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Lin X, Gao Y, Zhu C, Song J, Liu L, Li J, Wu X. Improved overall image quality in low-dose dual-energy computed tomography enterography using deep-learning image reconstruction. Abdom Radiol (NY) 2024; 49:2979-2987. [PMID: 38480547 DOI: 10.1007/s00261-024-04221-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/21/2024] [Accepted: 01/24/2024] [Indexed: 08/22/2024]
Abstract
OBJECTIVE To demonstrate the clinical advantages of a deep-learning image reconstruction (DLIR) in low-dose dual-energy computed tomography enterography (DECTE) by comparing images with standard-dose adaptive iterative reconstruction-Veo (ASIR-V) images. METHODS In this Institutional review board approved prospective study, 86 participants who underwent DECTE were enrolled. The early-enteric phase scan was performed using standard-dose (noise index: 8) and images were reconstructed at 5 mm and 1.25 mm slice thickness with ASIR-V at a level of 40% (ASIR-V40%). The late-enteric phase scan used low-dose (noise index: 12) and images were reconstructed at 1.25 mm slice thickness with ASIR-V40%, and DLIR at medium (DLIR-M) and high (DLIR-H). The 70 keV monochromatic images were used for image comparison and analysis. For objective assessment, image noise, artifact index, SNR and CNR were measured. For subjective assessment, subjective noise, image contrast, bowel wall sharpness, mesenteric vessel clarity, and small structure visibility were scored by two radiologists blindly. Radiation dose was compared between the early- and late-enteric phases. RESULTS Radiation dose was reduced by 50% in the late-enteric phase [(6.31 ± 1.67) mSv] compared with the early-enteric phase [(3.01 ± 1.09) mSv]. For the 1.25 mm images, DLIR-M and DLIR-H significantly improved both objective and subjective image quality compared to those with ASIR-V40%. The low-dose 1.25 mm DLIR-H images had similar image noise, SNR, CNR values as the standard-dose 5 mm ASIR-V40% images, but significantly higher scores in image contrast [5(5-5), P < 0.05], bowel wall sharpness [5(5-5), P < 0.05], mesenteric vessel clarity [5(5-5), P < 0.05] and small structure visibility [5(5-5), P < 0.05]. CONCLUSIONS DLIR significantly reduces image noise at the same slice thickness, but significantly improves spatial resolution and lesion conspicuity with thinner slice thickness in DECTE, compared to conventional ASIR-V40% 5 mm images, all while providing 50% radiation dose reduction.
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Affiliation(s)
- Xu Lin
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Yankun Gao
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Chao Zhu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Jian Song
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Ling Liu
- CT Research Center, GE Healthcare China, Shanghai, 210000, China
| | - Jianying Li
- CT Research Center, GE Healthcare China, Shanghai, 210000, China
| | - Xingwang Wu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
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Li J, Xie G, Tang W, Zhang L, Zhang Y, Zhang L, Wang D, Li K. Establishing a machine learning model based on dual-energy CT enterography to evaluate Crohn's disease activity. Insights Imaging 2024; 15:115. [PMID: 38735018 PMCID: PMC11089021 DOI: 10.1186/s13244-024-01703-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVES The simplified endoscopic score of Crohn's disease (SES-CD) is the gold standard for quantitatively evaluating Crohn's disease (CD) activity but is invasive. This study aimed to develop and validate a machine learning (ML) model based on dual-energy CT enterography (DECTE) to noninvasively evaluate CD activity. METHODS We evaluated the activity in 202 bowel segments of 46 CD patients according to the SES-CD score and divided the segments randomly into training set and testing set at a ratio of 7:3. Least absolute shrinkage and selection operator (LASSO) was used for feature selection, and three models based on significant parameters were established based on logistic regression. Model performance was evaluated using receiver operating characteristic (ROC), calibration, and clinical decision curves. RESULTS There were 110 active and 92 inactive bowel segments. In univariate analysis, the slope of spectral curve in the venous phases (λHU-V) has the best diagnostic performance, with an area under the ROC curve (AUC) of 0.81 and an optimal threshold of 1.975. In the testing set, the AUC of the three models established by the 7 variables to differentiate CD activity was 0.81-0.87 (DeLong test p value was 0.071-0.766, p > 0.05), and the combined model had the highest AUC of 0.87 (95% confidence interval (CI): 0.779-0.959). CONCLUSIONS The ML model based the DECTE can feasibly evaluate CD activity, and DECTE parameters provide a quantitative analysis basis for evaluating specific bowel activities in CD patients. CRITICAL RELEVANCE STATEMENT The machine learning model based on dual-energy computed tomography enterography can be used for evaluating Crohn's disease activity noninvasively and quantitatively. KEY POINTS Dual-energy CT parameters are related to Crohn's disease activity. Three machine learning models effectively evaluated Crohn's disease activity. Combined models based on conventional and dual-energy CT have the best performance.
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Affiliation(s)
- Junlin Li
- North Sichuan Medical College, Nanchong, 637100, China
- Department of Radiology, Chongqing General Hospital, Chongqing, 401121, China
| | - Gang Xie
- Department of Radiology, Chengdu Third People's Hospital, Chengdu, 610031, China
| | - Wuli Tang
- Department of Radiology, Chongqing General Hospital, Chongqing, 401121, China
- Chongqing Medical University, Chongqing, 400016, China
| | - Lingqin Zhang
- Department of Radiology, Chongqing General Hospital, Chongqing, 401121, China
| | - Yue Zhang
- Department of Radiology, Chongqing General Hospital, Chongqing, 401121, China
- Chongqing Medical University, Chongqing, 400016, China
| | - Lingfeng Zhang
- North Sichuan Medical College, Nanchong, 637100, China
- Department of Radiology, Chongqing General Hospital, Chongqing, 401121, China
| | - Danni Wang
- Department of Radiology, Chongqing General Hospital, Chongqing, 401121, China
| | - Kang Li
- North Sichuan Medical College, Nanchong, 637100, China.
- Department of Radiology, Chongqing General Hospital, Chongqing, 401121, China.
- Chongqing Medical University, Chongqing, 400016, China.
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Khosravi B, Salehnia A, Pak N, Montazeri SA, Sima AR, Vahedi H, Malekzadeh R, Radmard AR. A Practical Index to Distinguish Backwash Ileitis From Crohn's Terminal Ileitis in MR Enterography. Inflamm Bowel Dis 2023; 29:42-50. [PMID: 35259254 DOI: 10.1093/ibd/izac040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Differentiating ulcerative colitis-associated "backwash" ileitis (BWI) from Crohn's terminal ileitis (CTI) is a diagnostic challenge and highly affects patient's management. This study aimed to investigate magnetic resonance enterography (MRE) features including ileocecal valve patency index (ICPI) in patients with BWI and CTI and distinguish these entities based on MRE findings. METHODS After obtaining institutional review board approval, we reviewed 1654 MREs; 60 patients with pathologically proven BWI (n = 30) and CTI (n = 30) were enrolled. Two radiologists who were blinded to the clinical diagnosis analyzed MREs. We evaluated bowel wall thickness and enhancement pattern, ileocecal valve (ICV) diameter, and lip thickness. Ileocecal valve patency index-T and ICPI-C were calculated to normalize the ICV diameter with respect to terminal ileum (TI) and cecum, respectively. An additional group of non-BWI-UC patients (n = 30) was also included to validate indices. RESULTS Circumferential mural thickening (90% vs 1%, P < .001) and inner-wall enhancement (P < .001) of TI were more frequent in BWI patients than CTI. Serosal irregularity (53% vs 13%, P = .002), higher mural thickness (5mm vs 3mm, P < .001), and asymmetric hyperenhancement (P < .001) of TI were more prevalent in CTI than BWI. Ileocecal valve patency and lip atrophy were significantly higher in BWI than CTI and non-BWI-UC groups (both P < .001). Ileocecal valve patency indices-C and ICPI-T indices were able to accurately distinguish BWI from CTI (area under the ROC curve [AUC], 0.864 and 0.847 for ICPI-T and ICPI-C, respectively) and non-BWI-UC (AUC, 0.777 and 0.791 for ICPI-T and ICPI-C, respectively). Ileocecal valve patency indices-T ≥31.5% were 100% specific to distinguish BWI from CTI, but sensitivity was 63%. CONCLUSIONS Magnetic resonance enterography features of ICV and TI can accurately differentiate BWI from CTI. Two practical indices introduced in this study showed high specificity to distinguish BWI from CTI.
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Affiliation(s)
- Bardia Khosravi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Aneseh Salehnia
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Pak
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ali Reza Sima
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Homayoun Vahedi
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Malekzadeh
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Meng J, Mao Y, Zhou J, Chen Z, Huang S, Wang Y, Huang L, Zhang R, Shen X, Lv W, Xiao J, Ye Z, Chen Z, Mao R, Sun C, Li Z, Feng ST, Lin S, Li X. Mesenteric abnormalities play an important role in grading intestinal fibrosis in patients with Crohn's disease: a computed tomography and clinical marker-based nomogram. Therap Adv Gastroenterol 2022; 15:17562848221122504. [PMID: 36090482 PMCID: PMC9459497 DOI: 10.1177/17562848221122504] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND While the grading of intestinal fibrosis is closely related to the therapeutic strategy of patients with Crohn's disease (CD), it has not yet been well resolved. Mesenteric abnormalities are inextricably linked to intestinal fibrosis. OBJECTIVES We aimed to establish an optimal model for assessing intestinal fibrosis using computed tomography enterography (CTE) and clinical markers. DESIGN A total of 174 patients with CD between January 2014 and June 2020 were included in this retrospective multicentre study. METHODS All patients underwent CTE within 3 months prior to surgery. Intestinal fibrosis was pathologically scored as non-mild or moderate-to-severe. Selected imaging of the intestinal walls and mesentery and/or clinical factors were used to develop the diagnostic models. The area under the receiver operating characteristic curve (AUC) analysis was used to evaluate the discrimination performance of the models. A decision curve analysis was performed to evaluate the clinical usefulness of the models. RESULTS One-, two-, and three-variable models were identified as possible diagnostic models. Model 1 [mesenteric creeping fat index (MCFI)], Model 2 (mesenteric oedema and MCFI), and Model 3 (mesenteric oedema, MCFI, and disease duration) were established. The AUCs of Model 1 in training and test cohorts 1 and 2 were 0.799, 0.859, and 0.693, respectively; Model 2 was 0.851, 0.833, and 0.757, respectively; and Model 3 was 0.832, 0.821, and 0.850, respectively. We did not observe any significant difference in diagnostic performance between the training and total test cohorts in any model (all p > 0.05). The decision curves showed that Model 3 had the highest net clinical benefit in test cohort 2. The nomogram of this optimal model was constructed by considering the favourable and robust performance of Model 3. CONCLUSION A nomogram integrating mesenteric abnormalities on CTE with a clinical marker was optimal for differentiating between non-mild and moderate-to-severe fibrosis in patients with CD.
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Affiliation(s)
| | | | | | - Zhao Chen
- Department of Medical Imaging Center, Nan Fang
Hospital, Southern Medical University, Guangzhou, People’s Republic of
China
| | - Siyun Huang
- Department of Radiology, The First Affiliated
Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of
China
| | - Yangdi Wang
- Department of Radiology, The First Affiliated
Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of
China
| | - Li Huang
- Department of Radiology, The First Affiliated
Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of
China
| | - Ruonan Zhang
- Department of Radiology, The First Affiliated
Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of
China
| | - Xiaodi Shen
- Department of Radiology, The First Affiliated
Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of
China
| | - Wen Lv
- Department of Radiology, The First Affiliated
Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of
China
| | - Juxiong Xiao
- Department of Radiology, Xiangya Hospital,
Central South University, Changsha, Hunan, People’s Republic of China
| | - Ziyin Ye
- Department of Pathology, The First Affiliated
Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of
China
| | - Zhihui Chen
- Department of Gastrointestinal and Pancreatic
Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou,
People’s Republic of China
| | - Ren Mao
- Department of Gastroenterology, The First
Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of
China,Department of Gastroenterology, Hepatology and
Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic,
Cleveland, Ohio, USA
| | - Canhui Sun
- Department of Radiology, The First Affiliated
Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of
China
| | - Ziping Li
- Department of Radiology, The First Affiliated
Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of
China
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated
Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of
China
| | - Shaochun Lin
- 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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Maconi G, Sorin V, Kopylov U, Barzilay O, Ferretti F, Innamorati S, Tonolini M, Eliakim R, Amitai MM. Diagnostic significance of mesenteric lymph node involvement in proximal small bowel Crohn's disease. Therap Adv Gastroenterol 2022; 15:17562848221118664. [PMID: 36035308 PMCID: PMC9403447 DOI: 10.1177/17562848221118664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/24/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The diagnosis of proximal small bowel involvement in Crohn's disease (CD) can be challenging at magnetic resonance enterography (MRE). The inflammatory process in CD can be associated with peri-intestinal inflammatory reactions, including the presence of inflamed mesenteric lymph nodes. OBJECTIVES To evaluate the significance of inflamed mesenteric lymph nodes adjacent to the jejunum at MRE in CD and the association with proximal bowel disease as detected by video capsule endoscopy (VCE). DESIGN This retrospective study was performed in two tertiary medical centres, and included 64 patients with CD who underwent MRE as well as VCE within 1 year. METHODS Data were collected for examinations performed between August 2013 and February 2021. MRE images were independently reviewed by radiologists who were blinded to the clinical data. Association between the presence of mesenteric lymph nodes adjacent to jejunum at MRE and disease activity according to VCE Lewis scores of proximal small bowel was examined. RESULTS VCE detected proximal disease in 24/64 patients (37.5%). Presence of regional lymph nodes in the jejunal mesentery was significantly associated with jejunal disease as seen on VCE (p < 0.001). Of the 20 patients who had proximal mesenteric lymph nodes at MRE, 15 (75%) had jejunal disease at VCE (sensitivity, 62.5%; specificity, 87.5%; and negative and positive predictive values, 79.5 and 75%, respectively). The number of regional lymph nodes was positively correlated with jejunal disease (mean: 2.63 ± 2.90 versus 0.78 ± 2.60, p = 0.01). Other MRE features of lymph nodes were not significantly predictive of jejunal CD. CONCLUSION In patients with CD, inflamed regional lymph nodes in the jejunal mesentery at MRE can be valuable to suggest proximal small bowel disease, even when bowel wall features at imaging do not suggest disease involvement. PLAIN LANGUAGE SUMMARY The diagnosis of proximal small bowel involvement in Crohn's disease (CD) can be challenging at magnetic resonance enterography (MRE). We analysed MRE examinations in patients with CD for the presence of lymph nodes adjacent to the proximal small bowel. We included 64 patients with CD who had MRE examinations and video capsule endoscopy (VCE) examinations within 1 year. Of 64 patients, 24 had proximal small bowel disease according to VCE. We found that of 20 patients who had regional mesenteric lymph nodes in the jejunal mesentery at MRE, 15 had proximal bowel disease involvement. We also found that patients with jejunal disease had a larger number of regional lymph nodes compared to patients without jejunal disease. All but one patient had normal appearing bowel at MRE. But, using regional mesenteric lymphadenopathy at MRE as an indicator for disease, 15/24 (62.5%) patients with proximal small bowel disease were detected. We therefore conclude that regional mesenteric lymph nodes assessment at MRE can aid diagnose proximal bowel disease, even when the proximal bowel looks normal at imaging. Presence of proximal mesenteric lymph nodes at MRE in patients with CD possibly warrant further investigation of the proximal small bowel by endoscopic measures.
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Affiliation(s)
| | | | - Uri Kopylov
- Sackler Faculty of Medicine, Tel-Aviv
University, Tel-Aviv, Israel,Department of Gastroentergology, Chaim Sheba
Medical Center, Tel Hashomer, Israel
| | - Oranit Barzilay
- Sackler Faculty of Medicine, Tel-Aviv
University, Tel-Aviv, Israel,Department of Gastroentergology, Chaim Sheba
Medical Center, Tel Hashomer, Israel
| | - Francesca Ferretti
- Division of Gastroenterology, ASST
Fatebenefratelli-Sacco, L. Sacco University Hospital, Department of
Biochemical and Clinical Sciences, University of Milan, Milan, Italy
| | - Silvia Innamorati
- Department of Radiology, ASST
Fatebenefratelli-Sacco, L. Sacco University Hospital, Milan, Italy
| | - Massimo Tonolini
- Department of Radiology, ASST
Fatebenefratelli-Sacco, L. Sacco University Hospital, Milan, Italy
| | - Rami Eliakim
- Sackler Faculty of Medicine, Tel-Aviv
University, Tel-Aviv, Israel,Department of Gastroentergology, Chaim Sheba
Medical Center, Tel Hashomer, Israel
| | - Michal Marianne Amitai
- Department of Diagnostic Imaging, Chaim Sheba
Medical Center, Tel Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv
University, Tel-Aviv, Israel
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Nikolakis D, de Voogd FAE, Pruijt MJ, Grootjans J, van de Sande MG, D’Haens GR. The Role of the Lymphatic System in the Pathogenesis and Treatment of Inflammatory Bowel Disease. Int J Mol Sci 2022; 23:ijms23031854. [PMID: 35163775 PMCID: PMC8836364 DOI: 10.3390/ijms23031854] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 02/04/2023] Open
Abstract
Although the number of therapeutic options for the treatment of inflammatory bowel disease (IBD) has increased in recent years, patients suffer from decreased quality of life due to non-response or loss of response to the currently available treatments. An increased understanding of the disease’s etiology could provide novel insights for treatment strategies in IBD. Lymphatic system components are generally linked to immune responses and presumably related to inflammatory diseases pathophysiology. This review aims to summarize findings on immune-mediated mechanisms in lymphoid tissues linked with IBD pathogenesis and (potential) novel treatments. Enhanced innate and adaptive immune responses were observed in mesenteric lymph nodes (MLNs) and other lymphoid structures, such as Peyer’s patches, in patients with IBD and in animal models. Furthermore, the phenomenon of lymphatic obstruction in the form of granulomas in MLNs and lymphatic vessels correlates with disease activity. There is also evidence that abnormalities in the lymphatic stromal components and lymph node microbiome are common in IBD and could be exploited therapeutically. Finally, novel agents targeting lymphocyte trafficking have been added to the treatment armamentarium in the field of IBD. Overall, gut-associated lymphoid tissue plays a key role in IBD immunopathogenesis, which could offer novel therapeutic targets.
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Affiliation(s)
- Dimitrios Nikolakis
- Department of Gastroenterology, Amsterdam Institute for Gastroenterology Endocrinology and Metabolism, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (D.N.); (F.A.E.d.V.); (M.J.P.); (J.G.)
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology & Immunology Center (ARC), Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
- Department of Experimental Immunology, Amsterdam Institute for Infection & Immunity, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Onassis Foundation, 4 Aeschinou Street, 10558 Athens, Greece
| | - Floris A. E. de Voogd
- Department of Gastroenterology, Amsterdam Institute for Gastroenterology Endocrinology and Metabolism, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (D.N.); (F.A.E.d.V.); (M.J.P.); (J.G.)
| | - Maarten J. Pruijt
- Department of Gastroenterology, Amsterdam Institute for Gastroenterology Endocrinology and Metabolism, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (D.N.); (F.A.E.d.V.); (M.J.P.); (J.G.)
| | - Joep Grootjans
- Department of Gastroenterology, Amsterdam Institute for Gastroenterology Endocrinology and Metabolism, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (D.N.); (F.A.E.d.V.); (M.J.P.); (J.G.)
| | - Marleen G. van de Sande
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology & Immunology Center (ARC), Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
- Department of Experimental Immunology, Amsterdam Institute for Infection & Immunity, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Geert R. D’Haens
- Department of Gastroenterology, Amsterdam Institute for Gastroenterology Endocrinology and Metabolism, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (D.N.); (F.A.E.d.V.); (M.J.P.); (J.G.)
- Correspondence:
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Glutig K, Krüger PC, Oberreuther T, Nickel MD, Teichgräber U, Lorenz M, Mentzel HJ, Krämer M. Preliminary results of abdominal simultaneous multi-slice accelerated diffusion-weighted imaging with motion-correction in patients with cystic fibrosis and impaired compliance. Abdom Radiol (NY) 2022; 47:2783-2794. [PMID: 35596778 PMCID: PMC9300552 DOI: 10.1007/s00261-022-03549-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The aim of this prospective study was to compare scan time, image quality, signal-to-noise Ratio (SNR), and apparent diffusion coefficient (ADC) values of simultaneous multi-slice accelerated diffusion-weighted imaging with motion-correction (DWI SMS Moco) to standard diffusion-weighted imaging (sDWI) in free-breathing abdominal magnetic resonance imaging (MRI) in pediatric and young adult patients with cystic fibrosis (CF). MATERIAL AND METHODS 16 patients (7 male and 9 female, 12-41 years old) with CF were examined prospectively in a single-center from November 2020 to March 2021 on a 1.5 Tesla clinical MR scanner. The characteristics of overall image quality and delimitability of mesenteric lymph nodes were evaluated using a 5-point Likert scale by two experienced pediatric radiologists independently from each other. Quantitative parameters with SNR and ADC values were assessed in 8 different locations and compared using a Wilcoxon signed-rank test. RESULTS The acquisition time for DWI SMS Moco was 32% shorter than for sDWI. Regarding quality comparison, overall image quality and delimitability of mesenteric lymph nodes were significant higher in DWI SMS Moco (p ≤ 0.05 for both readers). The readers preferred DWI SMS Moco to sDWI in all cases (16/16). Mean SNR values from DWI SMS Moco and sDWI were similar in 7 from 8 locations. The ADC values showed no significant difference between DWI SMS Moco and sDWI in any of the evaluated locations (p > 0.05). CONCLUSIONS The DWI SMS Moco improves overall image quality and delimitability of mesenteric lymph nodes compared to sDWI with similar SNR and ADC values and a distinguished reduction of scan time in free-breathing by one third. We conclude that MRI with DWI SMS Moco could be helpful in monitoring the effect of the high-efficiency modulator (HEM) therapy in cystic fibrosis (CF) patients homozygous or heterozygous for F508del in the abdomen.
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Affiliation(s)
- Katja Glutig
- Department of Radiology, Section Pediatric Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
| | - Paul-Christian Krüger
- Department of Radiology, Section Pediatric Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Theresa Oberreuther
- Department of Radiology, Section Pediatric Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | | | - Ulf Teichgräber
- Department of Radiology, Jena University Hospital, Jena, Germany
| | - Michael Lorenz
- Cystic Fibrosis Centre, Department of Paediatrics, Jena University Hospital, Jena, Germany
| | - Hans-Joachim Mentzel
- Department of Radiology, Section Pediatric Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Martin Krämer
- Department of Radiology, Jena University Hospital, Jena, Germany
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Montazeri SA, Mahfoodh FH, Naybandi Atashi S, Sima AR, Saffar H, Radmard AR. Nodular lymphoid hyperplasia of terminal ileum: how to avoid overdiagnosis of Crohn's terminal ileitis in MR enterography? Abdom Radiol (NY) 2021; 46:1846-1854. [PMID: 33236219 DOI: 10.1007/s00261-020-02866-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/05/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the magnetic resonance enterography (MRE) characteristics of nodular lymphoid hyperplasia (NLH) and Crohn's terminal ileitis (CTI). METHODS Of 1552 MREs from November 2011 to July 2018, 61 individuals with biopsy-proven NLH (n = 24) and CTI (n = 37, 27 with active CTI) were selected based on the inclusion criteria. NLH cases were also followed up for median (range) of 40 (21-61) months. Two board-certified radiologists, blind to clinical data and diagnosis, reviewed MRE in consensus. Conventional, morphological, enhancement, and diffusion parameters were assessed. Mann-Whitney, χ2, and logistic regression analyses were conducted. RESULTS No NLH patient developed inflammatory bowel disease or lymphoproliferative disorders during the follow-up. Serosal surface irregularity (65% vs. 8%), pseudo-diverticula (27% vs. 0), and mesenteric fat involvement (38% vs. 4%) were more frequent in CTI than NLH (p < 0.01), while mucosal nodularity was more prevalent in NLH (71%) than CTI (19%) (p < 0.001). The upstream luminal diameter (15.0 vs. 12.5 mm, p = 0.015) and mural thickness (6.0 vs. 4.0 mm, p < 0.001) of the terminal ileum showed higher values in CTI than NLH. CONCLUSIONS Unlike enhancement and diffusion parameters, morphological features (mucosal nodularity, serosal surface irregularity, and mesenteric fat involvement) could distinguish NLH from CTI regardless of CTI activity.
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Affiliation(s)
- S Ali Montazeri
- Department of Radiology, Mayo Clinic, Florida, USA
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran, 14117, Iran
| | - Fatima Haitham Mahfoodh
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran, 14117, Iran
| | - Sara Naybandi Atashi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran, 14117, Iran
| | - Ali Reza Sima
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hiva Saffar
- Department of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran, 14117, Iran.
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The Role of Inflammation in Crohn's Disease Recurrence after Surgical Treatment. J Immunol Res 2020; 2020:8846982. [PMID: 33426097 PMCID: PMC7781709 DOI: 10.1155/2020/8846982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 02/08/2023] Open
Abstract
Introduction Postoperative recurrence after surgery for Crohn's disease (CD) is virtually inevitable, and its mechanism is poorly known. Aim To review the numerous factors involved in CD postoperative recurrence (POR) pathogenesis, focusing on single immune system components as well as the immune system as a whole and highlighting the clinical significance in terms of preventive strategies and future perspectives. Methods A systematic literature search on CD POR, followed by a review of the main findings. Results The immune system plays a pivotal role in CD POR, with many different factors involved. Memory T-lymphocytes retained in mesenteric lymph nodes seem to represent the main driving force. New pathophysiology-based preventive strategies in the medical and surgical fields may help reduce POR rates. In particular, surgical strategies have already been developed and are currently under investigation. Conclusions POR is a complex phenomenon, whose driving mechanisms are gradually being unraveled. New preventive strategies addressing these mechanisms seem promising.
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Potential MR Enterography Features to Differentiate Primary Small Intestinal Lymphoma From Crohn Disease. AJR Am J Roentgenol 2020; 215:864-873. [PMID: 32755202 DOI: 10.2214/ajr.19.22158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE. The purpose of this study was to assess the MR enterographic features of primary small intestinal lymphoma (PSIL) and compare them with active Crohn disease (CD) presenting with severe (≥ 10 mm) mural thickening of the small bowel. MATERIALS AND METHODS. This retrospective study included 15 patients with pathologically proven PSIL and 15 patients with active inflammatory CD with severe mural thickening. Various morphologic, enhancement, and diffusion parameters were compared between the two groups at MR enterography. The ratios of the upstream to involved luminal diameter and mural thickness to luminal diameter in the involved segment were calculated. An attempt was made to define a predictive model (morphologic score) for discriminating PSIL from CD with severe mural thickening. RESULTS. Patients with PSIL were more likely than those with CD to have unifocal disease (66.7% vs 20.0%, p = 0.025), circumferential involvement (86.7% vs 26.7%, p < 0.001), luminal dilatation (60.0% vs 7.0%, p = 0.005), and an attenuated fold pattern (53.3% vs none, p < 0.001). They were less likely to have serosal surface involvement (40.0% vs 100%, p = 0.001) and mesenteric fat infiltration (33.3% vs 100%, p < 0.001). Median upstream to involved luminal diameter ratio (1.5 vs 9.6, p < 0.001) and mural thickness to involved luminal diameter ratio (1.1 vs 4.3, p = 0.044) were significantly lower in patients with PSIL than in those with CD with severe mural thickening. No significant difference was observed in enhancement and diffusion measures. Morphologic score was based on the presence of luminal dilatation, unifocal involvement, mesenteric fat infiltration, and luminal stricture, yielding accuracy of 98% for differentiation between PSIL and CD with severe mural thickening. CONCLUSION. Morphologic features seen at MR enterography rather than enhancement or diffusion parameters may be valuable for differentiation of PSIL from active CD with severe mural thickening with significantly lower ratios of upstream to involved luminal diameter and mural thickness to involved luminal diameter in PSIL.
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Cheng J, Wang K, Leng X, Wang Y, Xu G, Wu G. Evaluating the inflammatory activity in Crohn's disease using magnetic resonance diffusion kurtosis imaging. Abdom Radiol (NY) 2019; 44:2679-2688. [PMID: 31093729 DOI: 10.1007/s00261-019-02013-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To explore the feasibility of diffusion kurtosis imaging (DKI) for evaluating inflammatory activity in Crohn's disease (CD). MATERIALS AND METHODS In all, 51 CD patients were included, who were performed with consecutive enteroscopy, MR and DKI (b values = 0-2000 mm2/s). The lesions of bowel segments were graded as inactive (0-2), mild (3-6), and moderate-severe group (> 6) based on simplified endoscopic activity score for Crohn's disease (SES-CD), The abilities of the parameters of DKI and DWI in grading different activity lesions were compared. RESULTS One hundred and twenty-seven bowel segments including inactive (15), mild (45) and moderate-severe (67) were analyzed. ADC (r = - 0.627, p < 0.001), Dapp (r = - 0.381, p < 0.001) and Kapp (r = 0.641, p < 0.001) were correlated with SES-CD. These parameters were significantly different among the three groups (all p < 0.001). ROC analysis found ADC had the highest accuracy (AUC = 0.884, p < 0.001) to differentiate inactive from active group with the threshold at 0.865 × 10-3 mm2/s, which was slightly higher than Kapp (AUC = 0.867, p < 0.001) with the threshold at 0.645, and was obviously higher than Dapp (AUC = 0.726, p = 0.005). Similarly, ADC also had the highest accuracy (AUC = 0.846, p < 0.001) to differentiate inactive-mild from moderate-severe group with the threshold at 0.825 × 10-3 mm2/s, and minimally higher than Kapp (AUC = 0.843, p < 0.001) with the threshold at 0.695, and obviously higher than Dapp (AUC = 0.690, p < 0.001). CONCLUSION DKI is feasible and comparable to conventional DWI for the evaluation of inflammatory activity in CD.
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Affiliation(s)
- Jingyun Cheng
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China
| | - Ke Wang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China
| | - Xiaoyuan Leng
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China
| | - Yan Wang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China
| | - Guobin Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China.
| | - Guangyao Wu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China.
- Radiology Department, Shenzhen University General Hospital and Shenzhen University Clinical Medical Academy, Shenzhen, People's Republic of China.
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