and 7 (7.8%) required corticosteroids. In the multivariate analysis, persistence of severe lesions (MaRIA ≥11) in any intestinal segment was associated with an increased risk of surgery [OR 11.6 (1.5-92.4)], of surgery and/or endoscopic balloon dilation [OR 6.3 (1.3-30.2)], and of clinical relapse [OR 4.6 (1.6-13.9)]. Penetrating lesions were associated with surgery [OR 3.4 (1.2-9.9)]. Creeping fat with hospitalization [OR 5.1 (1.1-25.0)] and corticosteroids requirement [OR 16.0 (1.2-210.0)]. The presence of complications (stricturing and/or penetrating lesions) was associated with having ≥1 adverse outcome [OR 3.35 (1.3-8.5)]. CONCLUSION MRE findings at week-46 after initiating biological therapy can predict long-term adverse outcomes in CD. Therapeutic intervention may be required in patients with persistence of severe inflammatory lesions, CD-associated complications, or creeping fat.
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Affiliation(s)
- Agnès Fernández-Clotet
- IBD Unit, Gastroenterology Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ingrid Ordás
- IBD Unit, Gastroenterology Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria Carme Masamunt
- IBD Unit, Gastroenterology Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Berta Caballol
- IBD Unit, Gastroenterology Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sonia Rodríguez
- IBD Unit, Radiology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Marta Gallego
- IBD Unit, Gastroenterology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Rebeca Barastegui
- IBD Unit, Gastroenterology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Julián Panés
- IBD Unit, Gastroenterology Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Elena Ricart
- IBD Unit, Gastroenterology Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jordi Rimola
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- IBD Unit, Radiology Department, Hospital Clinic de Barcelona, Barcelona, Spain
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Urquhart SA, Fletcher JG, Bruining DH. Editorial: Foretelling the future-Emerging role of magnetic resonance enterography as a prognostic tool in Crohn's disease. Aliment Pharmacol Ther 2024; 59:1455-1456. [PMID: 38643503 DOI: 10.1111/apt.17991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
LINKED CONTENTThis article is linked to Fernandez‐Clotet et al paper. To view this article, visit https://doi.org/10.1111/apt.17968
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Affiliation(s)
- Siri A Urquhart
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joel G Fletcher
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Cheng W, Huang Z, Qin S, Liang Z, Gao X, Liu G, Guo Q. Inflammatory mesenteric fat detected by Intestinal ultrasound is correlated with poor long-term clinical outcomes in patients with Crohn's disease. Dig Liver Dis 2024; 56:723-729. [PMID: 38061972 DOI: 10.1016/j.dld.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/15/2023] [Accepted: 10/19/2023] [Indexed: 04/29/2024]
Abstract
BACKGROUND Data on the correlation between inflammatory mesenteric fat (i-fat), detected by intestinal ultrasound (IUS), and the prognosis of Crohn's disease (CD) remains limited. AIMS To investigate the impact of IUS-detected i-fat on long-term clinical outcomes. METHODS We retrospectively enrolled 171 active CD patients who initiated infliximab. Clinical remission (CR), mucosal healing (MH) and transmural healing (TH) were assessed at week-14 and 1 year. RESULTS Baseline i-fat was detected in 107 patients, while 64 without i-fat. At week-14 and 1 year, patients with i-fat showed lower rates of CR (61.7% vs. 87.5%; 62.3% vs. 86.7%), MH (20.6% vs. 46.9%; 38.6% vs. 65.0%) and TH (10.3% vs. 31.3%; 21.6% vs. 51.7%), compared to those without (all p<0.01). Multivariable analysis revealed that baseline i-fat was a negative predictor for CR (OR=0.212) and MH (OR=0.425) at week-14, and CR (OR=0.340) and TH (OR=0.364) at 1 year (all p<0.05). At week-14, 56 patients with baseline i-fat recovered to without i-fat. Patients with i-fat recovery had higher rates of CR (86.8% vs. 23.1%), MH (58.5% vs. 7.7%) and TH (34.0% vs. 2.6%) at 1 year than those with i-fat at week-14 (all p<0.001). CONCLUSION IUS-detected i-fat correlated poor long-term clinical outcomes in CD with infliximab.
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Affiliation(s)
- Wenjie Cheng
- Department of Medical Ultrasound, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China
| | - Zicheng Huang
- Departments of Gastroenterology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China
| | - Si Qin
- Department of Medical Ultrasound, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China
| | - Zhuohua Liang
- Department of Medical Ultrasound, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China
| | - Xiang Gao
- Departments of Gastroenterology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China
| | - GuangJian Liu
- Department of Medical Ultrasound, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China.
| | - Qin Guo
- Departments of Gastroenterology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China.
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Dolinger MT, Aronskyy I, Kellar A, Gao M, Spencer EA, Pittman N, Dubinsky MC. Determining the Accuracy of Intestinal Ultrasound Scores as a Prescreening Tool in Crohn's Disease Clinical Trials. Am J Gastroenterol 2024; 119:930-936. [PMID: 38131626 DOI: 10.14309/ajg.0000000000002632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION High rates of screen failure for the minimum Simple Endoscopic Score for Crohn's Disease (SES-CD) plague Crohn's disease (CD) clinical trials. We aimed to determine the accuracy of segmental intestinal ultrasound (IUS) parameters and scores to detect segmental SES-CD activity. METHODS A single-center, blinded, cross-sectional cohort study of children and young adult patients with CD undergoing IUS and ileocolonoscopy, comparing segmental IUS bowel wall thickness (BWT), hyperemia (modified Limberg score [MLS]), and scores to detect segmental SES-CD activity: (i) SES-CD ≤2, (ii) SES-CD ≥6, and (iii) SES-CD ≥4 in the terminal ileum (TI) only. Primary outcome was accuracy of BWT, MLS, and IUS scores to detect SES-CD ≤2 and SES-CD ≥6. Secondary outcomes were accuracy of TI BWT, MLS, and IUS scores to detect SES-CD ≥4 and correlation with the SES-CD. RESULTS Eighty-two patients (median [interquartile range] age 16.5 [12.9-20.0] years) underwent IUS and ileocolonoscopy of 323 bowel segments. Segmental BWT ≤3.1 mm had a similar high accuracy to detect SES-CD ≤2 as IUS scores (area under the receiver operating curve [AUROC] 0.833 [95% confidence interval 0.76-0.91], 94% sensitivity, and 73% specificity). Segmental BWT ≥3.6 mm and ≥4.3 mm had similar high accuracy to detect SES-CD ≥6 (AUROC 0.950 [95% confidence interval 0.92-0.98], 89% sensitivity, 93% specificity) in the colon and an SES-CD ≥4 in the TI (AUROC 0.874 [0.79-0.96], 80% sensitivity, and 91% specificity) as IUS scores. Segmental IUS scores strongly correlated with the SES-CD. DISCUSSION Segmental IUS BWT is highly accurate to detect moderate-to-severe endoscopic inflammation. IUS may be the ideal prescreening tool to reduce unnecessary trial screen failures.
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Affiliation(s)
- Michael T Dolinger
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Pediatric Gastroenterology, Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Illya Aronskyy
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amelia Kellar
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Pediatric Gastroenterology, Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Gao
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Elizabeth A Spencer
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Pediatric Gastroenterology, Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nanci Pittman
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Pediatric Gastroenterology, Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marla C Dubinsky
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Pediatric Gastroenterology, Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Lu C, Rosentreter R, Delisle M, White M, Parker CE, Premji Z, Wilson SR, Baker ME, Bhatnagar G, Begun J, Bruining DH, Bryant R, Christensen B, Feagan BG, Fletcher JG, Jairath V, Knudsen J, Kucharzik T, Maaser C, Maconi G, Novak K, Rimola J, Taylor SA, Wilkens R, Rieder F. Systematic review: Defining, diagnosing and monitoring small bowel strictures in Crohn's disease on intestinal ultrasound. Aliment Pharmacol Ther 2024; 59:928-940. [PMID: 38436124 DOI: 10.1111/apt.17918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/29/2023] [Accepted: 02/11/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Stricturing Crohn's disease (CD) occurs most commonly in the terminal ileum and poses a clinical problem. Cross-sectional imaging modalities such as intestinal ultrasound (IUS), computed tomography enterography (CTE), and magnetic resonance enterography (MRE) allow for assessment of the entire bowel wall and associated peri-enteric findings. Radiologic definitions of strictures have been developed for CTE and MRE; their reliability and responsiveness are being evaluated in index development programs. A comprehensive assessment strategy for strictures using IUS is needed. AIMS To provide a detailed summary of definitions, diagnosis and monitoring of strictures on IUS as well as technical aspects of image acquisition. METHODS We searched four databases up to 6 January 2024. Two-stage screening was done in duplicate. We assessed risk of bias using QUADAS-2. RESULTS There were 56 studies eligible for inclusion. Definitions for strictures on IUS are heterogeneous, but the overall accuracy for diagnosis of strictures is high. The capability of IUS for characterising inflammation versus fibrosis in strictures is not accurate enough to be used in clinical practice or trials. We summarise definitions for improvement of strictures on IUS, and discuss parameters for image acquisition and standardisation. CONCLUSIONS This systematic review is the first step for a structured program to develop a stricture IUS index for CD.
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Affiliation(s)
- Cathy Lu
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Ryan Rosentreter
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Maxime Delisle
- Department of Medicine, Division of Gastroenterology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mattie White
- Department of Gastroenterology, Hepatology & Nutrition; Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - Zahra Premji
- Libraries, University of Victoria, Victoria, British Columbia, Canada
| | - Stephanie R Wilson
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Mark E Baker
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gauraang Bhatnagar
- Centre for Medical Imaging, University College London, London, UK
- Frimley Health NHS Foundation Trust, Surrey, UK
| | - Jakob Begun
- Department of Gastroenterology, Mater Hospital, Brisbane, Queensland, Australia
| | - David H Bruining
- Department of Gastroenterology, Queen Elizabeth Hospital, Adelaide, South Australia
| | - Robert Bryant
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Britt Christensen
- Department of Gastroenterology, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Brian G Feagan
- Alimentiv Inc., London, Ontario, Canada
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Joel G Fletcher
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Vipul Jairath
- Alimentiv Inc., London, Ontario, Canada
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Department of Medicine, Western University, London, Ontario, Canada
| | - John Knudsen
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Torsten Kucharzik
- Department of General Internal Medicine and Gastroenterology, University Teaching Hospital Lüneburg, Lüneburg, Germany
| | - Christian Maaser
- Outpatients' Department of Gastroenterology, University Teaching Hospital Lüneburg, Lüneberg, Germany
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Kerri Novak
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Jordi Rimola
- IBD Unit, Radiology Department, Hospital Clinic Barcelona, IDIBAPS, Barcelona, Spain
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Rune Wilkens
- Digestive Disease Center, Copenhagen University Hospital-Bispebjerg, Copenhagen, Denmark
- Copenhagen Intestinal Ultrasound, Bispebjerg Hospital, Copenhagen, Denmark
| | - Florian Rieder
- Department of Gastroenterology, Hepatology & Nutrition; Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Cleveland Clinic Center for Global Translational Inflammatory Bowel Diseases, Cleveland, Ohio, USA
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Rimola J, Beek KJ, Ordás I, Gecse KB, Cuatrecasas M, Stoker J. Contemporary Imaging Assessment of Strictures and Fibrosis in Crohn Disease, With Focus on Quantitative Biomarkers: From the AJR Special Series on Imaging of Fibrosis. AJR Am J Roentgenol 2024; 222:e2329693. [PMID: 37530400 DOI: 10.2214/ajr.23.29693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
Patients with Crohn disease commonly have bowel strictures develop, which exhibit varying degrees of inflammation and fibrosis. Differentiation of the distinct inflammatory and fibrotic components of strictures is key for the optimization of therapeutic management and for the development of antifibrotic drugs. Cross-sectional imaging techniques, including ultrasound, CT, and MRI, allow evaluation of the full thickness of the bowel wall as well as extramural complications and associated mesenteric abnormalities. Although promising data have been reported for a range of novel imaging biomarkers for detection of fibrosis and quantification of the degree of fibrosis, these biomarkers lack sufficient validation and standardization for clinical use. Additional methods, including PET with emerging radiotracers, artificial intelligence, and radiomics, are also under investigation for stricture characterization. In this review, we highlight the clinical relevance of identifying fibrosis in Crohn disease, review the histopathologic aspects of strictures in Crohn disease, summarize the morphologic imaging findings of strictures, and explore contemporary developments in the use of cross-sectional imaging techniques for detecting and characterizing intestinal strictures, with attention given to emerging quantitative biomarkers.
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Affiliation(s)
- Jordi Rimola
- Radiology Department, IBD Unit, Hospital Clínic de Barcelona, Villarroel 170, Escala 3, Planta 1, Barcelona 08036, Spain
- Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Kim J Beek
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ingrid Ordás
- Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Gastroenterology Department, IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Krisztina B Gecse
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Míriam Cuatrecasas
- Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Pathology Department, IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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10
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Kong N, Zhou F, Zhang F, Gao C, Wu L, Guo Y, Gao Y, Lin J, Xu M. Morphological and regional spontaneous functional aberrations in the brain associated with Crohn's disease: a systematic review and coordinate-based meta-analyses. Cereb Cortex 2024; 34:bhae116. [PMID: 38566507 DOI: 10.1093/cercor/bhae116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Crohn's disease is an acknowledged "brain-gut" disorder with unclear physiopathology. This study aims to identify potential neuroimaging biomarkers of Crohn's disease. Gray matter volume, cortical thickness, amplitude of low-frequency fluctuations, and regional homogeneity were selected as indices of interest and subjected to analyses using both activation likelihood estimation and seed-based d mapping with permutation of subject images. In comparison to healthy controls, Crohn's disease patients in remission exhibited decreased gray matter volume in the medial frontal gyrus and concurrently increased regional homogeneity. Furthermore, gray matter volume reduction in the medial superior frontal gyrus and anterior cingulate/paracingulate gyri, decreased regional homogeneity in the median cingulate/paracingulate gyri, superior frontal gyrus, paracentral lobule, and insula were observed. The gray matter changes of medial frontal gyrus were confirmed through both methods: decreased gray matter volume of medial frontal gyrus and medial superior frontal gyrus were identified by activation likelihood estimation and seed-based d mapping with permutation of subject images, respectively. The meta-regression analyses showed a positive correlation between regional homogeneity alterations and patient age in the supplementary motor area and a negative correlation between gray matter volume changes and patients' anxiety scores in the medial superior frontal gyrus. These anomalies may be associated with clinical manifestations including abdominal pain, psychiatric disorders, and possibly reflective of compensatory mechanisms.
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Affiliation(s)
- Ning Kong
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou 310006, China
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou 310006, China
| | - Feini Zhou
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou 310006, China
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou 310006, China
| | - Fan Zhang
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou 310006, China
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou 310006, China
- Key Laboratory of Digestive Pathophysiology of Zhejiang Province, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou 310006, China
| | - Chen Gao
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou 310006, China
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou 310006, China
| | - Linyu Wu
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou 310006, China
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou 310006, China
| | - Yifan Guo
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou 310006, China
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou 310006, China
| | - Yiyuan Gao
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou 310006, China
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou 310006, China
| | - Jiangnan Lin
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou 310006, China
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou 310006, China
| | - Maosheng Xu
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou 310006, China
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou 310006, China
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11
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Chen YJ, He JS, Xiong SS, Li MY, Chen SL, Chen BL, Qiu Y, Xia QQ, He Y, Zeng ZR, Chen MH, Xie XY, Mao R. Bowel Stiffness Assessed by Shear-Wave Ultrasound Elastography Predicts Disease Behavior Progression in Patients With Crohn's Disease. Clin Transl Gastroenterol 2024; 15:e00684. [PMID: 38270207 DOI: 10.14309/ctg.0000000000000684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/19/2024] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION There is a lack of reliable predictors of disease behavior progression in patients with Crohn's disease (CD). Real-time shear-wave elastography (SWE) is a novel method for evaluating tissue stiffness. However, its value for assessing CD has not yet been investigated. We aimed to explore the value of SWE and other ultrasound parameters at diagnosis in predicting CD behavior progression. METHODS We retrospectively collected data from patients with CD with the nonstenotic nonpenetrating disease (B1 phenotype based on the Montreal classification). All patients underwent intestinal ultrasound at baseline and were followed up. The end point was defined as disease behavior progression to stricturing (B2) or penetrating (B3) disease. Cox regression analysis was performed for the association between baseline characteristics and subsequent end points. In addition, a multivariate nomogram was established to predict the risk of disease behavior progression quantitatively. RESULTS A total of 130 patients with CD with B1 phenotype were enrolled. Twenty-seven patients (20.8%) developed B2 or B3 disease, with a median follow-up of 33 months. Multivariate analysis identified that SWE was the only independent predictor of disease behavior progression (hazard ratio 1.08, 95% confidence interval 1.03-1.12, P = 0.001). A reverse of the HR appeared at the cutoff 12.75 kPa. The nomogram incorporating SWE and other clinical characteristics showed a good prediction performance (area under the curve = 0.792). DISCUSSION Intestinal stiffness assessed using SWE is an independent predictor of disease behavior progression in patients with CD. Patients with CD with SWE >12.75 kPa at diagnosis are prone to progress toward stricturing or penetrating diseases.
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Affiliation(s)
- Yu-Jun Chen
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jin-Shen He
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shan-Shan Xiong
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Man-Ying Li
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shu-Ling Chen
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bai-Li Chen
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yun Qiu
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qing-Qing Xia
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yao He
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhi-Rong Zeng
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Min-Hu Chen
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ren Mao
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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12
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Tuma ISM, Cambi MPC, Moraes TPD, Magro DO, Kotze PG. BODY FAT COMPOSITION IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES: A COMPARATIVE STUDY BETWEEN SKINFOLDS AND ULTRASONOGRAPHY. Arq Gastroenterol 2024; 61:e23088. [PMID: 38451660 DOI: 10.1590/s0004-2803.246102023-88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/23/2023] [Indexed: 03/08/2024]
Abstract
BACKGROUND Inflammatory bowel diseases (IBD) are associated with important changes in nutritional status. OBJECTIVE The aim of the study was to compare body fat composition between two anthropometric methods: skinfolds and ultrasonography, in patients with IBD. METHODS Single-center cross-sectional study with IBD patients in remission or active disease. For the agreement analysis between the body fat assessment methods, the Bland Altman method was used. RESULTS A total of 101 patients with IBD were included, 75 with Crohn's disease and 26 with ulcerative colitis. Approximately 56% of the patients with Crohn's disease and 65.4% of those with ulcerative colitis had a body fat composition above normal levels, with no significant difference between the diseases (P=0.63). The Bland-Altman concordance analysis showed that the methods for assessing the percentage of fat by the adipometer and ultrasound were not in full agreement (P=0.001), despite both presented good correlation (CC 0.961; P=0.000). CONCLUSION The analysis of body fat percentage in patients with IBD was different between the skinfolds and ultrasound. Both methods can be used to assess the of body fat percentage of patients with IBD. However, monitoring of body fat sequentially and longitudinally should always be performed using the same method throughout the disease course. Prospective longitudinal studies are warranted to precisely define the role of these two methods of measuring body composition in patients with IBD. BACKGROUND • Inflammatory bowel diseases are associated with changes in nutritional status. BACKGROUND • Skinfolds measurements and ultrasound are valid methods for assessing body composition and body fat. BACKGROUND • These methods despite comparable are not identical and are useful in clinical nutritional practices in IBD.
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Affiliation(s)
- Isadora Sayuri Macedo Tuma
- Pontifícia Universidade Católica do Paraná, Unidade de Cirurgia Colorretal, Ambulatório de DII, Curitiba, PR, Brasil
| | - Maria Paula Carlin Cambi
- Pontifícia Universidade Católica do Paraná, Unidade de Cirurgia Colorretal, Ambulatório de DII, Curitiba, PR, Brasil
| | - Thyago Proença de Moraes
- Pontifícia Universidade Católica do Paraná, Unidade de Cirurgia Colorretal, Ambulatório de DII, Curitiba, PR, Brasil
| | - Daniéla Oliveira Magro
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Departamento de Cirurgia, Campinas, SP, Brasil
| | - Paulo Gustavo Kotze
- Pontifícia Universidade Católica do Paraná, Unidade de Cirurgia Colorretal, Ambulatório de DII, Curitiba, PR, Brasil
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Bonifacio C, Savini G, Reca C, Garoli F, Levi R, Vatteroni G, Balzarini L, Allocca M, Furfaro F, Dal Buono A, Armuzzi A, Danese S, Matteoli M, Rescigno M, Fiorino G, Politi LS. The gut-brain axis: Correlation of choroid plexus volume and permeability with inflammatory biomarkers in Crohn's disease. Neurobiol Dis 2024; 192:106416. [PMID: 38272141 DOI: 10.1016/j.nbd.2024.106416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/11/2024] [Accepted: 01/22/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The dysregulation of the gut-brain axis in chronic inflammatory bowel diseases can cause neuro-psychological disturbances, but the underlying mechanisms are still not fully understood. The choroid plexus (CP) maintains brain homeostasis and nourishment through the secretion and clearance of cerebrospinal fluid. Recent research has demonstrated the existence of a CP vascular barrier in mice which is modulated during intestinal inflammation. This study investigates possible correlations between CP modifications and inflammatory activity in patients with Crohn's disease (CD). METHODS In this prospective study, 17 patients with CD underwent concomitant abdominal and brain 3 T MRI. The volume and permeability of CP were compared with levels of C-reactive protein (CRP), fecal calprotectin (FC), sMARIA and SES-CD scores. RESULTS The CP volume was negatively correlated with CRP levels (R = -0.643, p-value = 0.024) and FC (R = -0.571, p-value = 0.050). DCE metrics normalized by CP volume were positively correlated with CRP (K-trans: R = 0.587, p-value = 0.045; Vp: R = 0.706, p-value = 0.010; T1: R = 0.699, p-value = 0.011), and FC (Vp: R = 0.606, p-value = 0.037). CONCLUSIONS Inflammatory activity in patients with CD is associated with changes in CP volume and permeability, thus supporting the hypothesis that intestinal inflammation could affect the brain through the modulation of CP vascular barrier also in humans.
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Affiliation(s)
- Cristiana Bonifacio
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giovanni Savini
- Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy; Neuroradiology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Christian Reca
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
| | - Federico Garoli
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
| | - Riccardo Levi
- Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy; Neuroradiology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giulia Vatteroni
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
| | - Luca Balzarini
- Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Mariangela Allocca
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Furfaro
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Arianna Dal Buono
- IBD Center, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Alessandro Armuzzi
- Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy; IBD Center, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Michela Matteoli
- Laboratory of Pharmacology and Brain Pathology, Neuro Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy; Institute of Neuroscience, National Research Council of Italy (CNR) c/o Humanitas Mirasole S.p.A, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Maria Rescigno
- Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Gionata Fiorino
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy; Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, Rome, Italy
| | - Letterio S Politi
- Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy; Neuroradiology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
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14
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Crowley E, Ma C, Guizzetti L, Zou G, Lewindon PJ, Gee MS, Hyams JS, Rosen MJ, von Allmen D, de Buck van Overstraeten A, Shackelton LM, Remillard J, Schleicher L, Dillman JR, Rimola J, Taylor SA, Fletcher JG, Church PC, Feagan BG, Griffiths AM, Jairath V, Greer MLC. Recommendations for Standardizing MRI-based Evaluation of Perianal Fistulizing Disease Activity in Pediatric Crohn's Disease Clinical Trials. Inflamm Bowel Dis 2024; 30:357-369. [PMID: 37524088 DOI: 10.1093/ibd/izad134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND Perianal fistulas and abscesses occur commonly as complications of pediatric Crohn's disease (CD). A validated imaging assessment tool for quantification of perianal disease severity and activity is needed to evaluate treatment response. We aimed to identify magnetic resonance imaging (MRI)-based measures of perianal fistulizing disease activity and study design features appropriate for pediatric patients. METHODS Seventy-nine statements relevant to MRI-based assessment of pediatric perianal fistulizing CD activity and clinical trial design were generated from literature review and expert opinion. Statement appropriateness was rated by a panel (N = 15) of gastroenterologists, radiologists, and surgeons using modified RAND/University of California Los Angeles appropriateness methodology. RESULTS The modified Van Assche Index (mVAI) and the Magnetic Resonance Novel Index for Fistula Imaging in CD (MAGNIFI-CD) were considered appropriate instruments for use in pediatric perianal fistulizing disease clinical trials. Although there was concern regarding the use of intravascular contrast material in pediatric patients, its use in clinical trials was considered appropriate. A clinically evident fistula tract and radiologic disease defined as at least 1 fistula or abscess on pelvic MRI were considered appropriate trial inclusion criteria. A coprimary clinical and radiologic end point and inclusion of a patient-reported outcome were also considered appropriate. CONCLUSION Outcomes of treatment of perianal fistulizing disease in children must include MRI. Existing multi-item measures, specifically the mVAI and MAGNIFI-CD, can be adapted and used for children. Further research to assess the operating properties of the indices when used in a pediatric patient population is ongoing.
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Affiliation(s)
- Eileen Crowley
- Department of Pediatrics, Division of Pediatric Gastroenterology, Children's Hospital Western Ontario, Western University, London Health Sciences Centre, London, Ontario, Canada
- Alimentiv Inc, London, ON, Canada
| | - Christopher Ma
- Alimentiv Inc, London, ON, Canada
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Guangyong Zou
- Alimentiv Inc, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Peter J Lewindon
- Department of Gastroenterology, Queensland Children's Hospital, University of Queensland, Brisbane, Queensland, Australia
- Children's Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital Boston, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Jeffrey S Hyams
- Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Michael J Rosen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Stanford Medicine, Stanford, CA, USA
| | - Daniel von Allmen
- Department of Pediatric Surgery and Surgical Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | | | | | | | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jordi Rimola
- IBD Unit, Radiology Department, Hospital Clinic Barcelona, IDIBAPS, Spain
| | - Stuart A Taylor
- Centre for Medical Imaging, Charles Bell House, University College London, London, UK
| | | | - Peter C Church
- Division of Gastroenterology, Hepatology & Nutrition, Department of Paediatrics and IBD Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Brian G Feagan
- Alimentiv Inc, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Medicine, Division of Gastroenterology, Western University, London, ON, Canada
| | - Anne M Griffiths
- Division of Gastroenterology, Hepatology & Nutrition, Department of Paediatrics and IBD Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Vipul Jairath
- Alimentiv Inc, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Medicine, Division of Gastroenterology, Western University, London, ON, Canada
| | - Mary-Louise C Greer
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
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15
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Pal P, Ramchandani M, Patel R, Banerjee R, Kanaganti S, Gupta R, Tandan M, Reddy DN. Role of ultra-high definition endoscopy (endomicroscopy and endocytoscopy) and real-time histologic examination in inflammatory bowel disease: Scoping review. Dig Endosc 2024; 36:274-289. [PMID: 37573562 DOI: 10.1111/den.14659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/06/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVES Confocal laser endomicroscopy (CLE) and endocytoscopy (EC) are ultra-high definition (HD) imaging modalities that enable real-time histological assessment. Although existent for nearly two decades, their role in current clinical decision making in inflammatory bowel disease management is not well defined. METHODS We searched PubMed using keywords ("confocal" OR "CLE" OR "endocytoscopy") AND ("IBD" OR "inflammatory bowel" OR "Crohn*" OR "Crohn's" OR "colitis ulcerosa" OR "ulcerative colitis") between 2005 and March 2023. We identified 52 studies for detailed review. RESULTS Confocal laser endomicroscopy was useful in real-time assessment of histologic inflammation and dysplasia characterization in both ulcerative colitis (UC) and Crohn's disease. Although CLE was associated with higher per-biopsy yield for UC-associated neoplasia (UCAN), the benefit was offset by higher procedure time, frequent equipment failure, and conflicting results on incremental yield over chromoendoscopy. Assessment of barrier dysfunction by CLE did not correlate with disease/endoscopic activity but could predict major adverse outcomes. The implications of residual CLE abnormalities in endoscopic remission remain uncertain. Ex vivo binding of labeled biologics can help in predicting biologic response in UC. EC can discriminate mucosal inflammatory cells by morphology and allows assessment of histologic activity. EC combined with pit pattern was better than pit pattern alone for UCAN. Artificial intelligence-assisted EC in UCAN needs further study. CONCLUSION Ultra-HD imaging in inflammatory bowel disease can be useful in assessment of UCAN, barrier dysfunction, predicting histologic remission, and biologic response. Future controlled studies are warranted to define the role of these novel technologies in clinical decision making.
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Affiliation(s)
- Partha Pal
- Asian Institute of Gastroenterology, Hyderabad, India
| | | | | | - Rupa Banerjee
- Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Rajesh Gupta
- Asian Institute of Gastroenterology, Hyderabad, India
| | - Manu Tandan
- Asian Institute of Gastroenterology, Hyderabad, India
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16
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Wang XY, Li XH. Rapid Onset of Intestinal Lymphoma in Crohn Disease. Radiology 2024; 310:e232512. [PMID: 38530169 DOI: 10.1148/radiol.232512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Affiliation(s)
- Xin-Yue Wang
- From the Department of Radiology, First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Rd, Guangzhou 510080, China
| | - Xue-Hua Li
- From the Department of Radiology, First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Rd, Guangzhou 510080, China
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17
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Zhang YN, Liu YB, Xu J, Cao KM, Zhang XX, Wang YB, Liu F, Duan BS, Hu YD, Chu SG. Magnetic resonance Index of Activity (MaRIA) is reliable in assessing response to treatment in patients with Crohn's disease (CD). Clin Radiol 2024; 79:230-236. [PMID: 38092646 DOI: 10.1016/j.crad.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 02/15/2024]
Abstract
AIM To assess the accuracy of Magnetic Resonance Index of Activity (MaRIA) in evaluating therapeutic efficacy in Crohn's disease (CD) patients with different activity levels using ileocolonoscopy as the reference standard. MATERIALS AND METHODS Forty-eight patients underwent magnetic resonance enterography (MRE) and ileocolonoscopy at baseline, week 26, and week 52, along with the Simple Endoscopic Score for Crohn's Disease (SES-CD) and MaRIA scores. According to the SES-CD score at baseline, all patients were subdivided into mild, moderate, and severe activity subgroups. The identification of endoscopic mucosal healing (MH) was explored primarily. Moreover, the Crohn's Disease Activity Index (CDAI), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), and interleukin-6 (IL-6) levels were collected and analysed. RESULTS MaRIA correlated significantly with SES-CD and CRP at baseline, week 26, and week 52. The discrepancies in MaRIA and SES-CD were statistically significant before and after treatment. MaRIA = 24.43 and ΔMaRIA = 12.77 as the cut-off points were found to have high diagnostic accuracy for predicting MH. MaRIA (p<0.001), SES-CD (p<0.001), CRP (p<0.05), ESR (p<0.05), and CDAI score (p<0.05) in patients with MH were considerably decreased compared to those in patients without MH. CONCLUSIONS MRE has good application value in evaluating the therapeutic response of CD patients treated with biological agents. MaRIA is a reliable indicator in the follow-up of CD patients, which is strongly correlated with SES-CD, and it has high accuracy in predicting endoscopic MH.
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Affiliation(s)
- Y-N Zhang
- Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Y-B Liu
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - J Xu
- Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - K-M Cao
- Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - X-X Zhang
- Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Y-B Wang
- Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - F Liu
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - B-S Duan
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Y-D Hu
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - S-G Chu
- Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
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18
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Lovett GC, Schulberg JD, Hamilton AL, Wilding HE, Kamm MA, Wright EK. Intestinal Ultrasound and MRI for Monitoring Therapeutic Response in Luminal Crohn's Disease: A Systematic Review. J Am Coll Radiol 2024; 21:441-463. [PMID: 37852561 DOI: 10.1016/j.jacr.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE Cross-sectional imaging facilitates the assessment of transmural healing in patients with Crohn's disease. This systematic review addresses the utility of MRI and intestinal ultrasound (IUS) in the assessment of disease activity in response to drug therapy compared with endoscopy in patients with luminal Crohn's disease. METHODS Database searches were undertaken using predefined terms. Studies with ≥10 patients with luminal Crohn's disease with paired endoscopy and imaging (MRI or IUS) after treatment initiation were included. Publications were identified through searches of six bibliographic databases, all run on June 24, 2022. Records were screened on title and abstract, then full text, by two independent reviewers. RESULTS In total, 5,760 records were identified, with 24 studies meeting the inclusion criteria. Ten studies examined IUS and found good correlation between IUS and endoscopic remission (κ = 0.63-0.73). Early reduction in bowel wall thickness at 4 to 8 weeks predicted endoscopic response at 12 to 38 weeks (area under the receiver operating characteristic curve [AUROC], 0.77; odds ratio, 10.8; P = .01). Twelve studies examined MRI, with the Magnetic Resonance Index of Activity score having high accuracy for predicting endoscopic remission (AUROC, 0.97; sensitivity, 93%; specificity, 77%). A Simplified Magnetic Resonance Index of Activity score cutoff of ≥1 identifies active endoscopic disease (AUROC, 0.92; 95% confidence interval, 0.88-0.95; P < .0001). CONCLUSIONS IUS and MRI are both reliable, noninvasive modalities for assessing transmural healing in patients with Crohn's disease and are accurate in monitoring the response to drug therapy. These modalities can be used to monitor response to biologic induction therapy, with early changes predictive of response to treatment.
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Affiliation(s)
- Grace C Lovett
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia.
| | - Julien D Schulberg
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Amy L Hamilton
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Helen E Wilding
- Library Service, St. Vincent's Hospital Melbourne, Melbourne, Australia
| | - Michael A Kamm
- Professor of Gastroenterology, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Emily K Wright
- Associate Professor of Gastroenterology, Department of Medicine, University of Melbourne, Melbourne, Australia
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Huang M, Tu L, Li J, Yue X, Wu L, Yang M, Chen Y, Han P, Li X, Zhu L. Differentiation of Crohn's disease, ulcerative colitis, and intestinal tuberculosis by dual-layer spectral detector CT enterography. Clin Radiol 2024; 79:e482-e489. [PMID: 38143229 DOI: 10.1016/j.crad.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 12/26/2023]
Abstract
AIM To investigate the value of radiological features and energy spectrum quantitative parameters in the differential diagnosis of Crohn's disease (CD), ulcerative colitis (UC), and intestinal tuberculosis (ITB) by dual-layer spectral detector computed tomography (CT) enterography (CTE). MATERIALS AND METHODS Clinical and CTE data were collected from 182 patients with CD, 29 with UC, and 51 with ITB. CT images were obtained at the enteric phases and portal phases. The quantitative energy spectrum parameters were iodine density (ID), normalised ID (NID), virtual non-contrast (VNC) value, and effective atomic number (Z-eff). The area under curve (AUC) of the receiver operating characteristic curve (ROC) was calculated. RESULTS The vascular comb sign (p=0.009) and enlarged lymph nodes (p=0.001) were more common in patients with CD than UC or ITB. In the differentiation of moderate-severe active CD from UC, enteric phase NID (AUC, 0.938; p<0.001) and portal phase Z-eff (AUC, 0.925; p<0.001) had the highest accuracy, which were compared separately. In the differentiation of moderate-severe active CD from ITB, enteric phase NID (AUC, 0.906; p<0.001) and portal phase Z-eff (AUC, 0.947; p<0.001) had the highest accuracy; however, the AUC value was highest when the four parameters are combined (AUC, 0.989; p<0.001; AUC, 0.986; p<0.001; AUC, 0.936; p<0.001; and AUC, 0.986; p<0.001). CONCLUSION The present study shows that the combined strategies of four parameters have higher sensitivity and specificity in differentiating CD, UC, and ITB, and may play a key role in guiding treatment.
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Affiliation(s)
- M Huang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - L Tu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - J Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - X Yue
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - L Wu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - M Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Y Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - P Han
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - X Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
| | - L Zhu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Melekh O, Barajas Ordonez F, Melekh B, Rodríguez-Feria P, Pech M, Flintrop W, Surov A. Association between sacroiliac joint forms and subchondral changes in patients with Crohn's disease. Int J Rheum Dis 2024; 27:e15046. [PMID: 38414165 DOI: 10.1111/1756-185x.15046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/30/2023] [Accepted: 01/11/2024] [Indexed: 02/29/2024]
Abstract
AIM To assess the relationship between anatomical variants of sacroiliac joint (SIJ) and subchondral changes detected in magnetic resonance enterography (MRE) in patients with Crohn's disease (CD). METHODS This was a retrospective study of 60 CD patients, who were divided into two groups: with (n = 16) and without SIJ (n = 44) involvement, depending on the presence of inflammatory (bone marrow edema) and structural changes (sclerosis and erosions) in MRE. Anatomical variants of SIJ were assessed in CT of the abdomen and/or pelvis, distinguishing typical form with convex iliac surface and atypical forms. Univariate and multivariate analyses were performed to reveal an association between joint changes and forms. RESULTS Our study included 60 patients (38 males; mean age 38.72 years ± 13.33). Patients with SIJ changes were older (p = .044). No significant differences in CD localization and behavior were found. The most common SIJ lesions were structural changes (in 75% of patients); the main atypical form was the iliosacral complex. The univariate and multivariate analyses showed a significant association of atypical forms with total subchondral changes (odds ratio [OR]: 3.429, 95% confidence interval [CI] 1.043-11.268; p = .042; OR: 5.066, 95% CI: 1.273-20.167; p = .021, respectively), and with structural changes (OR: 4.185, 95% CI: 1.155-15.160; p = .029; OR: 5.986, 95% CI: 1.293-27.700; p = .022, respectively). CONCLUSION Atypical forms of SIJ are a risk factor for the occurrence of structural joint changes in CD patients. An association between bone marrow edema and atypical forms was not found.
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Affiliation(s)
- Oksana Melekh
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Felix Barajas Ordonez
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH, Aachen, Germany
| | - Bohdan Melekh
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Pablo Rodríguez-Feria
- Department of International Health, CAPHRI - Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Maciej Pech
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Wiebke Flintrop
- Department of Pediatrics, University Hospital Magdeburg, Magdeburg, Germany
| | - Alexey Surov
- Institute for Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital by Muehlenkreiskliniken, Ruhr University Bochum, Minden, Germany
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21
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Sachan A, Kakadiya R, Mishra S, Kumar-M P, Jena A, Gupta P, Sebastian S, Deepak P, Sharma V. Artificial intelligence for discrimination of Crohn's disease and gastrointestinal tuberculosis: A systematic review. J Gastroenterol Hepatol 2024; 39:422-430. [PMID: 38058246 DOI: 10.1111/jgh.16430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 08/04/2023] [Accepted: 11/13/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND AND AIM Discrimination of gastrointestinal tuberculosis (GITB) and Crohn's disease (CD) is difficult. Use of artificial intelligence (AI)-based technologies may help in discriminating these two entities. METHODS We conducted a systematic review on the use of AI for discrimination of GITB and CD. Electronic databases (PubMed and Embase) were searched on June 6, 2022, to identify relevant studies. We included any study reporting the use of clinical, endoscopic, and radiological information (textual or images) to discriminate GITB and CD using any AI technique. Quality of studies was assessed with MI-CLAIM checklist. RESULTS Out of 27 identified results, a total of 9 studies were included. All studies used retrospective databases. There were five studies of only endoscopy-based AI, one of radiology-based AI, and three of multiparameter-based AI. The AI models performed fairly well with high accuracy ranging from 69.6-100%. Text-based convolutional neural network was used in three studies and Classification and regression tree analysis used in two studies. Interestingly, irrespective of the AI method used, the performance of discriminating GITB and CD did not match in discriminating from other diseases (in studies where a third disease was also considered). CONCLUSION The use of AI in differentiating GITB and CD seem to have acceptable accuracy but there were no direct comparisons with traditional multiparameter models. The use of multiple parameter-based AI models have the potential for further exploration in search of an ideal tool and improve on the accuracy of traditional models.
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Affiliation(s)
- Anurag Sachan
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rinkalben Kakadiya
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shubhra Mishra
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Anuraag Jena
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shaji Sebastian
- IBD Unit, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Parakkal Deepak
- Division of Gastroenterology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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22
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Yu CH, Chen Y, Tsai CC, Lee TH, Tsai YH, Chung CS. Magnifying Endoscopy With Narrow Band Imaging for Graft Failure and Disease Recurrence in Patients With Crohn Disease After Intestinal Transplantation: 2 Case Reports. Transplant Proc 2024; 56:422-426. [PMID: 38336485 DOI: 10.1016/j.transproceed.2024.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/16/2024] [Indexed: 02/12/2024]
Abstract
Crohn disease (CD) is one of the most common causes of short bowel syndrome and intestinal failure. Intestinal transplantation (IT) is sometimes needed for patients with CD who develop intestinal failure after multiple intestinal resections resulting from CD-related complications, such as uncontrollable bleeding and penetrating diseases. However, there have been few case reports concerning the endoscopic surveillance of patients with CD after IT. In this article, we present 2 patients with CD who underwent IT because of short bowel syndrome with intestinal failure. We administered posttransplantation immunosuppressants and conducted regular follow-up magnifying endoscopy with narrow-band imaging (ME-NBI). Both cases demonstrated favorable outcomes after surveillance with ME-NBI. In this report, we outline our post-IT follow-up strategies applying the VENCH scoring system, which is based on endoscopic features using ME-NBI to predict graft rejection. Our approach could effectively distinguish between acute cellular rejection and non-rejection, particularly disease recurrence of underlying CD. This study was approved by the institutional review board of Far Eastern Memorial Hospital (FEMH-105023-F). The patients provided written informed consent for publication.
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Affiliation(s)
- Chen-Huan Yu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yun Chen
- Taiwan Association for the Study of Small Intestinal Diseases (TASSID), Taoyuan City, Taiwan; Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Graduate Institute of Medicine, Yuan Ze University, Taoyuan City, Taiwan
| | - Chien-Chen Tsai
- Department of Anatomical Pathology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Tzong-Hsi Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ya-Hui Tsai
- Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Graduate Institute of Medicine, Yuan Ze University, Taoyuan City, Taiwan
| | - Chen-Shuan Chung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), Taoyuan City, Taiwan; College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan..
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23
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Gong M, Liu L, Ren H, He P, Ran X, Xu Y, Zou Y, Wu J, Li Z, Tan W, Zhang Z, Li K. Value of the virtual monoenergetic image from dual-layer dual-energy computed tomography enterography in the preoperative assessment of the internal penetrating complication of Crohn's disease. Abdom Radiol (NY) 2024; 49:814-822. [PMID: 38150141 DOI: 10.1007/s00261-023-04148-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/13/2023] [Accepted: 12/04/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND To determine the utility of virtual-monoenergetic imaging (VMI) at low energy levels from contrast-enhanced dual-layer dual-energy (DLDE) computed tomography enterography (CTE) in the preoperative assessment of internal penetrating lesions of Crohn's disease (CD). MATERIALS AND METHODS Thirty-eight patients with penetrating lesions of CD by surgery undergoing contrast-enhanced DLDE CTE were retrospectively included. Polyenergetic imaging (PEI) and VMIs at low energy levels [40-70 kiloelectron volts (keV)] with 10 keV intervals were reconstructed. The objective parameters of image quality [noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR)] and the subjective parameter of image quality [diagnostic performance of lesions (DPL), overall image quality(OIQ)] of PEI and all VMIs at the low energy level were compared to determine the VMI on the optimal energy level. The lesion detection capability between PEI and the optimal VMI was compared. RESULTS VMI40 was determined to be the optimal VMI among all VMIs at the low energy level for owning the best image quality. No significant difference was found in the detecting capability in penetrating lesions between VMI40 and PEI (p = 1.0), whereas a significant difference was found in the detecting capability in the bowel origin of the penetrating lesions (p = 0.004), the involved organ or structure by the fistula (p = 0.016) and the orifice of the fistula connected to the involved organ or structure ( p = 0.031) between them. CONCLUSIONS Compared to conventional PEI, VMI40 improves the detection capability in anatomical details of penetrating lesions of CD, helping colorectal surgeons rationalizing preoperative plans of internal penetrating lesions of CD.
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Affiliation(s)
- Meilin Gong
- Department of Radiology, Chongqing General Hospital, 118 Xingguang Street, Yubei District, Chongqing, 400000, ChongQing Province, China
| | - Lili Liu
- Department of Radiology, Chongqing General Hospital, 118 Xingguang Street, Yubei District, Chongqing, 400000, ChongQing Province, China
| | - Huanhuan Ren
- Department of Radiology, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Peipei He
- Department of Radiology, Chongqing General Hospital, 118 Xingguang Street, Yubei District, Chongqing, 400000, ChongQing Province, China
| | - Xiong Ran
- Department of Radiology, Chongqing General Hospital, 118 Xingguang Street, Yubei District, Chongqing, 400000, ChongQing Province, China
| | - Yu Xu
- Department of Radiology, Chongqing General Hospital, 118 Xingguang Street, Yubei District, Chongqing, 400000, ChongQing Province, China
| | - Ya Zou
- Department of Radiology, Chongqing General Hospital, 118 Xingguang Street, Yubei District, Chongqing, 400000, ChongQing Province, China
| | - Jingsong Wu
- Department of General Surgery, Chongqing General Hospital, Chongqing, China
| | - Zan Li
- Department of Pathology, Chongqing General Hospital, Chongqing, China
| | - Wei Tan
- Department of Gastroenterology, Chongqing General Hospital, Chongqing, China
| | - Zhengying Zhang
- Department of Health Management Center, Chongqing General Hospital, 5 Xingguang Road, Xingguang Street, Yubei District, Chongqing, 400000, ChongQing Province, China.
| | - Kang Li
- Department of Radiology, Chongqing General Hospital, 118 Xingguang Street, Yubei District, Chongqing, 400000, ChongQing Province, China.
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24
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Mao L, Li Y, Cui B, Lu L, Dou W, Pylypenko D, Zhu J, Li H. Multiparametric MRI for Staging of Bowel Inflammatory Activity in Crohn's Disease with MUSE-IVIM and DCE-MRI: A Preliminary Study. Acad Radiol 2024; 31:880-888. [PMID: 37730492 DOI: 10.1016/j.acra.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 09/22/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate if the combination of multishot diffusion imaging-based multiplexed sensitivity encoding intravoxel incoherent motion (MUSE-IVIM) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is feasible for staging Crohn's disease (CD) activity. MATERIALS AND METHODS A total of 65 CD patients were enrolled and analyzed in this retrospective study. The simplified endoscopic score for Crohn's disease (SES-CD) and magnetic resonance index of activity (MaRIA) were used as the reference. The MUSE-IVIM and DCE-MRI data were acquired at 3.0-T MRI scanner and processed by two radiologists. Three MUSE-IVIM parameters: fast apparent diffusion coefficient (ADCfast), slow apparent diffusion coefficient (ADCslow), and the fractional perfusion (Fraction of ADCfast), as well as four DCE-MRI parameters: volume transfer constant (Ktrans), rate constant (Kep), extravascular extracellular volume fraction (Ve), and plasma volume fraction (Vp) were generated. Intraclass correlation coefficient (ICC), non-parametric test (Kruskal-Wallis H and Mann-Whitney U), logistic regression, receiver operating characteristic analysis, Delong test, and Spearman's correlation test were performed. RESULTS According to SES-CD, 116 ileocolonic segments with CD lesions were identified as: inactive, mild, and moderate to severe. With multivariable logistic regression analysis, ADCfast (p < 0.001), Fraction of ADCfast (p = 0.005), Ktrans (p < 0.001) and Kep (p = 0.003) were identified as significant factors for differentiating among the three groups. Binary logistic analyses identified ADCfast (p = 0.001), Ktrans (p = 0.014), and Kep (p = 0.029) as independent predictors for the active status. The combination of ADCfast, Ktrans, and Kep performed better than MaRIA score (p = 0.028), for differentiating inactive and active status. MaRIA score was positively correlated with ADCfast (p < 0.001), Ktrans (p < 0.001), Kep (p < 0.001), and Ve (p = 0.001), however, negatively correlated with Fraction of ADCfast (p < 0.001). CONCLUSION The combination of MUSE-IVIM and DCE-MRI has been demonstrated to accurately stage inflammatory activity in CD.
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Affiliation(s)
- Liangqiang Mao
- Department of Radiology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Yan Li
- Department of Radiology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Bota Cui
- Department of Gastroenterology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Lin Lu
- Department of Radiology, Columbia University Medical Center, New York, New York
| | - Weiqiang Dou
- GE Healthcare, MR Research China, Beijing, PR China
| | | | - Jianguo Zhu
- Department of Radiology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, PR China.
| | - Haige Li
- Department of Radiology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
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25
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Oh DJ, Hwang Y, Kim SH, Nam JH, Jung MK, Lim YJ. Reading of small bowel capsule endoscopy after frame reduction using an artificial intelligence algorithm. BMC Gastroenterol 2024; 24:80. [PMID: 38388860 PMCID: PMC10885475 DOI: 10.1186/s12876-024-03156-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/04/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES Poorly visualized images that appear during small bowel capsule endoscopy (SBCE) can confuse the interpretation of small bowel lesions and increase the physician's workload. Using a validated artificial intelligence (AI) algorithm that can evaluate the mucosal visualization, we aimed to assess whether SBCE reading after the removal of poorly visualized images could affect the diagnosis of SBCE. METHODS A study was conducted to analyze 90 SBCE cases in which a small bowel examination was completed. Two experienced endoscopists alternately performed two types of readings. They used the AI algorithm to remove poorly visualized images for the frame reduction reading (AI user group) and conducted whole frame reading without AI (AI non-user group) for the same patient. A poorly visualized image was defined as an image with < 50% mucosal visualization. The study outcomes were diagnostic concordance and reading time between the two groups. The SBCE diagnosis was classified as Crohn's disease, bleeding, polyp, angiodysplasia, and nonspecific finding. RESULTS The final SBCE diagnoses between the two groups showed statistically significant diagnostic concordance (k = 0.954, p < 0.001). The mean number of lesion images was 3008.5 ± 9964.9 in the AI non-user group and 1401.7 ± 4811.3 in the AI user group. There were no cases in which lesions were completely removed. Compared with the AI non-user group (120.9 min), the reading time was reduced by 35.6% in the AI user group (77.9 min). CONCLUSIONS SBCE reading after reducing poorly visualized frames using the AI algorithm did not have a negative effect on the final diagnosis. SBCE reading method integrated with frame reduction and mucosal visualization evaluation will help improve AI-assisted SBCE interpretation.
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Affiliation(s)
- Dong Jun Oh
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, 27 Dongguk-ro, Ilsandong-gu, Goyang, 10326, Republic of Korea
| | - Youngbae Hwang
- Department of Electronics Engineering, Chungbuk National University, Cheongju, Republic of Korea
| | - Sang Hoon Kim
- Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea
| | - Ji Hyung Nam
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, 27 Dongguk-ro, Ilsandong-gu, Goyang, 10326, Republic of Korea
| | - Min Kyu Jung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Yun Jeong Lim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, 27 Dongguk-ro, Ilsandong-gu, Goyang, 10326, Republic of Korea.
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Kapoor A, Singh A, Kapur A, Mahajan G, Sharma S. Use of shear wave imaging with intestinal ultrasonography in patients with chronic diarrhea. J Clin Ultrasound 2024; 52:163-175. [PMID: 37997499 DOI: 10.1002/jcu.23594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE A retrospective study was designed to determine the role of shear wave elastography (SWE) and intestinal ultrasonography to differentiate between inflammatory and fibrotic bowel strictures by determining Young's modulus (E) and shear wave dispersion (SWD) and to compare its role with contrast-enhanced computed tomography (CECT) in patients with chronic diarrhea and pain abdomen. METHODS Seventy-six patients who had increased small bowel thickness (SBWT) >3 mm, and large bowel wall thickness (LBWT) >4 mm on intestinal ultrasonography (IUS) were evaluated in a two-step manner. The first step involved classifying patients with increased SBWT >3 mm and LBWT >4 mm by use of SWE and dispersion into three groups that is group I (fibrotic), group II (inflammatory) thickening, and group III (mixed-fibrosis and inflammatory) wall thickening. In the second step, etiological classification was done using six gray scale features of IUS that is length and degree of bowel thickening, presence of bowel stratification, Limberg grade of vascularity, status of mesenteric fat, juxta bowel status-nodes, fluid, and fistula formation to reach to a definitive diagnosis. These findings were compared with findings on CECT. Twenty-three patients had diagnosis confirmed by biopsy while 18 underwent surgery with histologic confirmation of operative findings. The sensitivity, specificity and AUROC for both modalities were compared. RESULTS Group I that is fibrotic group had 33 patients with fibrotic strictures of which fibrotic Crohn's disease (CD)and tuberculosis of the bowel were the dominant types followed by neoplastic and infective causes. In Group II that is inflammatory there were 32 patients with predominantly infective ileo-colitis, and ulcerative colitis patients while 11 patients were present in group III that is (mixed fibrotic and inflammatory) type of bowel wall thickening and were patients of inflammatory CD, infective ileo-colitis. The presence of length of bowel involvement, Limberg grade, mesenteric fat proliferation, and SBWT>9 mm were the statistically significant parameters on IUS which helped to reach to final diagnosis. The sensitivity and specificity of combined SWE with SWD and IUS were 100% and 99% while that of CECT was 78% and 96% respectively with AUROC of 100% and 64%. CONCLUSION SWI combined with IUS in a two-step manner is an accurate way to evaluate patients with chronic diarrhea who have increased SBWT and is not only able to differentiate inflammatory from fibrotic bowel wall thickening but also helps to form an etiological diagnosis.
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Affiliation(s)
- Atul Kapoor
- Department of Radiology, Advanced Diagnostics and Institute of Imaging, Amritsar, Punjab, India
| | - Anil Singh
- Department of Gastroenterology, North central Institute of Gastroenterology, Pathankot, Punjab, India
| | - Aprajita Kapur
- Department of Radiology, Advanced Diagnostics and Institute of Imaging, Amritsar, Punjab, India
| | - Goldaa Mahajan
- Department of Radiology, Advanced Diagnostics and Institute of Imaging, Amritsar, Punjab, India
| | - Shalinder Sharma
- Department of Radiology, Advanced Diagnostics and Institute of Imaging, Amritsar, Punjab, India
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Song F, Ma M, Zeng S, Shao F, Huang W, Feng Z, Rong P. CT enterography-based radiomics combined with body composition to predict infliximab treatment failure in Crohn's disease. Radiol Med 2024; 129:175-187. [PMID: 37982937 DOI: 10.1007/s11547-023-01748-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 10/27/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE Accurately predicting the treatment response in patients with Crohn's disease (CD) receiving infliximab therapy is crucial for clinical decision-making. We aimed to construct a prediction model incorporating radiomics and body composition features derived from computed tomography (CT) enterography for identifying individuals at high risk for infliximab treatment failure. METHODS This retrospective study included 137 patients with CD between 2015 and 2021, who were divided into a training cohort and a validation cohort with a ratio of 7:3. Patients underwent CT enterography examinations within 1 month before infliximab initiation. Radiomic features of the intestinal segments involved were extracted, and body composition features were measured at the level of the L3 lumbar vertebra. A model that combined radiomics with body composition was constructed. The primary outcome was the occurrence of infliximab treatment failure within 1 year. The model performance was evaluated using discrimination, calibration, and decision curves. RESULTS Fifty-two patients (38.0%) showed infliximab treatment failure. Eight significant radiomic features were used to develop the radiomics model. The model incorporating radiomics model score, skeletal muscle index (SMI), and creeping fat showed good discrimination for predicting infliximab treatment failure, with an area under the curve (AUC) of 0.88 (95% CI 0.81, 0.95) in the training cohort and 0.83 (95% CI 0.66, 1.00) in the validation cohort. The favorable clinical application was observed using decision curve analysis. CONCLUSIONS We constructed a comprehensive model incorporating radiomics and muscle volume, which could potentially be used to facilitate the individualized prediction of infliximab treatment response in patients with CD.
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Affiliation(s)
- Fulong Song
- Department of Radiology, Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Mengtian Ma
- Department of Radiology, Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Shumin Zeng
- Department of Radiology, Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Fang Shao
- Department of Radiology, Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Weiyan Huang
- Department of Radiology, Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Zhichao Feng
- Department of Radiology, Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Changsha, 410013, Hunan, China.
| | - Pengfei Rong
- Department of Radiology, Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Changsha, 410013, Hunan, China.
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VanFleet AX, Kinkead Z, Daniel J, Derr C. Utilization of point-of-care ultrasound to evaluate for enterovesical fistula. Emerg Radiol 2024; 31:113-115. [PMID: 38030949 DOI: 10.1007/s10140-023-02192-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Abstract
Enterovesical fistula formation is a relatively rare disease process although a common complication for patients with inflammatory bowel disease (IBD), notably Crohn's disease. Enterovesical fistulas most commonly arise from diverticulitis (65-80%), cancer (10-20%), or Crohn's disease (5-7%). An increasing amount of evidence supports the use of ultrasonography as the primary imaging method for the monitoring of complications in individuals with a documented history of IBD. Our case report presents a 30-year-old female with a history of Crohn's disease who presented to the Emergency Department with concern for possible enterovesical fistula formation. Using bedside gray-scale ultrasonography, a fistulous tract clearly visualizing air bubbles and fecal matter actively moving from bowel to the bladder through the fistula was visualized confirming the diagnosis of an enterovesical fistula. While CT imaging is instrumental in identifying mural and extramural complications of IBD, performing ultrasonography in patients with IBD serves as an efficient, inexpensive, and noninvasive diagnostic aid for the diagnosis of enterovesical fistula.
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Affiliation(s)
| | - Zoe Kinkead
- University of South Florida Emergency Medicine, Tampa, FL, USA
| | - Jeannez Daniel
- University of South Florida College of Medicine, Tampa, FL, USA
| | - Charlotte Derr
- University of South Florida Emergency Medicine, Tampa, FL, USA
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Zhang F, Zhou J, Wang L, Zeng Z, Fu S, Xie P, Meng X. Residual abnormalities on CTE predict adverse outcomes in Crohn's disease with endoscopic healing. Dig Liver Dis 2024; 56:248-257. [PMID: 37758612 DOI: 10.1016/j.dld.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Residual abnormalities on computed tomography enterography (CTE) in Crohn's disease (CD) with endoscopic healing (EH) may have prognostic implications and affect therapeutic strategy. METHODS CD patients with EH who underwent CTE between March 2015 and June 2022 were enrolled. CTE findings of the terminal ileum and the most severe segment of colon at the time of EH were assessed respectively for each patient. Cox regression analysis and Kaplan-Meier curves were used to evaluate the association between residual abnormalities and adverse outcomes. RESULTS A total of 140 patients (217 digestive segments) were included. Mesenteric edema (hazard ratio [HR] = 3.61, 95% CI = 1.81-7.20, P<0.001), fibrofatty proliferation (HR = 3.40, 95% CI = 1.97-5.85, P<0.001) and active small bowel inflammation (HR = 2.74, 95% CI = 1.59-4.71, P<0.001) were risk factors for clinical relapse. Furthermore, we built a scoring system using the three parameters. Radiologic score ≥ 1 was the best threshold to predict clinical relapse (HR = 4.56, 95% CI = 2.54-8.19, P<0.001) and it was validated in different outcomes. CONCLUSION The scoring system based on three residual abnormalities on CTE can predict adverse outcomes in CD patients with EH.
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Affiliation(s)
- Fangling Zhang
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University. 26th Yuancun the second Road, Guangzhou, Guangdong Province, 510655, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, China
| | - Jie Zhou
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University. 26th Yuancun the second Road, Guangzhou, Guangdong Province, 510655, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, China
| | - Ling Wang
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University. 26th Yuancun the second Road, Guangzhou, Guangdong Province, 510655, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, China
| | - Zhiming Zeng
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University. 26th Yuancun the second Road, Guangzhou, Guangdong Province, 510655, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, China
| | - Shuai Fu
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University. 26th Yuancun the second Road, Guangzhou, Guangdong Province, 510655, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, China
| | - Peiyi Xie
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University. 26th Yuancun the second Road, Guangzhou, Guangdong Province, 510655, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, China.
| | - Xiaochun Meng
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University. 26th Yuancun the second Road, Guangzhou, Guangdong Province, 510655, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, China.
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Dillman JR, Anupindi SA, Dane B. Proposal of an Abbreviated Noncontrast MR Enterography Protocol for Patients With Crohn Disease. AJR Am J Roentgenol 2024; 222:e2330422. [PMID: 38054957 DOI: 10.2214/ajr.23.30422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
MR enterography (MRE) protocols used in patients with Crohn disease are burdened by long acquisition time, high cost, and suboptimal patient experience. For several indications, highly diagnostic MRE can be performed in five or fewer sequences, without IV contrast material or antiperistaltic medication and with an examination room time of less than 12 minutes. As such, MRE could be more patient friendly, more frequently performed, and require fewer health care resources.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Ave, Cincinnati, OH 45229
| | - Sudha A Anupindi
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Bari Dane
- Department of Radiology, NYU Langone Health, New York, NY
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31
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Reyes Genere J, Ballard DH, Deepak P. Three-Dimensional Modeling to Guide Interventional Endoscopy in Fibrostenotic Crohn's Disease. Am J Gastroenterol 2024; 119:239. [PMID: 37830639 DOI: 10.14309/ajg.0000000000002558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/09/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Juan Reyes Genere
- Division of Gastroenterology, Inflammatory Bowel Diseases Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Parakkal Deepak
- Division of Gastroenterology, Inflammatory Bowel Diseases Center, Washington University School of Medicine, St. Louis, Missouri, USA
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Caron B, Jairath V, Laurent V, Stoker J, Laghi A, D'Haens GR, Danese S, Peyrin-Biroulet L. Defining Magnetic Resonance Imaging Treatment Response and Remission in Crohn's Disease: A Systematic Review. J Crohns Colitis 2024; 18:162-170. [PMID: 37523157 DOI: 10.1093/ecco-jcc/jjad125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Magnetic resonance imaging is increasingly used to assess treatment response in Crohn's disease clinical trials. We aimed to describe the definition of MRI response and remission as assessed by magnetic resonance enterography [MRE] to evaluate treatment efficacy in these patients. METHODS Electronic databases were searched up to May 1, 2023. All published studies enrolling patients with inflammatory bowel disease and assessment of treatment efficacy with MRE were eligible for inclusion. RESULTS Eighteen studies were included. All studies were performed in patients with Crohn's disease. The study period ranged from 2008 to 2023. The majority of studies used endoscopy as the reference standard [61.1%]. MRE response was defined in 11 studies [61.1%]. Five scores and nine different definitions were proposed for MRE response. MRE remission was defined in 12 studies [66.7%]. Three scores and nine different definitions for MRE remission were described. The MaRIA score was the most frequent index used to evaluate MRE response [63.6%] and remission [41.7%]. MRE response was defined as MaRIA score <11 in 63.6% of studies using this index. In 60% of studies using the MaRIA score, MRE remission was defined as MaRIA score <7. In addition, 11 different time points of assessment were reported, ranging from 6 weeks to years. CONCLUSION In this systematic review, significant heterogeneity in the definition of MRE response and remission evaluated in patients with Crohn's disease was observed. Harmonization of eligibility and outcome criteria for MRE in Crohn's Disease clinical trials is needed.
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Affiliation(s)
- Bénédicte Caron
- Department of Gastroenterology, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- INSERM, NGERE, University of Lorraine, F-54000 Nancy, France
- INFINY Institute, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- FHU-CURE, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
| | - Vipul Jairath
- Department of Medicine, Division of Gastroenterology, Western University, London, ON, Canada
| | - Valérie Laurent
- Department of Radiology, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
- IADI, U12454, INSERM, Université de Lorraine, CHRU Nancy, Nancy, France
| | - Jaap Stoker
- Amsterdam UMC, location University of Amsterdam, Department of Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Andrea Laghi
- Department of Medical Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, University of Rome Sapienza, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Geert R D'Haens
- Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- INSERM, NGERE, University of Lorraine, F-54000 Nancy, France
- INFINY Institute, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- FHU-CURE, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
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Brodersen JB, Jensen MD, Leenhardt R, Kjeldsen J, Histace A, Knudsen T, Dray X. Artificial Intelligence-assisted Analysis of Pan-enteric Capsule Endoscopy in Patients with Suspected Crohn's Disease: A Study on Diagnostic Performance. J Crohns Colitis 2024; 18:75-81. [PMID: 37527554 DOI: 10.1093/ecco-jcc/jjad131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND AND AIM Pan-enteric capsule endoscopy [PCE] is a highly sensitive but time-consuming tool for detecting pathology. Artificial intelligence [AI] algorithms might offer a possibility to assist in the review and reduce the analysis time of PCE. This study examines the agreement between PCE assessments aided by AI technology and standard evaluations, in patients suspected of Crohn's disease [CD]. METHOD PCEs from a prospective, blinded, multicentre study, including patients suspected of CD, were processed by the deep learning solution AXARO® [Augmented Endoscopy, Paris, France]. Based on the image output, two observers classified the patient's PCE as normal or suggestive of CD, ulcerative colitis, or cancer. The primary outcome was per-patient sensitivities and specificities for detecting CD and inflammatory bowel disease [IBD]. Complete reading of PCE served as the reference standard. RESULTS A total of 131 patients' PCEs were analysed, with a median recording time of 303 min. The AXARO® framework reduced output to a median of 470 images [2.1%] per patient, and the pooled median review time was 3.2 min per patient. For detecting CD, the observers had a sensitivity of 96% and 92% and a specificity of 93% and 90%, respectively. For the detection of IBD, both observers had a sensitivity of 97% and had a specificity of 91% and 90%, respectively. The negative predictive value was 95% for CD and 97% for IBD. CONCLUSIONS Using the AXARO® framework reduced the initial review time substantially while maintaining high diagnostic accuracy-suggesting its use as a rapid tool to rule out IBD in PCEs of patients suspected of Crohn's disease.
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Affiliation(s)
- Jacob Broder Brodersen
- Department of Internal Medicine, Section of Gastroenterology, Hospital of South West Jutland, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Michael Dam Jensen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Section of Gastroenterology, Lillebaelt Hospital, Vejle, Denmark
| | - Romain Leenhardt
- Équipes Traitement de l'Information et Systèmes, ETIS UMR 8051, CY Paris Cergy University, ENSEA, CNRS, Cergy, France
- Sorbonne University, Center for Digestive Endoscopy, Saint-Antoine Hospital, APHP, Paris, France
| | - Jens Kjeldsen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Aymeric Histace
- Équipes Traitement de l'Information et Systèmes, ETIS UMR 8051, CY Paris Cergy University, ENSEA, CNRS, Cergy, France
| | - Torben Knudsen
- Department of Internal Medicine, Section of Gastroenterology, Hospital of South West Jutland, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Xavier Dray
- Équipes Traitement de l'Information et Systèmes, ETIS UMR 8051, CY Paris Cergy University, ENSEA, CNRS, Cergy, France
- Sorbonne University, Center for Digestive Endoscopy, Saint-Antoine Hospital, APHP, Paris, France
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Schineis CHW, Pozios I, Boubaris K, Weixler B, Kamphues C, Margonis GA, Kreis ME, Strobel RM, Beyer K, Seifarth C, Luitjens J, Kaufmann D, Lauscher JC. Role of visceral fat on postoperative complications and relapse in patients with Crohn's disease after ileocecal resection: Is it overrated? Int J Colorectal Dis 2024; 39:20. [PMID: 38240842 PMCID: PMC10798911 DOI: 10.1007/s00384-023-04586-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/22/2024]
Abstract
INTRODUCTION The role of visceral fat in disease development, particularly in Crohn´s disease (CD), is significant. However, its preoperative prognostic value for postoperative complications and CD relapse after ileocecal resection (ICR) remains unknown. This study aims to assess the predictive potential of preoperatively measured visceral and subcutaneous fat in postoperative complications and CD recurrence using magnetic resonance imaging (MRI). The primary endpoint was postoperative anastomotic leakage of the ileocolonic anastomosis, with secondary endpoints evaluating postoperative complications according to the Clavien Dindo classification and CD recurrence at the anastomosis. METHODS We conducted a retrospective analysis of 347 CD patients who underwent ICR at our tertiary referral center between 2010 and 2020. We included 223 patients with high-quality preoperative MRI scans, recording demographics, postoperative outcomes, and CD recurrence rates at the anastomosis. To assess adipose tissue distribution, we measured total fat area (TFA), visceral fat area (VFA), subcutaneous fat area (SFA), and abdominal circumference (AC) at the lumbar 3 (L3) level using MRI cross-sectional images. Ratios of these values were calculated. RESULTS None of the radiological variables showed an association with anastomotic leakage (TFA p = 0.932, VFA p = 0.982, SFA p = 0.951, SFA/TFA p = 0.422, VFA/TFA p = 0.422), postoperative complications, or CD recurrence (TFA p = 0.264, VFA p = 0.916, SFA p = 0.103, SFA/TFA p = 0.059, VFA/TFA p = 0.059). CONCLUSIONS Radiological visceral obesity variables were associated with postoperative outcomes or clinical recurrence in CD patients undergoing ICR. Preoperative measurement of visceral fat measurement is not specific for predicting postoperative complications or CD relapse.
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Affiliation(s)
- Christian Hans Wolfgang Schineis
- Department of General and Visceral Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203, Berlin, Germany.
| | - Ioannis Pozios
- Department of General and Visceral Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203, Berlin, Germany
| | - Katharina Boubaris
- Department of General and Visceral Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203, Berlin, Germany
| | - Benjamin Weixler
- Department of General and Visceral Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203, Berlin, Germany
| | - Carsten Kamphues
- Department of General- and Visceral Surgery, Schloßparkklinik, Berlin, Germany
| | | | - Martin Ernst Kreis
- Department of General and Visceral Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203, Berlin, Germany
| | - Rahel Maria Strobel
- Department of General and Visceral Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203, Berlin, Germany
| | - Katharina Beyer
- Department of General and Visceral Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203, Berlin, Germany
| | - Claudia Seifarth
- Department of General and Visceral Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203, Berlin, Germany
| | - Jan Luitjens
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - David Kaufmann
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Johannes Christian Lauscher
- Department of General and Visceral Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203, Berlin, Germany
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Hunter SA, Baker ME, Ream JM, Sweet DE, Austin NA, Remer EM, Primak A, Bullen J, Obuchowski N, Karim W, Herts BR. Visceral adipose tissue volume effect in Crohn's disease using reduced exposure CT enterography. J Appl Clin Med Phys 2024; 25:e14235. [PMID: 38059633 PMCID: PMC10795447 DOI: 10.1002/acm2.14235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/08/2023] [Accepted: 11/25/2023] [Indexed: 12/08/2023] Open
Abstract
PURPOSE The purpose of this investigation was to assess the effect of visceral adipose tissue volume (VA) on reader efficacy in diagnosing and characterizing small bowel Crohn's disease using lower exposure CT enterography (CTE). Secondarily, we investigated the effect of lower exposure and VA on reader diagnostic confidence. METHODS Prospective paired investigation of 256 CTE, 129 with Crohn's disease, were reconstructed at 100% and simulated 50% and 30% exposure. The senior author provided the disease classification for the 129 patients with Crohn's disease. Patient VA was measured, and exams were evaluated by six readers for presence or absence of Crohn's disease and phenotype using a 0-10-point scale. Logistic regression models assessed the effect of VA on sensitivity and specificity. RESULTS The effect of VA on sensitivity was significantly reduced at 30% exposure (odds radio [OR]: 1.00) compared to 100% exposure (OR: 1.12) (p = 0.048). There was no statistically significant difference among the exposures with respect to the effect of visceral fat on specificity (p = 0.159). The study readers' probability of agreement with the senior author on disease classification was 60%, 56%, and 53% at 100%, 50%, and 30% exposure, respectively (p = 0.004). When detecting low severity Crohn's disease, readers' mean sensitivity was 83%, 75%, and 74% at 100%, 50%, and 30% exposure, respectively (p = 0.002). In low severity disease, sensitivity also tended to increase as visceral fat increased (ORs per 1000 cm3 increase in visceral fat: 1.32, 1.31, and 1.18, p = 0.010, 0.016, and 0.100, at 100%, 50%, and 30% exposure). CONCLUSIONS While the interaction is complex, VA plays a role in detecting and characterizing small bowel Crohn's disease when exposure is altered, particularly in low severity disease.
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Affiliation(s)
| | - Mark E. Baker
- Imaging Institute – Cleveland ClinicClevelandOhioUSA
| | | | | | | | | | | | - Jennifer Bullen
- Department of Quantitative Health Sciences – Cleveland ClinicClevelandOhioUSA
| | - Nancy Obuchowski
- Department of Quantitative Health Sciences – Cleveland ClinicClevelandOhioUSA
| | - Wadih Karim
- Imaging Institute – Cleveland ClinicClevelandOhioUSA
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Dane B, Qian K, Soni R, Megibow A. Crohn's disease inflammation severity assessment with iodine density from photon counting CT enterography: comparison with endoscopic histopathology. Abdom Radiol (NY) 2024; 49:271-278. [PMID: 37814149 DOI: 10.1007/s00261-023-04060-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE To determine optimal iodine density thresholds for active inflammation in CD patients with PCCT enterography and determine if iodine density can be used to stratify CD activity severity. METHODS A retrospective PACS search identified patients with CD imaged with PCCT enterography from 4/11/2022 to 10/30/2022 and with clinical notes, endoscopic/surgical pathology and available source PCCT data for iodine density analysis. Two abdominal radiologists with expertise in CD each drew two region of interest measurements within the visibly most affected region of terminal or neoterminal ileum wall on commercially available system (SyngoVia). Radiologists were blinded to clinical information and pathologic findings. Disease activity and severity were recorded from the pathology report. Harvey-Bradshaw Index, medications, and laboratory values were recorded. Receiver operating characteristic (ROC) curves were utilized to determine the optimum iodine density threshold for active inflammation and mild versus moderate-to-severe inflammation. Intra- and inter-reader agreement was assessed by intra-class correlation coefficient (ICC). RESULTS 23 CD patients (15 females; mean [SD] age: 52 [17] years) imaged with PCCT enterography were included. 15/23 had active inflammation: 9/15 mild, 4/15 moderate, and 2/15 severe active inflammation. The optimal iodine density threshold for active inflammation was 2.7 mg/mL, with 97% sensitivity, 100% specificity, and 98% accuracy (AUC = 1.00). The optimal iodine density threshold for distinguishing mild from moderate-to-severe inflammation was 3.4 mg/mL, with 83% sensitivity, 89% specificity, and 87% accuracy (AUC = 0.85). Intra-reader reliability (R1/R2) ICC was 0.81/0.86. Inter-reader reliability ICC was 0.94. CONCLUSION Iodine density from PCCT enterography can distinguish mild from moderate-to-severe active inflammation.
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Affiliation(s)
- Bari Dane
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA.
| | - Kun Qian
- Department of Biostatistics, NYU Langone Health, 180 Madison Avenue, New York, NY, 10016, USA
| | - Ria Soni
- NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Alec Megibow
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA
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Wang L, Zhang Y, Wu H, Tang Z, Wang Y, Huang Y. Intestinal ultrasound score predicts therapeutic outcomes of infliximab in pediatric patients with Crohn's disease. Scand J Gastroenterol 2024; 59:156-163. [PMID: 37905747 DOI: 10.1080/00365521.2023.2271110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/11/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND AND AIMS Objective evaluation of treatment response is critical in the management of Crohn's disease (CD). Compared with endoscopy, intestinal ultrasound (IUS) is non-invasive and well-tolerated. This study is aimed to assess the predictive value of IUS score for treatment response in pediatric CD patients. METHODS We conducted a retrospective study in pediatric CD patients who underwent endoscopy and IUS at start of infliximab treatment [T0] and after 22-38 weeks [T1] between February 2021 and January 2023. Pediatric Crohn's Disease Activity Index (PCDAI), biochemical parameters, the Simple Endoscopic Score for Crohn's disease (SES-CD) and IUS parameters were collected at two timepoints. IUS scores were assessed by International Bowel Ultrasound Segment Activity Score (IBUS-SAS). RESULTS Thirty patients were included, with 53.3% reaching endoscopic response and 43.3% endoscopic remission. After infliximab treatment, IBUS-SAS (58.5 ± 24.2 vs 34.4 ± 21.6, p = .0001) was significantly decreased. At T1, change in IBUS-SAS (-38.2 ± 22.0 vs -7.9 ± 24.1, p = .0015) were pronounced in patients with endoscopic response compared with endoscopic non-response. Significant correlation were observed between IBUS-SAS and SES-CD, PCDAI, C-reaction protein, erythrocyte sedimentation rate, hemoglobin, albumin. The most accurate cutoff values for predicting endoscopic response were 57.4% decrease of IBUS-SAS (AUROC: 0.862, p < .001). The optimal cut-off of IBUS-SAS to correlate endoscopic remission was 26.0 (AUROC: 0.686, p = .017). CONCLUSIONS The validated ultrasound-base score, IBUS-SAS is an effective index for monitoring endoscopic response to infliximab therapy in CD. IUS evaluation could guide treatment decision for pediatric CD.
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Affiliation(s)
- Lin Wang
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China
| | - Yuan Zhang
- Department of Ultrasonography, Children's Hospital of Fudan University, Shanghai, China
| | - Hailin Wu
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China
| | - Zifei Tang
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China
| | - Yuhuan Wang
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China
| | - Ying Huang
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China
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Jia Z, Wang Y, Li S, Yang M, Liu Z, Zhang H. MICDnet: Multimodal information processing networks for Crohn's disease diagnosis. Comput Biol Med 2024; 168:107790. [PMID: 38042104 DOI: 10.1016/j.compbiomed.2023.107790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/04/2023]
Abstract
Crohn's disease (CD) is a chronic inflammatory disease with increasing incidence worldwide and unclear etiology. Its clinical manifestations vary depending on location, extent, and severity of the lesions. In order to diagnose Crohn's disease, medical professionals need to comprehensively analyze patients' multimodal examination data, which includes medical imaging such as colonoscopy, pathological, and text information from clinical records. The processes of multimodal data analysis require collaboration among medical professionals from different departments, which wastes a lot of time and human resources. Therefore, a multimodal medical assisted diagnosis system for Crohn's disease is particularly significant. Existing network frameworks find it hard to effectively capture multimodal patient data for diagnosis, and multimodal data for Crohn's disease is currently lacking. In addition,a combination of data from patients with similar symptoms could serve as an effective reference for disease diagnosis. Thus, we propose a multimodal information diagnosis network (MICDnet) to learn CD feature representations by integrating colonoscopy, pathology images and clinical texts. Specifically, MICDnet first preprocesses each modality data, then uses encoders to extract image and text features separately. After that, multimodal feature fusion is performed. Finally, CD classification and diagnosis are conducted based on the fused features. Under the authorization, we build a dataset of 136 hospitalized inspectors, with colonoscopy images of seven areas, pathology images, and clinical record text for each individual. Training MICDnet on this dataset shows that multimodal diagnosis can improve the diagnostic accuracy of CD, and the diagnostic performance of MICDnet is superior to other models.
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Affiliation(s)
- Zixi Jia
- Faculty of Robot Science and Engineering, Northeastern University, Shenyang, Liaoning, 110169, China
| | - Yilu Wang
- Faculty of Robot Science and Engineering, Northeastern University, Shenyang, Liaoning, 110169, China
| | - Shengming Li
- Faculty of Robot Science and Engineering, Northeastern University, Shenyang, Liaoning, 110169, China
| | - Meiqi Yang
- Department of Endoscopy, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, China
| | - Zhongyuan Liu
- Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China.
| | - Huijing Zhang
- Department of Endoscopy, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, China.
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Balestrieri P, Ribolsi M, Cimini P, Alvaro G, Zobel BB, Tullio A, Cicala M. Wall Thickness Ratio-A New Magnetic Resonance Parameter-Is Associated With the Outcome of Biological Therapy in Patients With Ileal and Ileocolonic Crohn's Disease. J Clin Gastroenterol 2024; 58:64-70. [PMID: 36730458 DOI: 10.1097/mcg.0000000000001809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 10/20/2022] [Indexed: 02/04/2023]
Abstract
GOALS The present study was aimed at identifying a new magnetic resonance enterography (MRE) parameter assessing the clinical outcome of biological therapy in patients with active ileal/ileocolonic Crohn's disease (CD). BACKGROUND Transmural healing (TH) has been associated with improved outcomes in CD. However, some patients with clinical remission and inactive disease at endoscopy do not achieve TH. MATERIALS AND METHODS Ileal/ileocolonic CD patients scheduled for biological therapy were prospectively evaluated, at baseline (T0) and after 1 year of treatment (T1), with Harvey Bradshaw Index score, blood tests, ileocolonscopy, and MRE. Clinical activity was assessed after 2 years of treatment (T2). Wall thickness ratio (WTR) was calculated in the same affected ileal segment, as the ratio between the ileum wall thickness value at T1 and the ileum wall thickness value at T0. RESULTS A total of 103 patients were included. Mean WTR at T1 in nonresponders was significantly higher than in responders. At receiver operating characteristic analysis, WTR values were significantly associated to biological therapy responsiveness. A WTR cutoff value of 0.77 mm was identified to discriminate responders from nonresponders (sensitivity: 79%; specificity: 67%). In responders, the proportion of patients with a WTR<0.77 was significantly higher than the proportion of patients achieving TH at T1. Among patients achieving endoscopic remission, 11/29 (37.9%) presented TH, while 20/29 (68.9%) presented WTR<0.77 ( P : 0.035). At multivariate logistic regression analysis, WTR<0.77 was significantly associated to biological therapy response. CONCLUSION WTR index represents an easy-to-calculate MRE parameter and seems to be a promising tool for monitoring therapeutic response in CD patients during biological therapy.
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Affiliation(s)
| | | | - Paola Cimini
- Diagnostic Imaging, Campus Bio Medico University of Rome, Roma, Italy
| | - Giuseppe Alvaro
- Diagnostic Imaging, Campus Bio Medico University of Rome, Roma, Italy
| | - Bruno B Zobel
- Diagnostic Imaging, Campus Bio Medico University of Rome, Roma, Italy
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Radmard AR, Amouei M, Torabi A, Sima AR, Saffar H, Geahchan A, Davarpanah AH, Taouli B. MR Enterography in Ulcerative Colitis: Beyond Endoscopy. Radiographics 2024; 44:e230131. [PMID: 38127661 DOI: 10.1148/rg.230131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Ulcerative colitis (UC) is a chronic idiopathic inflammatory bowel disease (IBD) that progressively affects mucosa and submuccosa of the colon and rectum in a continual pattern. In comparison, Crohn disease (CD), the other type of IBD, is a chronic transmural inflammatory disorder that can involve any part of the gastrointestinal tract. MR enterography (MRE) has emerged as an important imaging modality for the diagnosis and detection of disease activity and complications in CD, with comparable results to those of endoscopy. But MRE has been underused for assessment of UC in recent years, and clinicians heavily rely on endoscopic findings for management of UC. Despite UC being considered an endoscopically assessable disease, MRE can provide useful information beyond that obtained with endoscopy about mural or extramural abnormalities, inaccessible parts of the colonic lumen, associated extraintestinal diseases, and superimposed pathologic conditions. Moreover, endoscopy might be contraindicated in some clinical settings due to the risk of colonic perforation. In addition to depicting the features of UC activity in different phases, MRE demonstrates findings of disease chronicity that cannot be achieved with endoscopy, particularly in a patient with colitis of unknown cause. The valuable diagnostic role of MRE to exclude undiagnosed CD in patients with UC who have refractory disease or those with postproctocolectomy complications is also emphasized. Radiologists can play a crucial role in the management of UC with MRE by addressing what is beyond endoscopy. ©RSNA, 2023 Test Your Knowledge questions are available in the supplemental material.
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Affiliation(s)
- Amir Reza Radmard
- From the Departments of Radiology (A.R.R., M.A., A.T.) and Pathology (H.S.), Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran 14117, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran (A.R.R., M.A., A.T.); Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (A.R.S.); Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran (A.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.H.D.)
| | - Mehrnam Amouei
- From the Departments of Radiology (A.R.R., M.A., A.T.) and Pathology (H.S.), Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran 14117, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran (A.R.R., M.A., A.T.); Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (A.R.S.); Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran (A.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.H.D.)
| | - Ala Torabi
- From the Departments of Radiology (A.R.R., M.A., A.T.) and Pathology (H.S.), Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran 14117, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran (A.R.R., M.A., A.T.); Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (A.R.S.); Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran (A.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.H.D.)
| | - Ali Reza Sima
- From the Departments of Radiology (A.R.R., M.A., A.T.) and Pathology (H.S.), Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran 14117, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran (A.R.R., M.A., A.T.); Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (A.R.S.); Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran (A.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.H.D.)
| | - Hiva Saffar
- From the Departments of Radiology (A.R.R., M.A., A.T.) and Pathology (H.S.), Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran 14117, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran (A.R.R., M.A., A.T.); Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (A.R.S.); Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran (A.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.H.D.)
| | - Amine Geahchan
- From the Departments of Radiology (A.R.R., M.A., A.T.) and Pathology (H.S.), Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran 14117, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran (A.R.R., M.A., A.T.); Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (A.R.S.); Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran (A.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.H.D.)
| | - Amir H Davarpanah
- From the Departments of Radiology (A.R.R., M.A., A.T.) and Pathology (H.S.), Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran 14117, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran (A.R.R., M.A., A.T.); Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (A.R.S.); Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran (A.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.H.D.)
| | - Bachir Taouli
- From the Departments of Radiology (A.R.R., M.A., A.T.) and Pathology (H.S.), Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran 14117, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran (A.R.R., M.A., A.T.); Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (A.R.S.); Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Center, Tehran, Iran (A.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (A.G., B.T.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.H.D.)
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Carter D, Albshesh A, Shimon C, Segal B, Yershov A, Kopylov U, Meyers A, Brzezinski RY, Ben Horin S, Hoffer O. Automatized Detection of Crohn's Disease in Intestinal Ultrasound Using Convolutional Neural Network. Inflamm Bowel Dis 2023; 29:1901-1906. [PMID: 36794834 DOI: 10.1093/ibd/izad014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Indexed: 02/17/2023]
Abstract
INTRODUCTION The use of intestinal ultrasound (IUS) for the diagnosis and follow-up of inflammatory bowel disease is steadily growing. Although access to educational platforms of IUS is feasible, novice ultrasound operators lack experience in performing and interpreting IUS. An artificial intelligence (AI)-based operator supporting system that automatically detects bowel wall inflammation may simplify the use of IUS by less experienced operators. Our aim was to develop and validate an artificial intelligence module that can distinguish bowel wall thickening (a surrogate of bowel inflammation) from normal bowel images of IUS. METHODS We used a self-collected image data set to develop and validate a convolutional neural network module that can distinguish bowel wall thickening >3 mm (a surrogate of bowel inflammation) from normal bowel images of IUS. RESULTS The data set consisted of 1008 images, distributed uniformly (50% normal images, 50% abnormal images). Execution of the training phase and the classification phase was performed using 805 and 203 images, respectively. The overall accuracy, sensitivity, and specificity for detection of bowel wall thickening were 90.1%, 86.4%, and 94%, respectively. The network exhibited an average area under the ROC curve of 0.9777 for this task. CONCLUSIONS We developed a machine-learning module based on a pretrained convolutional neural network that is highly accurate in the recognition of bowel wall thickening on intestinal ultrasound images in Crohn's disease. Incorporation of convolutional neural network to IUS may facilitate the use of IUS by inexperienced operators and allow automatized detection of bowel inflammation and standardization of IUS imaging interpretation.
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Affiliation(s)
- Dan Carter
- Institute of Gastroenterology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ahmed Albshesh
- Institute of Gastroenterology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel
| | - Carmi Shimon
- School of Electrical Engineering, Afeka Tel Aviv Academic College of Engineering, Tel Aviv, Israel
| | - Batel Segal
- School of Electrical Engineering, Afeka Tel Aviv Academic College of Engineering, Tel Aviv, Israel
| | - Alex Yershov
- School of Electrical Engineering, Afeka Tel Aviv Academic College of Engineering, Tel Aviv, Israel
| | - Uri Kopylov
- Institute of Gastroenterology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adele Meyers
- School of Electrical Engineering, Afeka Tel Aviv Academic College of Engineering, Tel Aviv, Israel
| | - Rafael Y Brzezinski
- School of Electrical Engineering, Afeka Tel Aviv Academic College of Engineering, Tel Aviv, Israel
| | - Shomron Ben Horin
- Institute of Gastroenterology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oshrit Hoffer
- School of Electrical Engineering, Afeka Tel Aviv Academic College of Engineering, Tel Aviv, Israel
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Rezazadeh F, Kilcline AP, Viola NT. Imaging Agents for PET of Inflammatory Bowel Disease: A Review. J Nucl Med 2023; 64:1858-1864. [PMID: 37918865 PMCID: PMC10690123 DOI: 10.2967/jnumed.123.265935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/27/2023] [Indexed: 11/04/2023] Open
Abstract
Inflammatory bowel disease (IBD), which encompasses ulcerative colitis and Crohn disease, is a chronic inflammatory disorder resulting from an aberrant immune response, though its exact cause is unknown. The current mainstay standard of care for the diagnosis and surveillance of IBD is endoscopy. However, this methodology is invasive and images only superficial tissue structures, revealing very little about the molecular drivers of inflammation. Accordingly, there is an unmet need for noninvasive imaging tools that provide reliable and quantitative visualization of intestinal inflammation with high spatial and molecular specificity. In recent years, several PET agents for imaging IBD have been reported. Such agents allow noninvasive visualization and quantification of dynamic molecular inflammatory processes in vivo. This review focuses on recent advancements in the development of PET tracers for imaging biomarkers of interest in IBD pathogenesis, such as cell-surface molecules that are overexpressed on immune cells and cytokines that perpetuate inflammatory signaling.
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Affiliation(s)
- Farzaneh Rezazadeh
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Aidan P Kilcline
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Nerissa T Viola
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
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Uzzan M, Assouline V, Chambenois E, Djabbari M, Arrive L, Charpy C, Luciani A, Sobhani I, Becq A, Beaugerie L, Svrcek M, Kirchgesner J. Focal loss of mural stratification as a radiological predictor for small bowel adenocarcinoma in Crohn's disease. Clin Res Hepatol Gastroenterol 2023; 47:102246. [PMID: 37967612 DOI: 10.1016/j.clinre.2023.102246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 11/17/2023]
Abstract
AIM Patients with Crohn's disease (CD) are at higher risk of small bowel adenocarcinoma (SBA). We aimed to identify radiological predictors of SBA in CD. METHODS We conducted a retrospective case-control study at two tertiary inflammatory bowel disease centers and identified CD patients diagnosed with SBA between 2003 and 2019. Patients were matched with up to four controls. Pre-operative imaging (magnetic resonance imaging (MRI) or computed tomography (CT)) were reviewed by three gastrointestinal radiologists. RESULTS Nineteen patients with CD-associated SBA with a mean age of 54.9 and 32 matched controls were included. Mean length of small bowel involvement was 216 (± 188) mm in the SBA group versus 156 (± 167) mm in the control group (p = 0.76). Only 11.8 % of cases had a diagnosis of SBA made preoperatively. In univariate analysis, focal loss of mural stratification (odds ratio [OR], 11; 95%CI, 2.43-49.5, p = 0.002), and wall thickening (OR, 1.32; 95%CI, 1.05-1.66, p = 0.02) were significantly associated with SBA. After adjustment, focal loss of mural stratification was the only independent risk factor (OR, 11; 95 % CI, 2.43-49.5, p = 0.002). CONCLUSIONS Focal loss of mural stratification was identified as a predictor of CD-associated SBA, which should be described in imaging reports and further validated.
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Affiliation(s)
- Mathieu Uzzan
- Department of gastroenterology, Hopital Henri Mondor, APHP, 1 rue Gustave Eiffel, Créteil 94000, France.
| | - Victoria Assouline
- Department of gastroenterology, Hopital Henri Mondor, APHP, 1 rue Gustave Eiffel, Créteil 94000, France
| | | | - Marjan Djabbari
- Department of gastroenterology, Hopital Henri Mondor, APHP, 1 rue Gustave Eiffel, Créteil 94000, France
| | - Lionel Arrive
- Department of radiology, Hopital Saint Antoine, APHP, Paris, France
| | - Cécile Charpy
- Department of pathology, Hopital Henri Mondor, APHP, Créteil, France
| | - Alain Luciani
- Department of gastroenterology, Hopital Henri Mondor, APHP, 1 rue Gustave Eiffel, Créteil 94000, France
| | - Iradj Sobhani
- Department of gastroenterology, Hopital Henri Mondor, APHP, 1 rue Gustave Eiffel, Créteil 94000, France
| | - Aymeric Becq
- Department of gastroenterology, Hopital Henri Mondor, APHP, 1 rue Gustave Eiffel, Créteil 94000, France
| | - Laurent Beaugerie
- Department of gastroenterology, Hopital Saint Antoine, APHP, Paris, France
| | - Magali Svrcek
- Department of pathology, Hopital Saint Antoine, APHP, Paris, France
| | - Julien Kirchgesner
- Department of gastroenterology, Hopital Saint Antoine, APHP, Paris, France
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Chóliz Ezquerro J, Aparicio López D, García López S, Hörndler Argárate C, Serradilla Martín M. Duodenal stenosis surgical treatment in Crohn's disease. Rev Esp Enferm Dig 2023; 115:733-734. [PMID: 36926950 DOI: 10.17235/reed.2023.9521/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
We present the case of a 34-year-old man with daily vomiting and 20% weight loss in a year. A gastroduodenoscopy was performed, noticing 2nd and 3rd duodenal portion dilatation and inflammatory involvement of the 3rd and 4th portion, causing luminal stenosis. These findings are the same than in the magnetic resonance . The biopsy proves the histological diagnosis of Crohn's disease. At the beginning the patient was treated with Prednisone, Adalimumab and Ustekinumab. After 9 months, surgery was decided because the disease was refractory to treatment and there was corticosteroid dependence. A partial resection of 3rd and 4th portion of the duodenum and the first loop of jejunum was performed, with duodenojejunal anastomosis. The patient presents good postoperative evolution and after 1 year he remained asymptomatic under treatment with Ustekinumab.
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You MW, Moon SK, Lee YD, Oh SJ, Park SJ, Lee CK. Assessing Active Bowel Inflammation in Crohn's Disease Using Intestinal Ultrasound: Correlation With Fecal Calprotectin. J Ultrasound Med 2023; 42:2791-2802. [PMID: 37578288 DOI: 10.1002/jum.16317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/13/2023] [Accepted: 07/30/2023] [Indexed: 08/15/2023]
Abstract
AIM To analyze the correlation between intestinal ultrasound (IUS) and serum and fecal biomarkers, and the characteristics of small bowel disease, for the assessment of active bowel inflammation. METHODS Patients with Crohn's disease (CD) who underwent an initial IUS examination between July 2018 and November 2022 at our institution were included retrospectively. We divided small and large bowels into seven segments, and recorded the presence of active inflammation according to following criteria: bowel wall thickness ≥ mm with ≥1 of feature of active disease on IUS. The correlations between IUS-assessed activity and serum C-reactive protein (CRP, mg/dL) and fecal calprotectin (FC, μg/g) levels were analyzed. RESULTS A total of 127 patients were included (mean age: 32.42 ± 12.07, M:F = 90:37, median disease duration 6 years [0-35]). Of them, 78 showed active bowel inflammation (61.4%), with inflammation distal to the terminal ileum being the most common disease location (n = 61, 78.2%). FC and serum CRP levels were significantly correlated with the number of segments with active inflammation (rho = 0.58, 0.48), number of segments with complications (r = 0.35, 0.31), and US activity score (r = 0.62, 0.54). With FC cutoff values of 100 and 150 μg/g, the concordance rates for patients with active small bowel disease were 78.7% (26/33) and 72.7% (24/33), respectively, which were better than those for other disease locations. CONCLUSIONS Disease activity determined by IUS was significantly correlated with the biomarkers, with a better concordance rate in patients with active small bowel disease than in those with other disease locations with FC cut-off values of 100 and 150 μg/g.
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Affiliation(s)
- Myung-Won You
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Sung Kyoung Moon
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Yong Dae Lee
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Shin Ju Oh
- Center for Crohn's and Colitis, Department of Gastroenterology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Seong Jin Park
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Chang Kyun Lee
- Center for Crohn's and Colitis, Department of Gastroenterology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
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Dell'Era A, Cannatelli R, Ferretti F, Manzotti C, Dilillo D, Zuccotti G, Meneghin F, Ardizzone S, Maconi G. Relevance of sonographic parameters for inflammatory bowel disease in children. J Ultrasound 2023; 26:815-822. [PMID: 37402110 PMCID: PMC10632348 DOI: 10.1007/s40477-023-00800-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/24/2023] [Indexed: 07/05/2023] Open
Abstract
PURPOSE Intestinal ultrasound (IUS) is widely used as the first exam in patients with suspected inflammatory bowel disease (IBD). This study investigated the accuracy of several IUS parameters, including increased bowel wall thickening (BWT), in detecting IBD in a paediatric population. METHODS The study included an unselected series of 113 patients aged 2-18 years (mean age 10.8 years, 65 male), referred for recurrent abdominal pain or altered bowel habits, without known organic diseases, to perform an IUS as first investigation of a diagnostic workup. Patients with full systematic IUS examination, clinical and biochemical exams, and ileocolonoscopy or an uneventful follow-up at least one year follow up were eligible. RESULTS 23 IBD patients (20.4%; 8 ulcerative colitis, 12 Crohn's disease and 3 indeterminate colitis) were diagnosed. We found that increased BWT > 3 mm (OR 5.4), altered IUS bowel pattern (IUS-BP, OR 9.8) and mesenteric hypertrophy (MH, OR 5.2) accurately identified IBD at the multivariate analysis. IUS-BP, MH and BWT > 3 mm had a sensitivity of 78.3%, 65.2% and 69.6% and a specificity of 93.3%, 92.2% and 96.7%, respectively. The combination of these three alterations increased the specificity up to 100%, whilst decreased sensitivity to 56.5%. CONCLUSION Among several US parameters suggestive of IBD, the increased BWT, MH and altered echopattern are independent predictors of IBD. The ultrasonographic diagnosis of IBD could be more accurate if relied on combination of different sonographic parameters, than on the sole BWT evaluation.
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Affiliation(s)
- Alessandra Dell'Era
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, University of Milan, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy
| | - Rosanna Cannatelli
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, University of Milan, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy
| | - Francesca Ferretti
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, University of Milan, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy
| | - Cristina Manzotti
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, University of Milan, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy
| | - Dario Dilillo
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Via Lodovico Castelvetro, 32, 20154, Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Via Lodovico Castelvetro, 32, 20154, Milan, Italy
| | - Fabio Meneghin
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Via Lodovico Castelvetro, 32, 20154, Milan, Italy
| | - Sandro Ardizzone
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, University of Milan, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, University of Milan, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy.
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Shi L, Wang YD, Shen XD, Mao R, Meng JX, Huang SY, Song T, Li ZP, Feng ST, Lin SC, Peng ZP, Li XH. Clinical outcome is distinct between radiological stricture and endoscopic stricture in ileal Crohn's disease. Eur Radiol 2023; 33:7595-7608. [PMID: 37231068 DOI: 10.1007/s00330-023-09743-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 03/13/2023] [Accepted: 03/26/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Differences in clinical adverse outcomes (CAO) based on different intestinal stricturing definitions in Crohn's disease (CD) are poorly documented. This study aims to compare CAO between radiological strictures (RS) and endoscopic strictures (ES) in ileal CD and explore the significance of upstream dilatation in RS. METHODS This retrospective double-center study included 199 patients (derivation cohort, n = 157; validation cohort, n = 42) with bowel strictures who simultaneously underwent endoscopic and radiologic examinations. RS was defined as a luminal narrowing with wall thickening relative to the normal gut on cross-sectional imaging (group 1 (G1)), which further divided into G1a (without upstream dilatation) and G1b (with upstream dilatation). ES was defined as an endoscopic non-passable stricture (group 2 (G2)). Strictures met the definitions of RS (with or without upstream dilatation) and ES were categorized as group 3 (G3). CAO referred to stricture-related surgery or penetrating disease. RESULTS In the derivation cohort, G1b (93.3%) had the highest CAO occurrence rate, followed by G3 (32.6%), G1a (3.2%), and G2 (0%) (p < 0.0001); the same order was found in the validation cohort. The CAO-free survival time was significantly different among the four groups (p < 0.0001). Upstream dilatation (hazard ratio, 1.126) was a risk factor for predicting CAO in RS. Furthermore, when upstream dilatation was added to diagnose RS, 17.6% of high-risk strictures were neglected. CONCLUSIONS CAO differs significantly between RS and ES, and clinicians should pay more attention to strictures in G1b and G3. Upstream dilatation has an important impact on the clinical outcome of RS but may not be an essential factor for RS diagnosis. CLINICAL RELEVANCE STATEMENT This study explored the definition of intestinal stricture with the greatest significance for the clinical diagnosis and prognosis of patients with CD, and consequently provided effective auxiliary information for clinicians to formulate strategies for the treatment of CD intestinal strictures. KEY POINTS • The retrospective double-center study showed that clinical adverse outcome is different between radiological strictures and endoscopic strictures in CD. • Upstream dilatation has an important impact on the clinical outcome of radiological strictures but may not be an essential factor for diagnosis of radiological strictures. • Radiological stricture with upstream dilatation and simultaneous radiological and endoscopic stricture were at increased risk for clinical adverse outcomes; thus, closer monitoring should be considered.
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Affiliation(s)
- Li Shi
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, 510150, People's Republic of China
| | - Yang-di Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Xiao-di Shen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Ren Mao
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Ji-Xin Meng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Si-Yun Huang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Ting Song
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, 510150, People's Republic of China
| | - Zi-Ping Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Shao-Chun Lin
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China.
| | - Zhen-Peng Peng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China.
| | - Xue-Hua Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China.
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Bihain F, Caron B, Ayav A, Peyrin-Biroulet L, Laurent V, Germain A. Preoperative Magnetic Resonance Enterography to Predict Pathological Specimen Length in Crohn's Disease. Dis Colon Rectum 2023; 66:e1119-e1127. [PMID: 36102838 DOI: 10.1097/dcr.0000000000002477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The European Crohn's and Colitis Organization guidelines have highlighted the importance of the preoperative evaluation of the affected segment length in patients with ileocolic Crohn's disease to determine the best surgical approach. OBJECTIVE This study aimed to evaluate the accuracy of preoperative magnetic resonance enterography in assessing the length of the affected segment in patients with ileocolic Crohn's disease. DESIGN This observational study was conducted with a prospectively maintained database and retrospective analysis. SETTINGS This study was conducted in a tertiary center. PATIENTS This study included consecutive patients undergoing ileocolic resection for Crohn's disease between August 2014 and June 2020. All patients underwent a preoperative magnetic resonance enterography. MAIN OUTCOME MEASURES The correlation between the length measured on magnetic resonance enterography and pathological examination was evaluated. RESULTS A total of 96 patients were included. The median time between magnetic resonance enterography and surgery was 65.5 (3-331) days. The length of the affected segment on magnetic resonance enterography was correlated with the length assessed on pathological evaluation ( R = 0.48, p < 0.001). No correlation was found between the 2 measurements when imaging was performed >6 months before surgery ( R = 0.14, p = 0.62). The presence of an abscess underestimated the length affected by Crohn's disease on imaging compared to pathology, whereas the presence of a fistula was associated with magnetic resonance enterography overestimation of the length of the affected segment. LIMITATIONS Limitations included single-center study and retrospective analysis. CONCLUSION In Crohn's disease, preoperative magnetic resonance enterography is a highly reliable tool for predicting the length of the affected segment compared to pathology examination in the absence of an abscess or fistula. See Video Abstract at http://links.lww.com/DCR/C26 . ENTEROGRAFA POR RESONANCIA MAGNTICA PREOPERATORIA PARA PREDECIR LA LONGITUD DE MUESTRAS PATOLGICAS EN LA ENFERMEDAD DE CROHN ANTECEDENTES:Las guías de la Organización Europea de Crohn y Colitis han resaltado la importancia de la evaluación preoperatoria de la longitud del segmento afectado para determinar el mejor abordaje quirúrgico.OBJETIVO:Evaluamos la precisión de la enterografía por resonancia magnética preoperatoria para evaluar la longitud del segmento afectado en pacientes con enfermedad de Crohn ileocólica.DISEÑO:Realizamos un estudio observacional con una base de datos mantenida prospectivamente y un análisis retrospectivo.CONFIGURACIÓN:Este estudio se realizó en un centro terciario.PACIENTES:Se incluyeron pacientes consecutivos sometidos a resección ileocólica por enfermedad de Crohn entre Agosto de 2014 y Junio de 2020. A todos los pacientes se les realizó una enterografía por resonancia magnética preoperatoria.PRINCIPALES MEDIDAS DE RESULTADO:Se evaluó la correlación entre la longitud medida en la enterografía por resonancia magnética y el examen patológico.RESULTADOS:Se incluyeron un total de 96 pacientes. El tiempo mediano entre la enterografía por resonancia magnética y la cirugía fue de 65,5 (3-331) días. La longitud del segmento afectado en la enterografía por resonancia magnética se correlacionó con la longitud evaluada en la evaluación patológica ( R = 0,48, p < 0,001). No hubo correlación entre las 2 mediciones cuando las imágenes se realizaron más de 6 meses antes de la cirugía ( R = 0,14, p = 0,62). La presencia de un absceso subestimó la longitud afectada por la enfermedad de Crohn en las imágenes en comparación con la patología, mientras que la presencia de una fístula se asoció con una sobrestimación de la longitud del segmento afectado por enterografía por resonancia magnética.LIMITACIONES:Las limitaciones incluyeron un estudio de un solo centro y un análisis retrospectivo.CONCLUSIÓNES:En la enfermedad de Crohn, la enterografía por resonancia magnética preoperatoria es una herramienta altamente confiable para predecir la longitud del segmento afectado en comparación con el examen de patología, en ausencia de absceso o fístula. Consulte el Video Resumen en http://links.lww.com/DCR/C26 . (Traducción-Dr. Yesenia Rojas-Khalil ).
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Affiliation(s)
- Florence Bihain
- Department of Hepatobiliary, Colorectal and Digestive Surgery, University of Nancy, CHU Nancy-Brabois, Nancy, France
| | - Bénédicte Caron
- Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Ahmet Ayav
- Department of Hepatobiliary, Colorectal and Digestive Surgery, University of Nancy, CHU Nancy-Brabois, Nancy, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Valérie Laurent
- Department of Radiology, University of Nancy, CHU Nancy-Brabois, Nancy, France
| | - Adeline Germain
- Department of Hepatobiliary, Colorectal and Digestive Surgery, University of Nancy, CHU Nancy-Brabois, Nancy, France
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Zhou J, Li W, Guo M, Huang Z, Kong D, Zhang F, Wang L, Gong J, Meng X. Mesenteric creeping fat index defined by CT enterography is associated with early postoperative recurrence in patients with Crohn's disease. Eur J Radiol 2023; 168:111144. [PMID: 37862926 DOI: 10.1016/j.ejrad.2023.111144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/12/2023] [Accepted: 10/05/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVES To investigate the value of mesenteric creeping fat index (MCFI) defined by computed-tomography enterography (CTE) in patients with Crohn's Disease (CD) for predicting early postoperative recurrence. METHODS A total of 110 patients with CD who underwent CTE and I-stage intestinal resection surgery from December 2013 to December 2018 were enrolled. Two radiologists independently assessed CTE parameters, including MCFI, with scores ranging from 1 to 8; bowel-wall thickening, with a scale of 1 to 3; mural hyperenhancement, mural stratification, submucosal fat deposition, mesenteric fibrofatty proliferation, mesenteric hypervascularity, mesenteric fat stranding, with a scale of 0 to 2; abscess/fistula, enlarged mesenteric lymph node, abdominal and pelvic effusion, with a scale of 0 to 1. Imaging findings associated with early recurrence were assessed using logistic regression analysis. RESULTS Within one year follow-up, early postoperative recurrence occurred in 56.4 % (62/110) patients with CD. In univariate analysis, MCFI, bowel-wall thickening, mesenteric hypervascularity, mesenteric fat stranding, abscess/fistula and mesenteric lymphadenopathy were associated with early postoperative recurrence. Among all variables, MCFI (score ≥ 4) contributes the optimal AUC (0.838 [0.758-0.919]), specificity (89.6 %), positive predictive value (90.7 %), accuracy (83.6 %), and risk ratio (OR = 32.42 [10.69-98.33], p < 0.001). In multivariate analysis, only MCFI was an independent predictor of early postoperative recurrence (OR = 25.71 [7.65-86.35], p < 0.001). CONCLUSION CTE features are useful in predicting early postoperative recurrence in patients with CD, MCFI may be a valuable tool for clinical monitoring and follow-up.
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Affiliation(s)
- Jie Zhou
- Department of Radiology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, People's Republic of China
| | - Wenru Li
- Department of Radiology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, People's Republic of China
| | - Minyi Guo
- Department of Radiology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, People's Republic of China
| | - Zicheng Huang
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, People's Republic of China; Department of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Decan Kong
- Department of Radiology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, People's Republic of China
| | - Fangling Zhang
- Department of Radiology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, People's Republic of China
| | - Ling Wang
- Department of Radiology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, People's Republic of China
| | - Jiaying Gong
- Department of Radiology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, People's Republic of China.
| | - Xiaochun Meng
- Department of Radiology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, People's Republic of China.
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Liu J, Tang H, Lin T, Wang J, Cui W, Xie C, Wang Z, Chen Y, Chen X. Sarcopenia assessed by computed tomography or magnetic resonance imaging is associated with the loss of response to biologic therapies in adult patients with Crohn's disease. Clin Transl Sci 2023; 16:2209-2221. [PMID: 37621024 PMCID: PMC10651652 DOI: 10.1111/cts.13621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
Sarcopenia occurs in patients with Crohn's disease (CD). However, the association between sarcopenia and loss of response (LOR) to biologic agents remains unclear. This study explored such an association in CD patients. This retrospective study included 94 CD patients who received biologic therapy. The skeletal muscle cross-sectional area at the third lumbar was assessed by computed tomography or magnetic resonance imaging for sarcopenia evaluation. A LOR was defined by fecal calprotectin (FC) < 250 μg/g or >50% reduction from baseline levels or other factors, such as the used agent being replaced by other biologic agents. The association between sarcopenia and LOR was assessed by logistic regression analysis. LOR was observed in 54 patients (57.4%). The prevalence of sarcopenia in the LOR group was higher than that in response group (70.4% vs. 40.0%, p = 0.003). Sarcopenia (odds ratio [OR] = 3.89, 95% confidence interval [CI]: 1.31-11.54), Montreal L1 type (OR = 0.20, 95% CI: 0.06-0.60), perianal lesions (OR = 4.08, 95% CI: 1.31-12.70), and monocytes percentage (OR = 1.27, 95% CI: 1.02-1.57) at baseline were independent associated factors for LOR. Sarcopenia was also associated with LOR in patients who received infliximab (OR = 3.31, 95% CI: 1.11-9.87). Montreal L1 type, perianal lesions, and monocytes percentage (Model 1), and with additional consideration of sarcopenia (Model 2), were developed to predict LOR. Model 2 showed better performance than Model 1 (area under the curve [AUC] 0.82 vs. 0.75). Sarcopenia was associated with the LOR to biological agents or infliximab in adult patients with CD.
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Affiliation(s)
- Jingjing Liu
- Department of RadiologyFunan County People's HospitalFuyangAnhuiChina
- Department of RadiologyThe Affiliated Hospital of Nanjing University of Chinese MedicineNanjingChina
| | - Hongye Tang
- Department of RadiologyThe Affiliated Hospital of Nanjing University of Chinese MedicineNanjingChina
| | - Tingting Lin
- Department of RadiologyThe Affiliated Hospital of Nanjing University of Chinese MedicineNanjingChina
| | - Jiangchuan Wang
- Department of RadiologyThe Affiliated Hospital of Nanjing University of Chinese MedicineNanjingChina
| | - Wenjing Cui
- Department of RadiologyThe Affiliated Hospital of Nanjing University of Chinese MedicineNanjingChina
| | - Chao Xie
- Center of Musculoskeletal ResearchUniversity of Rochester School of MedicineRochesterNew YorkUSA
| | - Zhongqiu Wang
- Department of RadiologyThe Affiliated Hospital of Nanjing University of Chinese MedicineNanjingChina
| | - Yugen Chen
- Department of Colon and Rectum SurgeryThe Affiliated Hospital of Nanjing University of Chinese MedicineNanjingChina
| | - Xiao Chen
- Department of RadiologyThe Affiliated Hospital of Nanjing University of Chinese MedicineNanjingChina
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