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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] [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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Bartlett DJ, Takahashi H, Bach CR, Lunn B, Thorpe MP, Broski SM, Packard AT, Fletcher JG, Navin PJ. Potential applications of PET/MRI in non-oncologic conditions within the abdomen and pelvis. Abdom Radiol (NY) 2023; 48:3624-3633. [PMID: 37145312 DOI: 10.1007/s00261-023-03922-0] [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: 02/21/2023] [Revised: 04/03/2023] [Accepted: 04/12/2023] [Indexed: 05/06/2023]
Abstract
PET/MRI is a relatively new imaging modality with several advantages over PET/CT that promise to improve imaging of the abdomen and pelvis for specific diagnostic tasks by combining the superior soft tissue characterization of MRI with the functional information acquired from PET. PET/MRI has an established role in staging and response assessment of multiple abdominopelvic malignancies, but the modality is not yet established for non-oncologic conditions of the abdomen and pelvis. In this review, potential applications of PET/MRI for non-oncologic conditions of abdomen and pelvis are outlined, and the available literature is reviewed to highlight promising areas for further research and translation into clinical practice.
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Affiliation(s)
| | | | - Corrie R Bach
- Department of Radiology, Mayo Clinic, Rochester, USA
| | - Brendan Lunn
- Department of Radiology, Mayo Clinic, Rochester, USA
| | | | | | - Ann T Packard
- Department of Radiology, Mayo Clinic, Rochester, USA
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Romero ÁB, Furtado FS, Sertic M, Goiffon RJ, Mahmood U, Catalano OA. Abdominal Positron Emission Tomography/Magnetic Resonance Imaging. Magn Reson Imaging Clin N Am 2023; 31:579-589. [PMID: 37741642 DOI: 10.1016/j.mric.2023.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
Hybrid positron emission tomography (PET)/magnetic resonance imaging (MRI) is highly suited for abdominal pathologies. A precise co-registration of anatomic and metabolic data is possible thanks to the simultaneous acquisition, leading to accurate imaging. The literature shows that PET/MRI is at least as good as PET/CT and even superior for some indications, such as primary hepatic tumors, distant metastasis evaluation, and inflammatory bowel disease. PET/MRI allows whole-body staging in a single session, improving health care efficiency and patient comfort.
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Affiliation(s)
- Álvaro Badenes Romero
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A Martinos Center for Biomedical Imaging, Harvard Medical School, Charlestown, MA, USA; Department of Nuclear Medicine, Joan XXIII Hospital, Tarragona, Spain
| | - Felipe S Furtado
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A Martinos Center for Biomedical Imaging, Harvard Medical School, Charlestown, MA, USA
| | - Madaleine Sertic
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Reece J Goiffon
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Umar Mahmood
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A Martinos Center for Biomedical Imaging, Harvard Medical School, Charlestown, MA, USA.
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Giraudo C, Carraro S, Zucchetta P, Cecchin D. Pediatric Imaging Using PET/MR Imaging. Magn Reson Imaging Clin N Am 2023; 31:625-636. [PMID: 37741646 DOI: 10.1016/j.mric.2023.06.001] [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] [Indexed: 09/25/2023]
Abstract
PET/MR imaging is a one-stop shop technique for pediatric diseases allowing not only an accurate clinical assessment of tumors at staging and restaging but also the diagnosis of neurologic, inflammatory, and infectious diseases in complex cases. Moreover, applying PET kinetic analyses and sequences such as diffusion-weighted imaging as well as quantitative analysis investigating the relationship between disease metabolic activity and cellularity can be applied. Complex radiomics analysis can also be performed.
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Affiliation(s)
- Chiara Giraudo
- Complex Unit of Nuclear Medicine, Department of Medicine (DIMED), University Hospital of Padova, Via Nicolo' Giustiniani 2, 35128, Padova, Italy
| | - Silvia Carraro
- Unit of Pediatric Allergy and Respiratory Medicine, Women's and Children's Health Department, University Hospital of Padova, Via Nicolo' Giustiniani 2, 35128, Padova, Italy
| | - Pietro Zucchetta
- Complex Unit of Nuclear Medicine, Department of Medicine (DIMED), University Hospital of Padova, Via Nicolo' Giustiniani 2, 35128, Padova, Italy
| | - Diego Cecchin
- Complex Unit of Nuclear Medicine, Department of Medicine (DIMED), University Hospital of Padova, Via Nicolo' Giustiniani 2, 35128, Padova, Italy.
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Tavares de Sousa H, Magro F. How to Evaluate Fibrosis in IBD? Diagnostics (Basel) 2023; 13:2188. [PMID: 37443582 DOI: 10.3390/diagnostics13132188] [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: 05/25/2023] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
In this review, we will describe the importance of fibrosis in inflammatory bowel disease (IBD) by discussing its distinct impact on Crohn's disease (CD) and ulcerative colitis (UC) through their translation to histopathology. We will address the existing knowledge on the correlation between inflammation and fibrosis and the still not fully explained inflammation-independent fibrogenesis. Finally, we will compile and discuss the recent advances in the noninvasive assessment of intestinal fibrosis, including imaging and biomarkers. Based on the available data, none of the available cross-sectional imaging (CSI) techniques has proved to be capable of measuring CD fibrosis accurately, with MRE showing the most promising performance along with elastography. Very recent research with radiomics showed encouraging results, but further validation with reliable radiomic biomarkers is warranted. Despite the interesting results with micro-RNAs, further advances on the topic of fibrosis biomarkers depend on the development of robust clinical trials based on solid and validated endpoints. We conclude that it seems very likely that radiomics and AI will participate in the future non-invasive fibrosis assessment by CSI techniques in IBD. However, as of today, surgical pathology remains the gold standard for the diagnosis and quantification of intestinal fibrosis in IBD.
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Affiliation(s)
- Helena Tavares de Sousa
- Gastroenterology Department, Algarve University Hospital Center, 8500-338 Portimão, Portugal
- ABC-Algarve Biomedical Center, University of Algarve, 8005-139 Faro, Portugal
| | - Fernando Magro
- Unit of Pharmacology and Therapeutics, Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Department of Gastroenterology, São João University Hospital Center, 4200-319 Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
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Scharitzer M, Macher-Beer A, Mang T, Unger LW, Haug A, Reinisch W, Weber M, Nakuz T, Nics L, Hacker M, Bergmann M, Rasul S. Evaluation of Intestinal Fibrosis with 68Ga-FAPI PET/MR Enterography in Crohn Disease. Radiology 2023; 307:e222389. [PMID: 36853176 DOI: 10.1148/radiol.222389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Background In Crohn disease, differentiation between active intestinal inflammation and fibrosis has implications for treatment, but current imaging modalities are not reliably accurate. Purpose To evaluate the predictive value of gallium 68 (68Ga)-labeled fibroblast activation protein inhibitor (FAPI) PET/MR enterography for the assessment of bowel wall fibrosis in Crohn disease. Materials and Methods In this prospective single-center study, consecutive participants with Crohn disease and obstructive symptoms underwent preoperative 68Ga-FAPI PET/MR enterography from May 2021 to January 2022. Histopathologic analysis of resected bowel segments was performed to grade active inflammation (A0-A2) and fibrosis (F0-F2), which served as the reference standard. The fibroblast activation protein (FAP) expression in bowel wall layers was analyzed immunohistochemically for each layer. 68Ga-FAPI-derived maximum standardized uptake value (SUVmax) was compared with histopathologic results by using mixed-model analysis of variance and Bonferroni-corrected post hoc tests. Results In 14 participants (mean age, 45 years ± 9 [SD]; 10 men), fibrosis was diagnosed histopathologically in 28 of 51 bowel segments (grade F1, n = 14; grade F2, n = 14). Mean SUVmax was higher in segments with fibrosis than without (7.6 vs 2.0; P < .001). In severe fibrosis, mean SUVmax was higher than in mild to moderate fibrosis (8.9 ± 0.9 vs 6.2 ± 0.9; P = .045). Bowel segments with isolated active inflammation had lower mean 68Ga-FAPI uptake than segments with combined active inflammation and fibrosis (SUVmax, 3.2 ± 0.4 vs 8.1 ± 0.1; P = .005). With an SUVmax cutoff value of 3.5, the area under the receiver operating characteristic curve for the prediction of fibrosis was 0.94 (95% CI: 0.9, 1.0), with sensitivity of 26 of 28 segments (93%) and specificity of five of six segments (83%). 68Ga-FAPI-derived SUVmax correlated with FAP expression across all bowel layers (R2 = 0.50, P < .001). Conclusion Higher gallium 68 fibroblast activation protein inhibitor uptake at PET/MR enterography was associated with histopathologically assessed bowel wall fibrosis in participants with Crohn disease, suggesting diagnostic potential for treatment decisions. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by O'Shea in this issue.
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Affiliation(s)
- Martina Scharitzer
- From the Department of Biomedical Imaging and Image-Guided Therapy (M.S., T.M., A.H., M.W., T.N., L.N., M.H., S.R.), Department of Pathology (A.M.B.), Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center (L.W.U., M.B.), and Department of Medicine III, Division of Gastroenterology and Hepatology (W.R.), Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Andrea Macher-Beer
- From the Department of Biomedical Imaging and Image-Guided Therapy (M.S., T.M., A.H., M.W., T.N., L.N., M.H., S.R.), Department of Pathology (A.M.B.), Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center (L.W.U., M.B.), and Department of Medicine III, Division of Gastroenterology and Hepatology (W.R.), Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Thomas Mang
- From the Department of Biomedical Imaging and Image-Guided Therapy (M.S., T.M., A.H., M.W., T.N., L.N., M.H., S.R.), Department of Pathology (A.M.B.), Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center (L.W.U., M.B.), and Department of Medicine III, Division of Gastroenterology and Hepatology (W.R.), Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Lukas W Unger
- From the Department of Biomedical Imaging and Image-Guided Therapy (M.S., T.M., A.H., M.W., T.N., L.N., M.H., S.R.), Department of Pathology (A.M.B.), Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center (L.W.U., M.B.), and Department of Medicine III, Division of Gastroenterology and Hepatology (W.R.), Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Alexander Haug
- From the Department of Biomedical Imaging and Image-Guided Therapy (M.S., T.M., A.H., M.W., T.N., L.N., M.H., S.R.), Department of Pathology (A.M.B.), Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center (L.W.U., M.B.), and Department of Medicine III, Division of Gastroenterology and Hepatology (W.R.), Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Walter Reinisch
- From the Department of Biomedical Imaging and Image-Guided Therapy (M.S., T.M., A.H., M.W., T.N., L.N., M.H., S.R.), Department of Pathology (A.M.B.), Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center (L.W.U., M.B.), and Department of Medicine III, Division of Gastroenterology and Hepatology (W.R.), Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Michael Weber
- From the Department of Biomedical Imaging and Image-Guided Therapy (M.S., T.M., A.H., M.W., T.N., L.N., M.H., S.R.), Department of Pathology (A.M.B.), Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center (L.W.U., M.B.), and Department of Medicine III, Division of Gastroenterology and Hepatology (W.R.), Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Thomas Nakuz
- From the Department of Biomedical Imaging and Image-Guided Therapy (M.S., T.M., A.H., M.W., T.N., L.N., M.H., S.R.), Department of Pathology (A.M.B.), Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center (L.W.U., M.B.), and Department of Medicine III, Division of Gastroenterology and Hepatology (W.R.), Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Lukas Nics
- From the Department of Biomedical Imaging and Image-Guided Therapy (M.S., T.M., A.H., M.W., T.N., L.N., M.H., S.R.), Department of Pathology (A.M.B.), Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center (L.W.U., M.B.), and Department of Medicine III, Division of Gastroenterology and Hepatology (W.R.), Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Marcus Hacker
- From the Department of Biomedical Imaging and Image-Guided Therapy (M.S., T.M., A.H., M.W., T.N., L.N., M.H., S.R.), Department of Pathology (A.M.B.), Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center (L.W.U., M.B.), and Department of Medicine III, Division of Gastroenterology and Hepatology (W.R.), Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Michael Bergmann
- From the Department of Biomedical Imaging and Image-Guided Therapy (M.S., T.M., A.H., M.W., T.N., L.N., M.H., S.R.), Department of Pathology (A.M.B.), Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center (L.W.U., M.B.), and Department of Medicine III, Division of Gastroenterology and Hepatology (W.R.), Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Sazan Rasul
- From the Department of Biomedical Imaging and Image-Guided Therapy (M.S., T.M., A.H., M.W., T.N., L.N., M.H., S.R.), Department of Pathology (A.M.B.), Department of General Surgery, Division of Visceral Surgery and Comprehensive Cancer Center (L.W.U., M.B.), and Department of Medicine III, Division of Gastroenterology and Hepatology (W.R.), Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Borhani A, Afyouni S, Attari MMA, Mohseni A, Catalano O, Kamel IR. PET/MR enterography in inflammatory bowel disease: A review of applications and technical considerations. Eur J Radiol 2023; 163:110846. [PMID: 37121100 DOI: 10.1016/j.ejrad.2023.110846] [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: 02/08/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/02/2023]
Abstract
Positron emission tomography (PET) magnetic resonance (MR) enterography is a novel hybrid imaging technique that is gaining popularity in the study of complex inflammatory disorders of the gastrointestinal system, such as inflammatory bowel disease (IBD). This imaging technique combines the metabolic information of PET imaging with the spatial resolution and soft tissue contrast of MR imaging. Several studies have suggested potential roles for PET/MR imaging in determining the activity status of IBD, evaluating treatment response, stratifying risk, and predicting long-term clinical outcomes. However, there are challenges in generalizing findings due to limited studies, technical aspects of hybrid MR/PET imaging, and clinical indications of this imaging modality. This review aims to further elucidate the possible role of PET/MR in IBD, highlight important technical aspects of imaging, and address potential pitfalls and prospects of this modality in IBDs.
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Affiliation(s)
- Ali Borhani
- Russell H. Morgan Department of Radiology and Radiological Sciences, John's Hopkins Medicine, John's Hopkins University, Baltimore, MD, United States
| | - Shadi Afyouni
- Russell H. Morgan Department of Radiology and Radiological Sciences, John's Hopkins Medicine, John's Hopkins University, Baltimore, MD, United States
| | - Mohammad Mirza Aghazadeh Attari
- Russell H. Morgan Department of Radiology and Radiological Sciences, John's Hopkins Medicine, John's Hopkins University, Baltimore, MD, United States
| | - Alireza Mohseni
- Russell H. Morgan Department of Radiology and Radiological Sciences, John's Hopkins Medicine, John's Hopkins University, Baltimore, MD, United States
| | - Onofrio Catalano
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, United States; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
| | - Ihab R Kamel
- Russell H. Morgan Department of Radiology and Radiological Sciences, John's Hopkins Medicine, John's Hopkins University, Baltimore, MD, United States.
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Replacing Endoscopy with Magnetic Resonance Enterography for Mucosal Activity Assessment in Terminal Ileal Crohn’s Disease: Are We There Yet? Diagnostics (Basel) 2023; 13:diagnostics13061061. [PMID: 36980368 PMCID: PMC10046927 DOI: 10.3390/diagnostics13061061] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/18/2023] Open
Abstract
Crohn’s disease (CD) is a chronic immune mediated disorder that most commonly affects the small bowel and/or the large bowel. Treatment targets in CD include mucosal healing assessed via ileocolonoscopy and transmural healing assessed through cross-sectional imaging modalities such as magnetic resonance enterography (MRE). More recently, histological healing in CD has emerged as a treatment target, though it is made cumbersome given its reliance on frequent endoscopic examinations. With expert guidelines now recommending regular objective assessments as part of a treat-to-target approach, accurate non-invasive assessment will become increasingly critical. MRE has an established role in the assessment of small bowel CD, with growing data supportive of its ability in detecting disease activity at mucosal and histological levels. This could therefore potentially reduce the need for serial endoscopic assessment. Thus, this review will assess the capacity of individual MRE parameters and MRE indices for detecting mucosal and histological small bowel CD activity. Furthermore, challenging scenarios, such as CD activity detection in post-operative clinical scenarios and abnormal findings in the context of a normal ileocolonoscopy, will be explored.
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Noriega-Álvarez E, Martín-Comín J. Molecular Imaging in Inflammatory Bowel Disease. Semin Nucl Med 2023; 53:273-286. [PMID: 36702729 DOI: 10.1053/j.semnuclmed.2022.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 01/26/2023]
Abstract
Inflammatory bowel diseases (IBD) are chronic immune-mediated inflammatory diseases affecting the gastrointestinal tract. Classically, two subtypes of IBD are recognized: Ulcerative colitis and Crohn's disease. There is not a single and reliable test for IBD diagnosis but the nuclear medicine techniques like 99mTc-HMPAO autologous labelled leukocytes scintigraphy (WBCS) and PET/CT plays a role in the management of IBD. Leukocytes can be labelled "in vitro" (using 99mTc-HMPAO in Europe or 111In-oxine in America) or "in vivo" using antigranulocyte monoclonal antibodies. Nuclear medicine techniques are not the first choice to investigate IBD. Ultrasonography and magnetic resonance (radiation free) are probably the first option, and the diagnosis is commonly established by endoscopic biopsies. Nevertheless, WBCS is highly sensitive and accurate and represent a real option when other methods cannot used for whatever reason. In fact, a normal scan discards the presence of active IBD. The test is also useful to measure the extension and severity of the diseases and to evaluate the response to treatment. PET/CT imaging using 18F-FDG has recently been introduced and studied in both children and adults showing an excellent sensitivity for detecting active intestinal inflammation, but poor specificity in some studies. PET alone appears to be sufficient for the evaluation of ulcerative colitis, but PET/CT provides considerably more information than PET alone in the evaluation of Crohn's disease. Current clinical applications of PET in IBD include its use in the early evaluation of IBD, especially in children who may not tolerate an invasive test such as colonoscopy. Many questions remain to be answered, but PET appears to be a promising tool in the non-invasive evaluation of IBD. On the other hand, PET/MR could become in the near future a powerful tool in the evaluation of IBD patients. In addition, immuno-PET with antibodies targeting innate immune markers is also being investigated to detect colonic inflammation. The development of these technologies in humans could offer a less invasive method than endoscopy for the diagnosis and monitoring of IBD.
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Affiliation(s)
- Edel Noriega-Álvarez
- Nuclear Medicine Department, University General Hospital of Ciudad Real, Ciudad Real, Spain.
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10
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O'Shea A. Imaging Intestinal Fibrosis with 68Ga-FAPI PET/MRE: A Promising Tool for the Assessment of Crohn Disease Strictures? Radiology 2023; 307:e230130. [PMID: 36853184 DOI: 10.1148/radiol.230130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Aileen O'Shea
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 427, Boston, MA 02114
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11
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Utility of PET Scans in the Diagnosis and Management of Gastrointestinal Tumors. Dig Dis Sci 2022; 67:4633-4653. [PMID: 35908126 DOI: 10.1007/s10620-022-07616-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 12/14/2022]
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12
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Bartlett DJ, Ramos GP, Fletcher JG, Bruining DH. Imaging Evaluation of Inflammatory Bowel Disease Complications. Gastrointest Endosc Clin N Am 2022; 32:651-673. [PMID: 36202508 DOI: 10.1016/j.giec.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Inflammatory bowel disease (IBD) is a chronic inflammatory condition that can progress to fibrostenotic and penetrating complications. Cross-sectional imaging is often needed for accurate diagnosis of IBD complication and for planning the appropriate management strategy. Computed tomography enterography, magnetic resonance enterography, and IBD ultrasound have become key tools for clinicians and interventional endoscopists. This article highlights and discusses various radiologic imaging techniques and their application to the diagnosis and management of IBD complications.
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Affiliation(s)
- David J Bartlett
- Department of Radiology, Mayo Clinic College of Medicine, 200 1st Street, SW, Rochester, MN 55905, USA; Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 1st Street, SW, Rochester, MN 55905, USA
| | - Guilherme Piovezani Ramos
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 1st Street, SW, Rochester, MN 55905, USA
| | - Joel G Fletcher
- Department of Radiology, Mayo Clinic College of Medicine, 200 1st Street, SW, Rochester, MN 55905, USA
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 1st Street, SW, Rochester, MN 55905, USA.
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13
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Lovinfosse P, Hustinx R. The role of PET imaging in inflammatory bowel diseases: state-of-the-art review. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2022; 66:206-217. [PMID: 35708600 DOI: 10.23736/s1824-4785.22.03467-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Inflammatory bowel diseases (IBD), i.e. Crohn disease and ulcerative colitis, are autoimmune processes of undetermined origin characterized by the chronic inflammation of the digestive tract. There is no single gold-standard to diagnose IBD which is therefore carried out through the combination of endoscopy, biopsy, radiological and biological investigations; and the development of non-invasive technique allowing the assessment and monitoring of these diseases is necessary. In this state-of-the-art review of the literature, we present the results of PET imaging studies for the diagnosis and staging of IBD (suspected or known), response evaluation to treatment and evaluation of one the main complication, i.e. strictures; explain the reasons why this examination is currently not considered in the IBD guidelines, e.g. radiation exposure, lack of standardization and not validated performances; and finally discuss the perspectives that could possibly allow it to find a place in the future, e.g. digital PET-CT, dynamic PET images acquisition, new radiopharmaceuticals, use of radiomics and use of artificial intelligence for automatically characterize and quantify digestive [18F]FDG uptake.
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Affiliation(s)
- Pierre Lovinfosse
- Division of Nuclear Medicine and Oncological Imaging, University Hospital CHU of Liège, Liège, Belgium -
- GIGA-CRC in vivo Imaging, University of Liège, Liège, Belgium -
| | - Roland Hustinx
- Division of Nuclear Medicine and Oncological Imaging, University Hospital CHU of Liège, Liège, Belgium
- GIGA-CRC in vivo Imaging, University of Liège, Liège, Belgium
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Intestinal fibrosis classification in patients with Crohn's disease using CT enterography-based deep learning: comparisons with radiomics and radiologists. Eur Radiol 2022; 32:8692-8705. [PMID: 35616733 DOI: 10.1007/s00330-022-08842-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/13/2022] [Accepted: 04/25/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Accurate evaluation of bowel fibrosis in patients with Crohn's disease (CD) remains challenging. Computed tomography enterography (CTE)-based radiomics enables the assessment of bowel fibrosis; however, it has some deficiencies. We aimed to develop and validate a CTE-based deep learning model (DLM) for characterizing bowel fibrosis more efficiently. METHODS We enrolled 312 bowel segments of 235 CD patients (median age, 33 years old) from three hospitals in this retrospective study. A training cohort and test cohort 1 were recruited from center 1, while test cohort 2 from centers 2 and 3. All patients performed CTE within 3 months before surgery. The histological fibrosis was semi-quantitatively assessed. A DLM was constructed in the training cohort based on a 3D deep convolutional neural network with 10-fold cross-validation, and external independent validation was conducted on the test cohorts. The radiomics model (RM) was developed with 4 selected radiomics features extracted from CTE images by using logistic regression. The evaluation of CTE images was performed by two radiologists. DeLong's test and a non-inferiority test were used to compare the models' performance. RESULTS DLM distinguished none-mild from moderate-severe bowel fibrosis with an area under the receiver operator characteristic curve (AUC) of 0.828 in the training cohort and 0.811, 0.808, and 0.839 in the total test cohort, test cohorts 1 and 2, respectively. In the total test cohort, DLM achieved better performance than two radiologists (*1 AUC = 0.579, *2 AUC = 0.646; both p < 0.05) and was not inferior to RM (AUC = 0.813, p < 0.05). The total processing time for DLM was much shorter than that of RM (p < 0.001). CONCLUSION DLM is better than radiologists in diagnosing intestinal fibrosis on CTE in patients with CD and not inferior to RM; furthermore, it is more time-saving compared to RM. KEY POINTS • Question Could computed tomography enterography (CTE)-based deep learning model (DLM) accurately distinguish intestinal fibrosis severity in patients with Crohn's disease (CD)? • Findings In this cross-sectional study that included 235 patients with CD, DLM achieved better performance than that of two radiologists' interpretation and was not inferior to RM with significant differences and much shorter processing time. • Meaning This DLM may accurately distinguish the degree of intestinal fibrosis in patients with CD and guide gastroenterologists to formulate individualized treatment strategies for those with bowel strictures.
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Gordon IO, Bettenworth D, Bokemeyer A, Srivastava A, Rosty C, de Hertogh G, Robert ME, Valasek MA, Mao R, Li J, Harpaz N, Borralho P, Pai RK, Odze R, Feakins R, Parker CE, Guizzetti L, Nguyen T, Shackelton LM, Sandborn WJ, Jairath V, Baker M, Bruining D, Fletcher JG, Feagan BG, Pai RK, Rieder F. International consensus to standardise histopathological scoring for small bowel strictures in Crohn's disease. Gut 2022; 71:479-486. [PMID: 33952604 PMCID: PMC8903083 DOI: 10.1136/gutjnl-2021-324374] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/31/2021] [Accepted: 04/26/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Effective medical therapy and validated trial outcomes are lacking for small bowel Crohn's disease (CD) strictures. Histopathology of surgically resected specimens is the gold standard for correlation with imaging techniques. However, no validated histopathological scoring systems are currently available for small bowel stricturing disease. We convened an expert panel to evaluate the appropriateness of histopathology scoring systems and items generated based on panel opinion. DESIGN Modified RAND/University of California Los Angeles methodology was used to determine the appropriateness of 313 candidate items related to assessment of CD small bowel strictures. RESULTS In this exercise, diagnosis of naïve and anastomotic strictures required increased bowel wall thickness, decreased luminal diameter or internal circumference, and fibrosis of the submucosa. Specific definitions for stricture features and technical sampling parameters were also identified. Histopathologically, a stricture was defined as increased thickness of all layers of the bowel wall, fibrosis of the submucosa and bowel wall, and muscularisation of the submucosa. Active mucosal inflammatory disease was defined as neutrophilic inflammation in the lamina propria and any crypt or intact surface epithelium, erosion, ulcer and fistula. Chronic mucosal inflammatory disease was defined as crypt architectural distortion and loss, pyloric gland metaplasia, Paneth cell hyperplasia, basal lymphoplasmacytosis, plasmacytosis and fibrosis, or prominent lymphoid aggregates at the mucosa/submucosa interface. None of the scoring systems used to assess CD strictures were considered appropriate for clinical trials. CONCLUSION Standardised assessment of gross pathology and histopathology of CD small bowel strictures will improve clinical trial efficiency and aid drug development.
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Affiliation(s)
- Ilyssa O Gordon
- Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Dominik Bettenworth
- Department of Medicine B, Gastroenterology and Hepatology, University of Münster, Münster, NRW, Germany
| | - Arne Bokemeyer
- Department of Medicine B, Gastroenterology and Hepatology, University of Münster, Münster, NRW, Germany
| | - Amitabh Srivastava
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Christophe Rosty
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia,Department of Clinical Pathology, The University of Melbourne, Parville, VIC, Australia,Envoi Specialist Pathologists, Brisbane, QLD, Australia
| | - Gert de Hertogh
- Department of Pathology, University Hospital Gasthuisberg, KULeuven, Leuven, Belgium
| | - Marie E Robert
- Department of Pathology and Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mark A Valasek
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Ren Mao
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China,Department of Inflammation and Immunity, Cleveland Clinic Foundation, Cleveland, Ohio, USA,Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jiannan Li
- Department of Inflammation and Immunity, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Noam Harpaz
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Paula Borralho
- Faculdade de Medicina da Universidade de Lisboa, Instituto de Anatomia Patológica, Lisbon, Portugal
| | - Reetesh K Pai
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Roger Feakins
- Department of Cellular Pathology, Royal London Hospital, London, UK
| | - Claire E Parker
- Alimentiv, Inc (formerly Robarts Clinical Trials, Inc), London, Ontario, Canada
| | - Leonardo Guizzetti
- Alimentiv, Inc (formerly Robarts Clinical Trials, Inc), London, Ontario, Canada
| | - Tran Nguyen
- Alimentiv, Inc (formerly Robarts Clinical Trials, Inc), London, Ontario, Canada
| | - Lisa M Shackelton
- Alimentiv, Inc (formerly Robarts Clinical Trials, Inc), London, Ontario, Canada
| | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Vipul Jairath
- Alimentiv, Inc (formerly Robarts Clinical Trials, Inc), London, Ontario, Canada,Department of Medicine and Department of Biostatistics and Epidemiology, Western University, London, Ontario, Canada
| | - Mark Baker
- Section of Abdominal Imaging, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - David Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joel G Fletcher
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian G Feagan
- Alimentiv, Inc (formerly Robarts Clinical Trials, Inc), London, Ontario, Canada,Department of Medicine and Department of Biostatistics and Epidemiology, Western University, London, Ontario, Canada
| | - Rish K Pai
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Florian Rieder
- Department of Inflammation and Immunity, Cleveland Clinic Foundation, Cleveland, Ohio, USA .,Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Ismail MS, Charabaty A. Management of Crohn's stricture: medical, endoscopic and surgical therapies. Frontline Gastroenterol 2022; 13:524-530. [PMID: 36250181 PMCID: PMC9555137 DOI: 10.1136/flgastro-2021-101827] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/21/2022] [Indexed: 02/04/2023] Open
Abstract
Patients with Crohn's disease are at high risk of presenting with or developing a bowel stricture during the course of their disease. The available therapeutic options to manage a symptomatic Crohn's stricture include medical therapy (mainly biologics), surgical resection and endoscopic interventions. The choice of therapeutic modality depends on the clinical presentation of the stricture, the nature of the stricture (inflammatory vs fibrotic, primary vs anastomotic) and its anatomical characteristics on endoscopy and imaging (length, number, location of strictures and severity of obstruction). The aim herein is to provide an overview of the comprehensive assessment of a Crohn's stricture and to review the indications of the different therapeutic modalities, their success rates and their limitations to help clinicians properly evaluate and manage Crohn's strictures.
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Affiliation(s)
- Mohamed Saleh Ismail
- Gastroenterology and Hepatology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Aline Charabaty
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Sibley Memorial Hospital, Washington, District of Columbia, USA
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Li Z, Lu B, Lin J, He S, Huang L, Wang Y, Meng J, Li Z, Feng ST, Lin S, Mao R, Li XH. A Type I Collagen-Targeted MR Imaging Probe for Staging Fibrosis in Crohn's Disease. Front Mol Biosci 2021; 8:762355. [PMID: 34859052 PMCID: PMC8631902 DOI: 10.3389/fmolb.2021.762355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/20/2021] [Indexed: 02/01/2023] Open
Abstract
Fibrostenosis is a serious complication of Crohn's disease (CD), affecting approximately one-half of all patients. Surgical resection is the typical clinical end due to ineffective antifibrotic therapy mainly through anti-inflammatory treatment and fibrosis can be reverted only at early stages. Mover, human fibrotic disorders is known to be associated with aging process. Thus, accurate monitoring of the progression of fibrosis is crucial for CD management as well as can be benefit to aging related fibrosis. The excessive deposition of type I collagen (ColI) is the core point in major complications of fibrosis, including that in patients with CD and aging related fibrosis. Therefore, a MR imaging probe (EP-3533) targeted ColI was employed to stage bowel fibrosis in CD using a rat model and to compare its efficiency with the common MR imaging contrast medium gadopentetatedimeglumine (Gd-DTPA). The bowel fibrotic rat model was established with different degrees of bowel fibrosis, were scanned using a 3.0-T MRI scanner with a specialized animal coil. MRI sequence including T 1 mapping and T1-weighed imaging were performed before and after injecting the MRI probe (EP-3533 or Gd-DTPA). The T 1 relaxation time (T 1 value) and change in the contrast-to-noise ratio (ΔCNR) were measured to evaluate bowel fibrosis. Masson's trichrome staining was performed to determine the severity of fibrosis. EP-3533 offered a better longitudinal relaxivity (r1) with 67.537 L/mmol·s, which was approximately 13 times that of Gd-DTPA. The T 1 value on bowel segments was reduced in the images from EP-3533 compared to that from Gd-DTPA (F = 16.478; p < 0.001). Additionally, a better correlation between ΔCNR calculated from EP-3533 imaging and bowel fibrosis (AUC = 0.846) was determined 10 min after enhanced media administration than with Gd-DTPA (AUC = 0.532). The 10th-minute ΔCNR performed using the ColI probe showed the best correlation with the severity of bowel fibrosis (r = 0.538; p = 0.021). Our results demonstrates that targeted MRI probe (EP-3533) supplies a better enhanced effect compared to Gd-DTPA and could be a promising method to evaluate the progression and monitor the therapeutic response of bowel fibrosis.
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Affiliation(s)
- Zhoulei Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Baolan Lu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jinjiang Lin
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shaofu He
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Li Huang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yangdi Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jixin Meng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ziping Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shaochun Lin
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ren Mao
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xue-Hua Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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Detection of intramural fat accumulation by 3D-Dixon-Caipirinha-Vibe and the contribution of this technique to the determination of the chronicity of Chron's disease. Magn Reson Imaging 2021; 85:93-101. [PMID: 34662701 DOI: 10.1016/j.mri.2021.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/01/2021] [Accepted: 10/12/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES In this study; we aimed to evaluate the efficacy of the 3D-Dixon-Caipirinha-Vibe fat images in detecting intramural fat accumulation (IFA) and contributions of 3D-Dixon-Caipirinha-Vibe in the management of patients with Chron's disease. METHODS Eighty-five patients who had a 3-tesla MR enterography (MRE) with the 3D-Dixon-Caipirinha-Vibe technique were included. Wall thickness, ADC-value, intramural edema, presence/extension of IFA, and contrast-material enhancement of the affected segments were examined. Findings of MRE were compared statistically with clinical, laboratory, endoscopy, and pathological exams. RESULTS The presence of IFA was more common in patients with chronic active and chronic inflammation than only active inflammation and normal cases. Patients with IFA had a longer disease duration than patients without IFA. IFA-containing segment lengths of patients with chronic active inflammation and chronic inflammation were found to be longer than those with active inflammation. It was found that patients whose pathology results were reported as active inflammation contained less IFA than patients with chronic inflammation. CONCLUSIONS The presence of IFA is strongly related to chronicity. 3D-Dixon-Caipirinha-Vibe is a fast, easy, and useful method for detecting IFA and evaluating Chron's disease.
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Sepehrizadeh T, Jong I, DeVeer M, Malhotra A. PET/MRI in paediatric disease. Eur J Radiol 2021; 144:109987. [PMID: 34649143 DOI: 10.1016/j.ejrad.2021.109987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022]
Abstract
Nuclear medicine and molecular imaging have a small but growing role in the management of paediatric and neonatal diseases. During the past decade, combined PET/MRI has emerged as a clinically important hybrid imaging modality in paediatric medicine due to diagnostic advantages and reduced radiation exposure compared to alternative techniques. The applications for nuclear medicine, radiopharmaceuticals and combined PET/MRI in paediatric diagnosis is broadly similar to adults, however there are some key differences. There are a variety of clinical applications for PET/MRI imaging in children including, but not limited to, oncology, neurology, cardiovascular, infection and chronic inflammatory diseases, and in renal-urological disorders. In this article, we review the applications of PET/MRI in paediatric and neonatal imaging, its current role, advantages and disadvantages over other hybrid imaging techniques such as PET/CT, and its future applications. Overall, PET/MRI is a powerful imaging technology in diagnostic medicine and paediatric diseases. Higher soft tissue contrasts and lower radiation dose of the MRI makes it the superior technology compared to other conventional techniques such as PET/CT or scintigraphy. However, this relatively new hybrid imaging has also some limitations. MRI based attenuation correction remains a challenge and although methodologies have improved significantly in the last decades, most remain under development.
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Affiliation(s)
| | - Ian Jong
- Department of diagnostic imaging, Monash Health, Melbourne, Australia
| | - Michael DeVeer
- Monash Biomedical Imaging, Monash University, Melbourne, Australia
| | - Atul Malhotra
- Monash Newborn, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia
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Extracellular Matrix Components as Diagnostic Tools in Inflammatory Bowel Disease. BIOLOGY 2021; 10:biology10101024. [PMID: 34681123 PMCID: PMC8533508 DOI: 10.3390/biology10101024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/14/2021] [Accepted: 09/30/2021] [Indexed: 12/20/2022]
Abstract
Simple Summary For decades, the extracellular matrix (ECM) has been defined as a structure component playing a rather neglected role in the human body. In recent years, research has shed light on the role of ECM within cellular processes, including proliferation, migration and differentiation, as well as in inflammation. In inflammation, ECM composition is constantly being remodeled and undergoes dynamic and rapid changes. Tracking these changes could serve as a novel diagnostic tool. Inflammatory bowel disease is accompanied by complications such as fibrosis, stenosis and fistulas. All of these structural complications involve excessive synthesis or degradation of ECM. With this review, we explored whether the analysis of ECM composition can be of support in diagnosing inflammatory bowel disease and whether changes within ECM can help to predict a complicated disease course early on. Abstract Work from the last years indicates that the extracellular matrix (ECM) plays a direct role in various cellular processes, including proliferation, migration and differentiation. Besides homeostatic processes, its regulatory function in inflammation becomes more and more evident. In inflammation, such as inflammatory bowel disease, the ECM composition is constantly remodeled, and this can result in a structuring of fistulizing disease course. Thus, tracking early ECM changes might bear the potential to predict the disease course. In this review, we provide an overview of relevant diagnostic methods, focusing on ECM changes.
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21
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Zhao J, Liao D, Wilkens R, Krogh K, Glerup H, Gregersen H. Bowel stiffness associated with histopathologic scoring of stenosis in patients with Crohn's disease. Acta Biomater 2021; 130:332-342. [PMID: 34119715 DOI: 10.1016/j.actbio.2021.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Intestinal stenosis is a common complication of Crohn's Disease (CD). Stenosis is associated with alteration of bowel mechanical properties. This study aims to quantitate the mechanical properties of the intestinal stenosis and to explore associations between histology and mechanical remodeling at stenotic intestinal sites in CD patients. METHODS Intestinal segments from stenotic sites were studied in vitro from 19 CD patients. A luminal catheter with a bag was used to stepwise pressurize the intestinal segments from 0-100 cmH2O with 10 cmH2O increments. B-mode ultrasound images were obtained at the narrowest part of the stenosis at each pressure level and morphometric parameters were obtained from ultrasound images. The mechanical behavior of the stenotic tissue were characterized by using an isotropic three dimensional strain energy function in Demiray model form, the mechanical constants were obtained by fitting the model to the recorded intraluminal pressure and the inner radius of the stenotic segment of the small bowel. Grading scores were used for histological analysis of inflammation, fibrosis, muscular hypertrophy and adipocyte proliferation in the intestinal layers. The collagen area fraction in intestinal layers was also calculated. Associations between histological and the mechanical constants (stiffness) were analyzed. RESULTS Chronic inflammation was mainly located in mucosa whereas fibrosis was found in submucosa. The mechanical remodeling was performed with changed mechanical constants ranged between 0.35-13.68kPa. The mechanical properties changes were associated mainly with chronic inflammation, fibrosis and combination of inflammation and fibrosis (R>0.69, P<0.001). Furthermore, the mechanical properties correlated with the collagen fraction in submucosa and muscular layers (R>0.53, P<0.05). CONCLUSIONS We quantitated the intestinal stenosis stiffness. Associations were found between bowel mechanical remodeling and histological changes at the stenotic site in CD patients. STATEMENT OF SIGNIFICANCE Although intestinal ultrasonography, CT and MRI can be used to diagnose Crohn's Disease (CD)-associated bowel strictures, these techniques may not have sufficient accuracy and resolution to differentiate predominantly inflammatory strictures from predominantly fibrotic strictures. The present study aims to quantitate the mechanical remodeling of intestinal stenosis and to explore the associations between histological parameters and mechanical properties at the intestinal stenotic sites in CD patients. For the first time, we quantitatively demonstrated that the mechanical properties of the intestinal wall in CD stenosis are associated with the chronic inflammation, fibrosis and collagen fraction in the intestinal layers. The results of this study may facilitate design and development of artificial biomaterials for gastrointestinal organs. The potential clinical implication of this study is that the histological characteristics in patients with CD can be predicted clinically by means of inflammation and fibrosis assessment in conjunction with tissue stiffness measurement.
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Affiliation(s)
- Jingbo Zhao
- Standard (Chongqing) Pathological Diagnosis Center. No. 8 Xiyuan North Road, Shapingba District, Chongqing, China; Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark; Giome Academia, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Donghua Liao
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark; Giome Academia, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Rune Wilkens
- Gastrounit, Division of Medicine, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Klaus Krogh
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Henning Glerup
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
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Tenhami M, Virtanen J, Kauhanen S, Koffert J, Kemppainen J, Saunavaara V, Kujari H, Hurme S, Teperi S, Voutilainen M. The value of combined positron emission tomography/magnetic resonance imaging to diagnose inflammatory bowel disease: a prospective study. Acta Radiol 2021; 62:851-857. [PMID: 32722966 DOI: 10.1177/0284185120944900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The clinical utility of positron emission tomography/magnetic resonance imaging (PET/MRI) in comparison to standard work-up with patients with known or suspected inflammatory bowel disease (IBD) is unknown. PURPOSE To evaluate the value of 18F-fluorodeoxyglucose (18F-FDG) PET/MRI in the diagnostics of IBD and further compare the data obtained using PET/MRI to histological findings. MATERIALS AND METHODS Ten patients with relapse in IBD or with symptoms of suspected IBD were recruited either from a gastroenterology outpatient clinic or from a hospital ward. Intestinal inflammation was assessed with histology and 18F-FDG PET/MRI. Maximum standard uptake values (SUVmax) were calculated in six regions of the intestine (small bowel, ascending, transverse, descending and sigmoid colon, and rectum) and compared to histological analysis of inflammation activity. RESULTS The study showed that both the inflammation activity (P = 0.008) and the region of the biopsy in the intestine (P = 0.015) had a significant effect on SUV. SUVs obtained from severe inflammation activity emerged significantly from the background (P = 0.006). In addition, the SUVs obtained from moderate inflammation raised from background, but the difference was not statistically significant (P = 0.083), while SUVs of mild inflammation were at the same level with SUVs of normal bowel wall (P = 0.988). CONCLUSION 18F-FDG PET/MRI is a promising method of detecting especially severe inflammatory bowel lesions. More data are required to define its sensitivity and specificity.
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Affiliation(s)
- Mervi Tenhami
- Division of Digestive Surgery, Turku University Hospital, Turku, Finland
| | - Johanna Virtanen
- Department of Radiology, Turku University Hospital, Turku, Finland; Medical Imaging Centre of Southwest Finland, University of Turku, Turku, Finland
| | - Saila Kauhanen
- Division of Digestive Surgery, Turku University Hospital, Turku, Finland
| | - Jukka Koffert
- Department of Gastroenterology, Turku University Hospital, Turku, Finland
| | - Jukka Kemppainen
- Department of Clinical Physiology and Nuclear Medicine and Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Virva Saunavaara
- Department of Medical Physics and Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Harry Kujari
- Department of Pathology, Turku University Hospital, Turku, Finland
| | - Saija Hurme
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Simo Teperi
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Markku Voutilainen
- Department of Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
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Abstract
PURPOSE OF REVIEW Recent advances in computed tomography (CT), ultrasound (US), magnetic resonance imaging (MRI), and nuclear radiology have improved the diagnosis and characterization of small bowel pathology. Our purpose is to highlight the current status and recent advances in multimodality noninvasive imaging of the small bowel. RECENT FINDINGS CT and MR enterography are established techniques for small bowel evaluation. Dual-energy CT is a novel technique that has shown promise for the mesenteric ischemia and small bowel bleeding. Advanced US techniques and MRI sequences are being investigated to improve assessment of bowel inflammation, treatment response assessment, motility, and mural fibrosis. Novel radiotracers and scanner technologies have made molecular imaging the new reference standard for small bowel neuroendocrine tumors. Computational image analysis and artificial intelligence (AI) have the potential to augment physician expertise, reduce errors and variability in assessment of the small bowel on imaging. SUMMARY Advances in translational imaging research coupled with progress in imaging technology have led to a wider adoption of cross-sectional imaging for the evaluation and management of small bowel entities. Ongoing developments in image acquisition and postprocessing techniques, molecular imaging and AI have the strongest potential to transform the care and outcomes of patients with small bowel diseases.
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Foti PV, Travali M, Farina R, Palmucci S, Coronella M, Spatola C, Puzzo L, Garro R, Inserra G, Riguccio G, Zanoli L, Basile A. Can Conventional and Diffusion-Weighted MR Enterography Biomarkers Differentiate Inflammatory from Fibrotic Strictures in Crohn's Disease? ACTA ACUST UNITED AC 2021; 57:medicina57030265. [PMID: 33803953 PMCID: PMC8000737 DOI: 10.3390/medicina57030265] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/07/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022]
Abstract
Background and Objectives: To retrospectively assess the value of magnetic resonance enterography (MRE) parameters derived from conventional and diffusion weighted imaging (DWI) sequences to differentiate fibrotic strictures from inflammatory ones in adult patients with Crohn’s disease (CD), using surgical specimens as the histopathological reference standard. Material and Methods: Twenty-three patients with CD who had undergone surgical resection of ileal strictures with full-thickness histopathologic analysis within 3 months from preoperative MRE were included. Two radiologists blinded to histopathology in consensus evaluated the following biomarkers on MRE images matched to resected pathological specimens: T1 ratio, T2 ratio, enhancement pattern, mural thickness, pre-stenotic luminal diameter, and apparent diffusion coefficient (ADC). A blinded pathologist graded stricture histological specimens with acute inflammation score (AIS) and fibrosis score (FS). MRE measurements were correlated with the reference standard. Results: Inflammation and fibrosis coexisted in 78.3% of patients. T2 ratio was reduced in patients with severe fibrosis (p = 0.01). Pre-stenotic bowel dilatation positively correlated with FS (p = 0.002). The ADC value negatively correlated with FS (p < 0.001) and was different between FS grades (p < 0.05). The area under the receiver operating characteristic curve for discriminating between none and mild/moderate–severe bowel wall fibrosis was 0.75 for pre-stenotic bowel dilatation (sensitivity 100%, specificity 44.4%) and 0.97 for ADC (sensitivity 80%, specificity 100%). Conclusions: Inflammation and fibrosis often coexist in CD bowel strictures needing surgery. The combination of parameters derived from conventional MR sequences (T2 ratio, pre-stenotic dilatation) and from DWI (ADC) may provide a contribution to detect and grade bowel fibrosis in adult CD patients.
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Affiliation(s)
- Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia, 78-95123 Catania, Italy; (M.T.); (R.F.); (S.P.); (M.C.); (C.S.); (A.B.)
- Correspondence: ; Tel.: +39-095-378-2360; Fax: +39-095-378-2368
| | - Mario Travali
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia, 78-95123 Catania, Italy; (M.T.); (R.F.); (S.P.); (M.C.); (C.S.); (A.B.)
| | - Renato Farina
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia, 78-95123 Catania, Italy; (M.T.); (R.F.); (S.P.); (M.C.); (C.S.); (A.B.)
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia, 78-95123 Catania, Italy; (M.T.); (R.F.); (S.P.); (M.C.); (C.S.); (A.B.)
| | - Maria Coronella
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia, 78-95123 Catania, Italy; (M.T.); (R.F.); (S.P.); (M.C.); (C.S.); (A.B.)
| | - Corrado Spatola
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia, 78-95123 Catania, Italy; (M.T.); (R.F.); (S.P.); (M.C.); (C.S.); (A.B.)
| | - Lidia Puzzo
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Anatomic Pathology Section, University of Catania, Via Santa Sofia, 78-95123 Catania, Italy; (L.P.); (R.G.)
| | - Rossella Garro
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Anatomic Pathology Section, University of Catania, Via Santa Sofia, 78-95123 Catania, Italy; (L.P.); (R.G.)
| | - Gaetano Inserra
- Department of Clinical and Experimental Medicine, U.O. Medicina Interna, University of Catania, Via Santa Sofia, 78-95123 Catania, Italy; (G.I.); (G.R.)
| | - Gaia Riguccio
- Department of Clinical and Experimental Medicine, U.O. Medicina Interna, University of Catania, Via Santa Sofia, 78-95123 Catania, Italy; (G.I.); (G.R.)
| | - Luca Zanoli
- Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia, 78-95123 Catania, Italy;
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia, 78-95123 Catania, Italy; (M.T.); (R.F.); (S.P.); (M.C.); (C.S.); (A.B.)
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Ito J, Nogami M, Morita Y, Sakaguchi K, Komada H, Hirota Y, Sugawara K, Tamori Y, Zeng F, Murakami T, Ogawa W. Dose-dependent accumulation of glucose in the intestinal wall and lumen induced by metformin as revealed by 18 F-labelled fluorodeoxyglucose positron emission tomography-MRI. Diabetes Obes Metab 2021; 23:692-699. [PMID: 33236523 DOI: 10.1111/dom.14262] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/30/2020] [Accepted: 11/22/2020] [Indexed: 12/21/2022]
Abstract
AIM To investigate the relationships between various clinical variables and the metformin-induced accumulation of fluorodeoxyglucose (FDG) in the intestine, with distinction between the intestinal wall and lumen, in individuals with type 2 diabetes who were receiving metformin treatment and underwent 18 F-labelled FDG ([18 F]FDG) positron emission tomography (PET)-MRI. MATERIALS AND METHODS We evaluated intestinal accumulation of [18 F]FDG with both subjective (a five-point visual scale determined by two experienced radiologists) and objective analyses (measurement of the maximum standardized uptake value [SUVmax ]) in 26 individuals with type 2 diabetes who were receiving metformin and underwent [18 F]FDG PET-MRI. [18 F]FDG accumulation within the intestinal wall was discriminated from that in the lumen on the basis of SUVmax . RESULTS SUVmax for the large intestine was correlated with blood glucose level (BG) and metformin dose, but not with age, body mass index, HbA1c level or estimated glomerular filtration rate (eGFR). SUVmax for the small intestine was not correlated with any of these variables. Visual scale analysis yielded essentially similar results. Metformin dose and eGFR were correlated with SUVmax for the wall and lumen of the large intestine, whereas BG was correlated with that for the wall. Multivariable analysis identified metformin dose as an explanatory factor for SUVmax in the wall and lumen of the large intestine after adjustment for potential confounders including BG and eGFR. CONCLUSIONS Metformin dose is an independent determinant of [18 F]FDG accumulation in the wall and lumen of the large intestine in individuals treated with this drug.
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Affiliation(s)
- Jun Ito
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Munenobu Nogami
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yasuko Morita
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazuhiko Sakaguchi
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hisako Komada
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yushi Hirota
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenji Sugawara
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshikazu Tamori
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
- Division of Creative Health Promotion, Department of Social/Community Medicine and Health Science, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Feibi Zeng
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Wataru Ogawa
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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26
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Suarez-Weiss KE, Herold A, Gervais D, Palmer E, Amorim B, King JD, Weier L, Shahein T, Bernstine H, Domachevsk L, Cañamaque LG, Herrmann K, Umutlu L, Groshar D, Catalano OA. Hybrid imaging of the abdomen and pelvis. Radiologe 2021; 60:80-89. [PMID: 32424463 DOI: 10.1007/s00117-020-00661-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Accurate imaging is crucial for lesion detection in abdominal organs, for the noninvasive characterization of focal and diffuse abnormalities, and for surgical planning. To accomplish these tasks, several imaging modalities such as multidetector computer tomography (MDCT), magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) are used for abdominal imaging, providing important morphological, functional or metabolic information. More recently, PET/MRI has been gaining attention due to the possibility of combining high-resolution imaging with metabolic imaging. PET/MRI is a novel hybrid imaging technology that in the near future might play a pivotal role in the clinical management of oncologic and inflammatory abdominopelvic diseases. Despite the still limited number of published clinical studies, PET/MRI has been proven to be at least equivalent to PET/CT and to standalone MRI in a variety of oncologic disease. Moreover, in selected and focused clinical studies, it has been proven to outperform current standard of care imaging, for example, in evaluating cholangiocarcinomas, liver metastases, untreated and treated rectal cancer. This has also had an impact on therapeuticmanagement in some studies. Therefore in some institutions, including those of the authors, PET/MRI is becoming the new standard imaging modality in staging treatment-naïve intrahepatic massforming cholangiocarcinomas and prior to complicated hepatic surgery.
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Affiliation(s)
| | | | - Debra Gervais
- Division of Abdominal Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Edwin Palmer
- Division of Abdominal Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Joseph D King
- Division of Abdominal Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Li Weier
- Division of Abdominal Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Tajmir Shahein
- Division of Abdominal Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | | | | | | | - Onofrio A Catalano
- Division of Abdominal Radiology, Massachusetts General Hospital, Boston, MA, USA.
- University of Naples Parthenope, Naples, Italy.
- Harvard Medical School, Massachusetts General Hospital, 55 Fruits St, Boston, MA, USA.
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27
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Initial Experience With Low-Dose 18F-Fluorodeoxyglucose Positron Emission Tomography/Magnetic Resonance Imaging With Deep Learning Enhancement. J Comput Assist Tomogr 2021; 45:637-642. [PMID: 34176877 PMCID: PMC8597977 DOI: 10.1097/rct.0000000000001174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To demonstrate the utility of deep learning enhancement (DLE) to achieve diagnostic quality low-dose positron emission tomography (PET)/magnetic resonance (MR) imaging. METHODS Twenty subjects with known Crohn disease underwent simultaneous PET/MR imaging after intravenous administration of approximately 185 MBq of 18F-fluorodeoxyglucose (FDG). Five image sets were generated: (1) standard-of-care (reference), (2) low-dose (ie, using 20% of PET counts), (3) DLE-enhanced low-dose using PET data as input, (4) DLE-enhanced low-dose using PET and MR data as input, and (5) DLE-enhanced using no PET data input. Image sets were evaluated by both quantitative metrics and qualitatively by expert readers. RESULTS Although low-dose images (series 2) and images with no PET data input (series 5) were nondiagnostic, DLE of the low-dose images (series 3 and 4) achieved diagnostic quality images that scored more favorably than reference (series 1), both qualitatively and quantitatively. CONCLUSIONS Deep learning enhancement has the potential to enable a 90% reduction of radiotracer while achieving diagnostic quality images.
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28
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Casali M, Lauri C, Altini C, Bertagna F, Cassarino G, Cistaro A, Erba AP, Ferrari C, Mainolfi CG, Palucci A, Prandini N, Baldari S, Bartoli F, Bartolomei M, D’Antonio A, Dondi F, Gandolfo P, Giordano A, Laudicella R, Massollo M, Nieri A, Piccardo A, Vendramin L, Muratore F, Lavelli V, Albano D, Burroni L, Cuocolo A, Evangelista L, Lazzeri E, Quartuccio N, Rossi B, Rubini G, Sollini M, Versari A, Signore A. State of the art of 18F-FDG PET/CT application in inflammation and infection: a guide for image acquisition and interpretation. Clin Transl Imaging 2021; 9:299-339. [PMID: 34277510 PMCID: PMC8271312 DOI: 10.1007/s40336-021-00445-w] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/19/2021] [Indexed: 02/06/2023]
Abstract
AIM The diagnosis, severity and extent of a sterile inflammation or a septic infection could be challenging since there is not one single test able to achieve an accurate diagnosis. The clinical use of 18F-fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) imaging in the assessment of inflammation and infection is increasing worldwide. The purpose of this paper is to achieve an Italian consensus document on [18F]FDG PET/CT or PET/MRI in inflammatory and infectious diseases, such as osteomyelitis (OM), prosthetic joint infections (PJI), infective endocarditis (IE), prosthetic valve endocarditis (PVE), cardiac implantable electronic device infections (CIEDI), systemic and cardiac sarcoidosis (SS/CS), diabetic foot (DF), fungal infections (FI), tuberculosis (TBC), fever and inflammation of unknown origin (FUO/IUO), pediatric infections (PI), inflammatory bowel diseases (IBD), spine infections (SI), vascular graft infections (VGI), large vessel vasculitis (LVV), retroperitoneal fibrosis (RF) and COVID-19 infections. METHODS In September 2020, the inflammatory and infectious diseases focus group (IIFG) of the Italian Association of Nuclear Medicine (AIMN) proposed to realize a procedural paper about the clinical applications of [18F]FDG PET/CT or PET/MRI in inflammatory and infectious diseases. The project was carried out thanks to the collaboration of 13 Italian nuclear medicine centers, with a consolidate experience in this field. With the endorsement of AIMN, IIFG contacted each center, and the pediatric diseases focus group (PDFC). IIFG provided for each team involved, a draft with essential information regarding the execution of [18F]FDG PET/CT or PET/MRI scan (i.e., indications, patient preparation, standard or specific acquisition modalities, interpretation criteria, reporting methods, pitfalls and artifacts), by limiting the literature research to the last 20 years. Moreover, some clinical cases were required from each center, to underline the teaching points. Time for the collection of each report was from October to December 2020. RESULTS Overall, we summarized 291 scientific papers and guidelines published between 1998 and 2021. Papers were divided in several sub-topics and summarized in the following paragraphs: clinical indications, image interpretation criteria, future perspectivess and new trends (for each single disease), while patient preparation, image acquisition, possible pitfalls and reporting modalities were described afterwards. Moreover, a specific section was dedicated to pediatric and PET/MRI indications. A collection of images was described for each indication. CONCLUSIONS Currently, [18F]FDG PET/CT in oncology is globally accepted and standardized in main diagnostic algorithms for neoplasms. In recent years, the ever-closer collaboration among different European associations has tried to overcome the absence of a standardization also in the field of inflammation and infections. The collaboration of several nuclear medicine centers with a long experience in this field, as well as among different AIMN focus groups represents a further attempt in this direction. We hope that this document will be the basis for a "common nuclear physicians' language" throughout all the country. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40336-021-00445-w.
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Affiliation(s)
- Massimiliano Casali
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Chiara Lauri
- grid.7841.aNuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Corinna Altini
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Francesco Bertagna
- grid.412725.7Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Gianluca Cassarino
- grid.5608.b0000 0004 1757 3470Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | | | - Anna Paola Erba
- grid.5395.a0000 0004 1757 3729Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Cristina Ferrari
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Ciro Gabriele Mainolfi
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Andrea Palucci
- grid.415845.9Department of Nuclear Medicine, “Ospedali Riuniti di Torrette” Hospital, Ancona, Italy
| | - Napoleone Prandini
- grid.418324.80000 0004 1781 8749Nuclear Medicine Unit, Department of Diagnostic Imaging, Centro Diagnostico Italiano, Milan, Italy
| | - Sergio Baldari
- grid.10438.3e0000 0001 2178 8421Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Francesco Bartoli
- grid.5395.a0000 0004 1757 3729Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Mirco Bartolomei
- grid.416315.4Nuclear Medicine Unit, Oncological Medical and Specialists Department, University Hospital of Ferrara, Ferrara, Italy
| | - Adriana D’Antonio
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Francesco Dondi
- grid.412725.7Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Patrizia Gandolfo
- grid.418324.80000 0004 1781 8749Nuclear Medicine Unit, Department of Diagnostic Imaging, Centro Diagnostico Italiano, Milan, Italy
| | - Alessia Giordano
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Riccardo Laudicella
- grid.10438.3e0000 0001 2178 8421Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, University of Messina, Messina, Italy
| | | | - Alberto Nieri
- grid.416315.4Nuclear Medicine Unit, Oncological Medical and Specialists Department, University Hospital of Ferrara, Ferrara, Italy
| | | | - Laura Vendramin
- grid.5608.b0000 0004 1757 3470Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Francesco Muratore
- Rheumatology Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Valentina Lavelli
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Domenico Albano
- grid.412725.7Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Luca Burroni
- grid.415845.9Department of Nuclear Medicine, “Ospedali Riuniti di Torrette” Hospital, Ancona, Italy
| | - Alberto Cuocolo
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Laura Evangelista
- grid.5608.b0000 0004 1757 3470Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Elena Lazzeri
- grid.5395.a0000 0004 1757 3729Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Natale Quartuccio
- grid.419995.9Nuclear Medicine Unit, A.R.N.A.S. Civico di Cristina and Benfratelli Hospitals, Palermo, Italy
| | - Brunella Rossi
- Nuclear Medicine Unit, Department of Services, ASUR MARCHE-AV5, Ascoli Piceno, Italy
| | - Giuseppe Rubini
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Martina Sollini
- grid.417728.f0000 0004 1756 8807Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Annibale Versari
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Alberto Signore
- grid.7841.aNuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, Rome, Italy
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Abstract
FDG-PET/CT has potential in inflammatory bowel disease. The literature generally presents good sensitivity and specificity in various settings. At present, the most promising roles are assessment of early treatment response and stricture characterization, whereas general use in the initial diagnostic workup should be reserved for equivocal cases for the time being. However, it is challenging to image the moving and physiologically active bowel with FDG, and available literature is far from ideal. Thus, several issues remain unclarified, and further data are needed to make firm conclusions on the role of FDG and PET/CT in inflammatory bowel disease.
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Affiliation(s)
- Jacob Broder Brodersen
- Department of Gastroenterology, Hospital of Southwest Jutland, Finsensgade 35, Esbjerg Dk-6700, Denmark
| | - Søren Hess
- Department of Radiology and Nuclear Medicine, Hospital of Southwest Jutland, Finsensgade 35, Esbjerg Dk-6700, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
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Dmochowska N, Tieu W, Keller MD, Hollis CA, Campaniello MA, Mavrangelos C, Takhar P, Hughes PA. 89Zr-pro-MMP-9 F(ab') 2 detects colitis induced intestinal and kidney fibrosis. Sci Rep 2020; 10:20372. [PMID: 33230169 PMCID: PMC7683569 DOI: 10.1038/s41598-020-77390-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 11/04/2020] [Indexed: 12/26/2022] Open
Abstract
Intestinal fibrosis is a common complication of inflammatory bowel disease but remains difficult to detect. Matrix metalloproteases (MMPs) have key roles in fibrosis and are therefore potential targets for fibrosis detection. We determined whether immunoPET of F(ab′)2 antibody fragments targeting MMPs detects colitis induced colonic fibrosis. Mice were administered 2% dextran sulfate sodium treated water for 1 cycle (inflamed) or 3 cycles (fibrotic), or were untreated (control). Colonic and kidney collagen, innate cytokine, MMPs and fecal MPO concentrations were analyzed by multiplex/ELISA. α-pro-MMP-9 F(ab′)2 fragments were engineered and conjugated to 89Zr for PET imaging, ex-vivo Cherenkov analysis and bio-distribution. Colonic innate cytokine concentrations and fecal myeloperoxidase were increased in inflamed mice but not fibrotic mice, while collagen concentrations were increased in fibrotic mice. MMPs were increased in inflamed mice, but only pro-MMP-9 remained increased in fibrotic mice. 89Zr-pro-MMP-9 F(ab′)2 uptake was increased in the intestine but also in the kidney of fibrotic mice, where collagen and pro-MMP-9 concentrations were increased. 89Zr-pro-MMP-9 F(ab′)2 detects colitis induced intestinal fibrosis and associated kidney fibrosis.
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Affiliation(s)
- Nicole Dmochowska
- Centre for Nutrition and Gastrointestinal Diseases, Adelaide Medical School, Level 7, University of Adelaide and South Australian Health and Medical Research Institute, Adelaide, South Australia, 5000, Australia
| | - William Tieu
- Molecular Imaging and Therapy Research Unit (MITRU), South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Marianne D Keller
- Centre for Nutrition and Gastrointestinal Diseases, Adelaide Medical School, Level 7, University of Adelaide and South Australian Health and Medical Research Institute, Adelaide, South Australia, 5000, Australia.,Preclinical, Imaging and Research Laboratories (PIRL), South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Courtney A Hollis
- Molecular Imaging and Therapy Research Unit (MITRU), South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Melissa A Campaniello
- Centre for Nutrition and Gastrointestinal Diseases, Adelaide Medical School, Level 7, University of Adelaide and South Australian Health and Medical Research Institute, Adelaide, South Australia, 5000, Australia
| | - Chris Mavrangelos
- Centre for Nutrition and Gastrointestinal Diseases, Adelaide Medical School, Level 7, University of Adelaide and South Australian Health and Medical Research Institute, Adelaide, South Australia, 5000, Australia
| | - Prab Takhar
- Molecular Imaging and Therapy Research Unit (MITRU), South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Patrick A Hughes
- Centre for Nutrition and Gastrointestinal Diseases, Adelaide Medical School, Level 7, University of Adelaide and South Australian Health and Medical Research Institute, Adelaide, South Australia, 5000, Australia.
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31
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Le Fur M, Zhou IY, Catalano O, Caravan P. Toward Molecular Imaging of Intestinal Pathology. Inflamm Bowel Dis 2020; 26:1470-1484. [PMID: 32793946 PMCID: PMC7500524 DOI: 10.1093/ibd/izaa213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Indexed: 12/13/2022]
Abstract
Inflammatory bowel disease (IBD) is defined by a chronic relapsing and remitting inflammation of the gastrointestinal tract, with intestinal fibrosis being a major complication. The etiology of IBD remains unknown, but it is thought to arise from a dysregulated and excessive immune response to gut luminal microbes triggered by genetic and environmental factors. To date, IBD has no cure, and treatments are currently directed at relieving symptoms and treating inflammation. The current diagnostic of IBD relies on endoscopy, which is invasive and does not provide information on the presence of extraluminal complications and molecular aspect of the disease. Cross-sectional imaging modalities such as computed tomography enterography (CTE), magnetic resonance enterography (MRE), positron emission tomography (PET), single photon emission computed tomography (SPECT), and hybrid modalities have demonstrated high accuracy for the diagnosis of IBD and can provide both functional and morphological information when combined with the use of molecular imaging probes. This review presents the state-of-the-art imaging techniques and molecular imaging approaches in the field of IBD and points out future directions that could help improve our understanding of IBD pathological processes, along with the development of efficient treatments.
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Affiliation(s)
- Mariane Le Fur
- The Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, The Institute for Innovation in Imaging, Massachusetts General Hospital and Harvard Medical School, MA, USA
| | - Iris Y Zhou
- The Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, The Institute for Innovation in Imaging, Massachusetts General Hospital and Harvard Medical School, MA, USA
| | - Onofrio Catalano
- The Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, The Institute for Innovation in Imaging, Massachusetts General Hospital and Harvard Medical School, MA, USA,The Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, MA, USA
| | - Peter Caravan
- The Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, The Institute for Innovation in Imaging, Massachusetts General Hospital and Harvard Medical School, MA, USA,Address correspondence to: Peter Caravan, PhD, The Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, The Institute for Innovation in Imaging, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth Street, Charlestown 02129, MA, USA. E-mail:
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Katal S, Gholamrezanezhad A, Nikpanah M, Christensen TQ, Werner TJ, Saboury B, Alavi A, Hess S. Potential Applications of PET/CT/MR Imaging in Inflammatory Diseases: Part I: Musculoskeletal and Gastrointestinal Systems. PET Clin 2020; 15:547-558. [PMID: 32768367 DOI: 10.1016/j.cpet.2020.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
During the past decades, the role of fludeoxyglucose (FDG)-PET and hybrid PET/computed tomography (CT) has been established clinically in the diagnostic workup of a multitude of infectious and inflammatory disorders. In recent years, the fusion of MR imaging to PET has also been increasingly explored, and this may be especially useful in musculoskeletal and gastrointestinal inflammatory diseases due to exceptional soft tissue contrast and reduced radiation dose. This article outlines the current potential for hybrid molecular imaging in the musculoskeletal system and the gastrointestinal tract with special focus on the potential for fused PET/CT/MR imaging.
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Affiliation(s)
- Sanaz Katal
- Department of Nuclear Medicine/PET-CT, Kowsar Hospital, Shiraz, Iran
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Health Sciences Campus, 1500 San Pablo Street, Los Angeles, California 90033, USA.
| | - Moozhan Nikpanah
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Thomas Q Christensen
- Department of Clinical Engineering, Region of Southern Denmark, Esbjerg, Denmark 5000
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Babak Saboury
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA; Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Søren Hess
- Department of Radiology and Nuclear Medicine, Hospital of South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark 6700
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33
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Morita Y, Nogami M, Sakaguchi K, Okada Y, Hirota Y, Sugawara K, Tamori Y, Zeng F, Murakami T, Ogawa W. Enhanced Release of Glucose Into the Intraluminal Space of the Intestine Associated With Metformin Treatment as Revealed by [ 18F]Fluorodeoxyglucose PET-MRI. Diabetes Care 2020; 43:1796-1802. [PMID: 32493754 DOI: 10.2337/dc20-0093] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/06/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Positron emission tomography (PET)-computed tomography has revealed that metformin promotes the intestinal accumulation of [18F]fluorodeoxyglucose (FDG), a nonmetabolizable glucose derivative. It has remained unknown, however, whether this accumulation occurs in the wall or intraluminal space of the intestine. We here addressed this question with the use of [18F]FDG PET-MRI, a recently developed imaging method with increased accuracy of registration and high soft-tissue contrast. RESEARCH DESIGN AND METHODS Among 244 individuals with type 2 diabetes who underwent PET-MRI, we extracted 24 pairs of subjects matched for age, BMI, and HbA1c level who were receiving treatment with metformin (metformin group) or were not (control group). We evaluated accumulation of [18F]FDG in different portions of the intestine with both a visual scale and measurement of maximum standardized uptake value (SUVmax), and such accumulation within the intestinal wall or lumen was discriminated on the basis of SUVmax. RESULTS SUVmax of the jejunum, ileum, and right or left hemicolon was greater in the metformin group than in the control group. [18F]FDG accumulation in the ileum and right or left hemicolon, as assessed with the visual scale, was also greater in the metformin group. SUVmax for the intraluminal space of the ileum and right or left hemicolon, but not that for the intestinal wall, was greater in the metformin group than in the control group. CONCLUSIONS Metformin treatment was associated with increased accumulation of [18F]FDG in the intraluminal space of the intestine, suggesting that this drug promotes the transport of glucose from the circulation into stool.
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Affiliation(s)
- Yasuko Morita
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Munenobu Nogami
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazuhiko Sakaguchi
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuko Okada
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yushi Hirota
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenji Sugawara
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshikazu Tamori
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Division of Creative Health Promotion, Department of Social/Community Medicine and Health Science, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Feibi Zeng
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Wataru Ogawa
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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34
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Tavares de Sousa H, Estevinho MM, Peyrin-Biroulet L, Danese S, Dias CC, Carneiro F, Magro F. Transmural Histological Scoring Systems in Crohn's Disease: A Systematic Review With Assessment of Methodological Quality and Operating Properties. J Crohns Colitis 2020; 14:743-756. [PMID: 31985012 DOI: 10.1093/ecco-jcc/jjz178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The relative proportion of inflammation and fibrosis in a stricture is highly relevant in defining the clinical approach for Crohn's disease [CD] patients. Whereas transmural inflammation in CD can be accurately estimated by cross-sectional imaging, evaluating the extent and severity of fibrosis still requires surgical pathology of intestinal resection specimens. This study systematically reviewed all existing transmural histopathological scoring systems developed for the assessment of inflammation and/or fibrosis in CD. METHODS A systematic review of histopathological scoring systems for the assessment of transmural inflammation and/or fibrosis in CD, focusing on originally developed scoring systems. Risk of bias, methodological quality, and operating or psychometric properties [validity, reliability, responsiveness, and feasibility] of each histological scoring system were analysed. RESULTS A total of 29 original scoring systems were included in this review. Three scoring systems were highlighted as the most widely reproduced, one aimed at assessing inflammation only and two aimed at assessing inflammation and fibrosis. These scores were more widely reproduced probably due to their ease of application in clinical studies. Two highly comprehensive scores were identified, showing good operating properties and high methodological quality, as well as the lowest risk of bias; these should, therefore, be further validated in clinical research studies. CONCLUSIONS This study reviewed all existing transmural histopathological scoring systems for the assessment of inflammation and/or fibrosis in CD and identified the most reliable and accurate scores for clinical research and clinical practice settings.
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Affiliation(s)
- Helena Tavares de Sousa
- Gastroenterology Department - Portimão Unit, Algarve University Hospital Centre, Portimão, Portugal.,Algarve Biomedical Centre, University of Algarve, Faro, Portugal
| | - Maria Manuela Estevinho
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, University of Porto, Porto, Portugal
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Silvio Danese
- Gastrointestinal Immunopathology Laboratory and IBD Unit, Humanitas Clinical and Research Center, Milan, Italy
| | - Cláudia Camila Dias
- Department of Community Medicine, Information and Decision in Health, University of Porto, Porto, Portugal.,Centre for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Fátima Carneiro
- Department of Pathology, São João University Hospital and Faculty of Medicine, University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto [Ipatimup]/i3S, Porto, Portugal
| | - Fernando Magro
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, University of Porto, Porto, Portugal.,Department of Gastroenterology, São João University Hospital, Porto, Portugal.,MedInUP, Centre for Drug Discovery and Innovative Medicines, Porto, Portugal
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36
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Zhong YK, Lu BL, Huang SY, Chen YJ, Li ZP, Rimola J, Li XH. Cross-sectional imaging for assessing intestinal fibrosis in Crohn's disease. J Dig Dis 2020; 21:342-350. [PMID: 32418328 DOI: 10.1111/1751-2980.12881] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
More than 30% of patients with Crohn's disease (CD) develop fibrotic strictures in the bowel as the disease progresses. Excessive deposition of extracellular matrix components in the submucosa and smooth muscle hypertrophy or hyperplasia are the main features of fibrosis in CD. Cross-sectional imaging technology provides a wealth of information on the anatomy, histological composition, and physiological function of the bowel, allowing for a non-invasive and complete evaluation of associated abnormalities. This review summarizes recent advances in and the potential technologies of cross-sectional imaging for assessing intestinal fibrosis in CD, including ultrasound imaging, computed tomography, and magnetic resonance imaging.
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Affiliation(s)
- Ying Kui Zhong
- Department of Radiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Bao Lan Lu
- Department of Radiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Si Yun Huang
- Department of Radiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Yu Jun Chen
- Department of Ultrasound, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Zi Ping Li
- Department of Radiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Jordi Rimola
- Department of Radiology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Xue Hua Li
- Department of Radiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
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Suarez-Weiss KE, Herold A, Gervais D, Palmer E, Amorim B, King JD, Weier L, Shahein T, Bernstine H, Domachevsk L, Cañamaque LG, Umutlu L, Herrmann K, Groshar D, Catalano OA. [Hybrid imaging of the abdomen and pelvis. German version]. Radiologe 2020; 60:394-404. [PMID: 32232543 DOI: 10.1007/s00117-020-00660-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Accurate imaging is crucial for lesion detection in abdominal organs, for the noninvasive characterization of focal and diffuse abnormalities, and for surgical planning. To accomplish these tasks, several imaging modalities such as multidetector computer tomography (MDCT), magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) are used for abdominal imaging, providing important morphological, functional or metabolic information. More recently, PET/MRI has been gaining attention due to the possibility of combining high-resolution imaging with metabolic imaging. PET/MRI is a novel hybrid imaging technology that in the near future might play a pivotal role in the clinical management of oncologic and inflammatory abdominopelvic diseases. Despite the still limited number of published clinical studies, PET/MRI has been proven to be at least equivalent to PET/CT and to stand-alone MRI in a variety of oncologic disease. Moreover, in selected and focused clinical studies, it has been proven to outperform current standard of care imaging, for example, in evaluating cholangiocarcinomas, liver metastases, untreated and treated rectal cancer. This has also had an impact on therapeutic management in some studies. Therefore in some institutions, including those of the authors, PET/MRI is becoming the new standard imaging modality in staging treatment-naïve intrahepatic mass-forming cholangiocarcinomas and prior to complicated hepatic surgery.
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Affiliation(s)
- Krista Elise Suarez-Weiss
- Division of Abdominal Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, 02114, Boston MA, USA
| | | | - Debra Gervais
- Division of Abdominal Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, 02114, Boston MA, USA
| | - Edwin Palmer
- Division of Abdominal Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, 02114, Boston MA, USA
| | | | - Joseph D King
- Division of Abdominal Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, 02114, Boston MA, USA
| | - Li Weier
- Division of Abdominal Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, 02114, Boston MA, USA
| | - Tajmir Shahein
- Division of Abdominal Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, 02114, Boston MA, USA
| | | | | | | | | | | | | | - Onofrio A Catalano
- Division of Abdominal Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, 02114, Boston MA, USA. .,University of Naples Parthenope, Neapel, Italien.
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38
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Li Y, Langhorst J, Koch AK, Demircioglu A, Schaarschmidt B, Theysohn JM, Martin O, Herrmann K, Catalano O, Umutlu L. Comparison of acceptance of PET/MR enterography and ileocolonoscopy in patients with inflammatory bowel diseases. Clin Imaging 2020; 64:11-17. [PMID: 32200275 DOI: 10.1016/j.clinimag.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/21/2020] [Accepted: 03/11/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aim of this study was to compare PET/MR enterography with ileocolonoscopy regarding patients' acceptance and their future preference. METHODS Between October 2014 and February 2018 one-hundred-eleven patients underwent PET/MR enterography and ileocolonoscopy within 2 weeks. Overall acceptance of each modality was rated using a 10-point Likert scale with higher score indicating worse experience. Wilcoxon test was used to assess difference. Patients' acceptance of bowel cleansing and oral intake of contrast agent was analyzed in the same way. Furthermore, to find out if diagnosis, gender and age might influence patients' acceptance and future preference, Mann-Whitney U test for ordinal and Chi-squared test for categorical parameters were applied. RESULTS 77 patients (47 females) with a mean age of 44.5 years and diagnosed ulcerative colitis (UC; n = 46) and Crohn's disease (CD; n = 31), were included in the analysis. Overall, ileocolonoscopy was significantly better rated than PET/MR enterography (p < 0.001). Bowel cleansing was worse tolerated than oral intake of liquid (p < 0.001). Patients with CD preferred PET/MR enterography as future screening method, while UC patients favored ileocolonoscopy (p = 0.012). PET/MR enterography tended to be better accepted by CD patients (p = 0.08). Females tolerated both bowel cleansing and oral contrast agent worse than males (p = 0.05 and 0.047). No significant difference between different age groups was found. CONCLUSIONS Ileocolonoscopy was rated as better tolerable than PET/MR and the overall rate for future preference was very similar. Optimization of both modalities might enhance patients' acceptance.
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Affiliation(s)
- Yan Li
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany.
| | - Jost Langhorst
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, University of Duisburg-Essen, Am Deimelsberg 34a, 45276 Essen, Germany
| | - Anna K Koch
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, University of Duisburg-Essen, Am Deimelsberg 34a, 45276 Essen, Germany
| | - Aydin Demircioglu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Benedikt Schaarschmidt
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Jens M Theysohn
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Ole Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Onofrio Catalano
- Abdominal Imaging and Martinos Center for Biomedical Imaging Research, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
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Pellino G, Keller DS, Sampietro GM, Angriman I, Carvello M, Celentano V, Colombo F, Di Candido F, Laureti S, Luglio G, Poggioli G, Rottoli M, Scaringi S, Sciaudone G, Sica G, Sofo L, Leone S, Danese S, Spinelli A, Delaini G, Selvaggi F. Inflammatory bowel disease position statement of the Italian Society of Colorectal Surgery (SICCR): Crohn's disease. Tech Coloproctol 2020; 24:421-448. [PMID: 32172396 DOI: 10.1007/s10151-020-02183-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/24/2020] [Indexed: 02/07/2023]
Abstract
The Italian Society of Colorectal Surgery (SICCR) promoted the project reported here, which consists of a position statement of Italian colorectal surgeons to address the surgical aspects of Crohn's disease management. Members of the society were invited to express their opinions on several items proposed by the writing committee, based on evidence available in the literature. The results are presented, focusing on relevant points. The present paper is not an alternative to available guidelines; rather, it offers a snapshot of the attitudes of SICCR surgeons about the surgical treatment of Crohn's disease. The committee was able to identify some points of major disagreement and suggested strategies to improve quality of available data and acceptance of guidelines.
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Affiliation(s)
- G Pellino
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Policlinico CS, Piazza Miraglia 2, 80138, Naples, Italy.
| | - D S Keller
- Division of Colon and Rectal Surgery, Department of Surgery, New York-Presbyterian, Columbia University Medical Center, New York, NY, USA
| | | | - I Angriman
- General Surgery Unit, Azienda Ospedaliera di Padova, Padua, Italy
| | - M Carvello
- Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - V Celentano
- Portsmouth Hospitals NHS Trust, University of Portsmouth, Portsmouth, UK
| | - F Colombo
- L. Sacco University Hospital, Milan, Italy
| | - F Di Candido
- Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - S Laureti
- Surgery of the Alimentary Tract, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - G Luglio
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - G Poggioli
- Surgery of the Alimentary Tract, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - M Rottoli
- Surgery of the Alimentary Tract, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - S Scaringi
- Surgical Unit, Department of Surgery and Translational Medicine, University of Firenze, Florence, Italy
| | - G Sciaudone
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Policlinico CS, Piazza Miraglia 2, 80138, Naples, Italy
| | - G Sica
- Minimally Invasive and Gastro-Intestinal Unit, Department of Surgery, Policlinico Tor Vergata, Rome, Italy
| | - L Sofo
- Abdominal Surgery Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Rome, Rome, Italy
| | - S Leone
- CEO, Associazione nazionale per le Malattie Infiammatorie Croniche dell'Intestino "A.M.I.C.I. Onlus", Milan, Italy
| | - S Danese
- Division of Gastroenterology, IBD Center, Humanitas University, Rozzano, Milan, Italy
| | - A Spinelli
- Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - G Delaini
- Department of Surgery, "Pederzoli" Hospital, Peschiera del Garda, Verona, Italy
| | - F Selvaggi
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Policlinico CS, Piazza Miraglia 2, 80138, Naples, Italy
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40
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Pellino G, Keller DS, Sampietro GM, Annese V, Carvello M, Celentano V, Coco C, Colombo F, Cracco N, Di Candido F, Franceschi M, Laureti S, Mattioli G, Pio L, Sciaudone G, Sica G, Villanacci V, Zinicola R, Leone S, Danese S, Spinelli A, Delaini G, Selvaggi F. Inflammatory bowel disease (IBD) position statement of the Italian Society of Colorectal Surgery (SICCR): general principles of IBD management. Tech Coloproctol 2020; 24:105-126. [PMID: 31983044 DOI: 10.1007/s10151-019-02145-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 12/23/2019] [Indexed: 02/08/2023]
Abstract
The Italian Society of Colorectal Surgery (SICCR) promoted the project reported here, which consists of a Position Statement of Italian colorectal surgeons to address the surgical aspects of inflammatory bowel disease management. Members of the society were invited to express their opinions on several items proposed by the writing committee, based on evidence available in the literature. The results are presented, focusing on relevant points. The present paper is not an alternative to available guidelines; rather, it offers a snapshot of the attitudes of SICCR surgeons about the general principles of surgical treatment of inflammatory bowel disease. The committee was able to identify some points of major disagreement and suggested strategies to improve quality of available data and acceptance of guidelines.
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Affiliation(s)
- G Pellino
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania "Luigi Vanvitelli", Policlinico CS, Piazza Miraglia 2, 80138, Naples, Italy.
| | - D S Keller
- Division of Colon and Rectal Surgery, Department of Surgery, NewYork-Presbyterian, Columbia University Medical Center, New York, USA
| | | | - V Annese
- Gastroenterology Unit, DEA-Medicina E Chirurgia Generale E D'Urgenza, University Hospital Careggi, Firenze, Italy
| | - M Carvello
- Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - V Celentano
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
- University of Portsmouth, Portsmouth, UK
| | - C Coco
- UOC Chirurgia Generale 2, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - F Colombo
- L. Sacco University Hospital Milano, Milan, Italy
| | - N Cracco
- Department of General Surgery, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - F Di Candido
- Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - M Franceschi
- IBD Surgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - S Laureti
- Surgery of the Alimentary Tract, Sant'Orsola Hospital, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - G Mattioli
- Pediatric Surgery Unit, Istituto Giannina Gaslini, and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - L Pio
- Pediatric Surgery Department, Hôpital Robert-Debré and Université de Paris, Paris, France
| | - G Sciaudone
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania "Luigi Vanvitelli", Policlinico CS, Piazza Miraglia 2, 80138, Naples, Italy
| | - G Sica
- Minimally Invasive and Gastro-Intestinal Unit, Department of Surgery, Policlinico Tor Vergata, Rome, Italy
| | - V Villanacci
- Institute of Pathology, Spedali Civili Brescia, Brescia, Italy
| | - R Zinicola
- Department of Emergency Surgery, University Hospital Parma, Parma, Italy
| | - S Leone
- CEO, Associazione Nazionale Per Le Malattie Infiammatorie Croniche Dell'Intestino "A.M.I.C.I. Onlus", Milan, Italy
| | - S Danese
- Division of Gastroenterology, IBD Center, Humanitas University, Rozzano, Milan, Italy
| | - A Spinelli
- Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - G Delaini
- Department of Surgery, "Pederzoli" Hospital, Peschiera del Garda, Verona, Italy
| | - F Selvaggi
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania "Luigi Vanvitelli", Policlinico CS, Piazza Miraglia 2, 80138, Naples, Italy
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Gordon IO, Bettenworth D, Bokemeyer A, Srivastava A, Rosty C, de Hertogh G, Robert ME, Valasek MA, Mao R, Kurada S, Harpaz N, Borralho P, Pai RK, Pai RK, Odze R, Feakins R, Parker CE, Nguyen T, Jairath V, Baker ME, Bruining DH, Fletcher JG, Feagan BG, Rieder F. Histopathology Scoring Systems of Stenosis Associated With Small Bowel Crohn's Disease: A Systematic Review. Gastroenterology 2020; 158:137-150.e1. [PMID: 31476299 PMCID: PMC7649049 DOI: 10.1053/j.gastro.2019.08.033] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/29/2019] [Accepted: 08/22/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Stenosis is a common complication of Crohn's disease (CD) that has no effective medical therapy. Development of antifibrotic agents will require testing in randomized controlled trials. Computed tomography enterography- and magnetic resonance enterography-based technologies might be used to measure outcomes in these trials. These approaches have been validated in studies of patients with symptomatic strictures who underwent imaging evaluations followed by resection with histopathologic grading of the intestinal tissue for inflammation and/or fibrosis (the reference standard). Imaging findings have correlated with findings from quantitative or semiquantitative histologic evaluation of the degree of fibromuscular stenosis and/or inflammation on the resection specimen. However, it is not clear whether histologic findings are an accurate reference standard. We performed a systematic review of all published histologic scoring systems used to assess stenosing CD. METHODS We performed a comprehensive search of Embase and MEDLINE of studies through March 13, 2019, that used a histologic scoring system to characterize small bowel CD and assessed inflammatory and fibrotic alterations within the same adult individual. All scores fitting the criteria were included in our analysis, independent of the presence of stricturing disease, as long as inflammation and fibrosis were evaluated separately but in the same scoring system. RESULTS We observed substantial heterogeneity among the scoring systems, which were not derived from modern principles for evaluative index development. None had undergone formal validity or reliability testing. None of the existing indices had been constructed according to accepted methods for the development of evaluative indices. Basic knowledge regarding their operating properties were lacking. Specific indices for evaluating the important pathologic component of myofibroblast hypertrophy or hyperplasia have not been proposed. CONCLUSIONS In a systematic review of publications, we found a lack of validated histopathologic scoring systems for assessment of fibromuscular stenosis. Data that describe the operating properties of existing cross-sectional imaging techniques for stenosing CD should be questioned. Development and validation of a histopathology index is an important research priority.
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Affiliation(s)
- Ilyssa O Gordon
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Dominik Bettenworth
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
| | - Arne Bokemeyer
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
| | - Amitabh Srivastava
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christophe Rosty
- Department of Clinical Pathology, The University of Melbourne, Parville, Victoria, Australia; Envoi Specialist Pathologists, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Gert de Hertogh
- Department of Pathology, University Hospital Leuven, Leuven, Belgium
| | - Marie E Robert
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Mark A Valasek
- Department of Pathology, University of California San Diego, La Jolla, California
| | - Ren Mao
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Satya Kurada
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute; Cleveland Clinic Foundation, Cleveland, Ohio
| | - Noam Harpaz
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paula Borralho
- Faculdade de Medicina da Universidade de Lisboa, Instituto de Anatomia Patológica, Lisbon, Portugal
| | - Reetesh K Pai
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Rish K Pai
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Robert Odze
- Pathology Department, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Roger Feakins
- Department of Cellular Pathology, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | | | - Tran Nguyen
- Robarts Clinical Trials, Inc, London, Ontario, Canada
| | - Vipul Jairath
- Robarts Clinical Trials, Inc, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada; Department of Biostatistics and Epidemiology, Western University, London, Ontario, Canada
| | - Mark E Baker
- Department of Diagnostic Radiology, Imaging Institute, Digestive Diseases and Surgery Institute, Cleveland, Ohio; Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - J G Fletcher
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Brian G Feagan
- Robarts Clinical Trials, Inc, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada; Department of Biostatistics and Epidemiology, Western University, London, Ontario, Canada
| | - Florian Rieder
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute; Cleveland Clinic Foundation, Cleveland, Ohio.
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Quantitative Phase Imaging Using Digital Holographic Microscopy Reliably Assesses Morphology and Reflects Elastic Properties of Fibrotic Intestinal Tissue. Sci Rep 2019; 9:19388. [PMID: 31852983 PMCID: PMC6920451 DOI: 10.1038/s41598-019-56045-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 12/02/2019] [Indexed: 12/13/2022] Open
Abstract
Intestinal strictures are a frequent complication in patients with Crohn’s Disease (CD) and the presence of fibrosis within strictures impacts the therapeutic treatment approach. Here, we evaluate quantitative phase imaging (QPI) using digital holographic microscopy (DHM) for the evaluation of fibrosis within CD strictures. 30 full thickness resection specimens were obtained from non-stenotic and stenotic tissue areas of 15 CD patients. Cryostat sections were analyzed by DHM to measure the spatial distribution of the refractive index (RI) to quantify tissue density. Complementary, histopathological evaluation of H&E staining and immunofluorescence (IF) targeting fibrosis markers served as the gold standard. Moreover, tissue stiffness was evaluated by elastography. RI values assessed by DHM were significantly higher in stenotic compared to non-stenotic tissue areas (p < 0.001). Histopathological analysis using H&E staining and IF confirmed the elevated expression of fibrosis markers in stenotic compared to non-stenotic tissue (all p < 0.001). The RI retrieved by DHM strongly correlated with the amount of fibrosis as determined by IF (p < 0.001; R2 = 0.48). Furthermore, elastography detected a significantly higher tissue stiffness in stenotic as compared to non-stenotic tissue sections (p < 0.001). In conclusion, QPI using DHM accurately assesses fibrotic properties of CD-associated strictures and may improve the characterization of CD strictures.
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43
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Allocca M, Fiorino G, Bonifacio C, Peyrin-Biroulet L, Danese S. Noninvasive Multimodal Methods to Differentiate Inflamed vs Fibrotic Strictures in Patients With Crohn's Disease. Clin Gastroenterol Hepatol 2019; 17:2397-2415. [PMID: 30995529 DOI: 10.1016/j.cgh.2019.04.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 04/08/2019] [Accepted: 04/10/2019] [Indexed: 02/07/2023]
Abstract
Fibrotic strictures occur in 30% of patients with Crohn's disease (CD). However, there are no therapeutic agents that prevent or reverse fibrotic strictures. Strictures are treated by endoscopic dilatation procedures and surgical procedures, but there are high rates of recurrence. Two antifibrotic agents (nintedanib and pirfenidone) recently were approved for the treatment of idiopathic pulmonary fibrosis and inhibitors of Rho-associated protein kinases 1 and 2 reversed fibrosis in mice with chronic intestinal inflammation. Cross-sectional imaging techniques, such as magnetic resonance (MR) enterography, computed tomography enterography, and bowel ultrasound, are used to assess small-bowel and CD-related complications, including strictures. It is important to be able to determine the degree of inflammation and fibrosis in strictures to select the best therapy; this can be a challenge because inflammation and fibrosis co-exist to varying degrees in a damaged bowel segment. Delayed gadolinium enhancement, magnetization transfer MR imaging, and ultrasound elastography seem to be promising tools for assessing fibrosis in patients with CD. We review noninvasive techniques for fibrosis assessment, including analyses of genetic, epigenetic, and protein markers. We discuss the potential of imaging techniques such as diffusion-weighted and magnetization transfer MR imaging, strain elastography, shear-wave imaging, and positron emission tomography to guide therapeutic decisions for patients with stricturing CD.
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Affiliation(s)
- Mariangela Allocca
- Inflammatory Bowel Disease Centre, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Gionata Fiorino
- Inflammatory Bowel Disease Centre, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Cristiana Bonifacio
- Division of Diagnostic Radiology, Humanitas Clinical and Research Centre, Rozzano, Milano, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm U954, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Silvio Danese
- Inflammatory Bowel Disease Centre, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.
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44
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The Role of the Radiologist in Determining Disease Severity in Inflammatory Bowel Diseases. Gastrointest Endosc Clin N Am 2019; 29:447-470. [PMID: 31078247 DOI: 10.1016/j.giec.2019.02.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Crohn's disease and ulcerative colitis are chronic inflammatory diseases that lead to progressive bowel damage including the development of stricturing and penetrating complications. Increasingly, cross-sectional imaging with computed tomography or magnetic resonance scans have emerged as leading tools to: (1) assess disease activity; (2) monitor response to therapy or disease recurrence; and (3) identify disease-related complications. Several validated radiological scoring systems have been developed to quantify cross-sectional and longitudinal inflammatory burden in these diseases and to monitor response to treatment. Bowel ultrasound is also a simple and inexpensive tool but is operator dependent in its performance.
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45
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Bettenworth D, Bokemeyer A, Baker M, Mao R, Parker CE, Nguyen T, Ma C, Panés J, Rimola J, Fletcher JG, Jairath V, Feagan BG, Rieder F. Assessment of Crohn's disease-associated small bowel strictures and fibrosis on cross-sectional imaging: a systematic review. Gut 2019; 68:1115-1126. [PMID: 30944110 PMCID: PMC6580870 DOI: 10.1136/gutjnl-2018-318081] [Citation(s) in RCA: 163] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 12/12/2022]
Abstract
Patients with Crohn's disease commonly develop ileal and less commonly colonic strictures, containing various degrees of inflammation and fibrosis. While predominantly inflammatory strictures may benefit from a medical anti-inflammatory treatment, predominantly fibrotic strictures currently require endoscopic balloon dilation or surgery. Therefore, differentiation of the main components of a stricturing lesion is key for defining the therapeutic management. The role of endoscopy to diagnose the nature of strictures is limited by the superficial inspection of the intestinal mucosa, the lack of depth of mucosal biopsies and by the risk of sampling error due to a heterogeneous distribution of inflammation and fibrosis within a stricturing lesion. These limitations may be in part overcome by cross-sectional imaging techniques such as ultrasound, CT and MRI, allowing for a full thickness evaluation of the bowel wall and associated abnormalities. This systematic literature review provides a comprehensive summary of currently used radiologic definitions of strictures. It discusses, by assessing only manuscripts with histopathology as a gold standard, the accuracy for diagnosis of the respective modalities as well as their capability to characterise strictures in terms of inflammation and fibrosis. Definitions for strictures on cross-sectional imaging are heterogeneous; however, accuracy for stricture diagnosis is very high. Although conventional cross-sectional imaging techniques have been reported to distinguish inflammation from fibrosis and grade their severity, they are not sufficiently accurate for use in routine clinical practice. Finally, we present recent consensus recommendations and highlight experimental techniques that may overcome the limitations of current technologies.
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Affiliation(s)
- Dominik Bettenworth
- Department of Medicine B, Gastroenterology and Hepatology, University of Münster, Münster, North Rhine-Westphalia, Germany
| | - Arne Bokemeyer
- Department of Medicine B, Gastroenterology and Hepatology, University of Münster, Münster, North Rhine-Westphalia, Germany
| | - Mark Baker
- Section of Abdominal Imaging, Imaging Institute, Digestive Disease Institute and Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ren Mao
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China,Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - Tran Nguyen
- Robarts Clinical Trials, London, Ontario, Canada
| | - Christopher Ma
- Robarts Clinical Trials, London, Ontario, Canada,Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Julián Panés
- Department of Gastroenterology, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Jordi Rimola
- Department of Radiology, Hospital Clínic de Barcelona, Institut d’investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Joel G Fletcher
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Vipul Jairath
- Robarts Clinical Trials, London, Ontario, Canada,Department of Medicine, Western University, London, Ontario, Canada,Department of Biostatistics and Epidemiology, Western University, London, Ontario, Canada
| | - Brian G Feagan
- Robarts Clinical Trials, London, Ontario, Canada,Department of Medicine, Western University, London, Ontario, Canada,Department of Biostatistics and Epidemiology, Western University, London, Ontario, Canada
| | - Florian Rieder
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA,Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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46
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Argollo M, Gilardi D, Roda G, Fiorino G, Peyrin-Biroulet L, Danese S. Anti-fibrotic Drugs for Crohn’s Disease: Ready for Prime Time? Curr Pharm Des 2019; 25:47-56. [DOI: 10.2174/1381612825666190308100844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 03/01/2019] [Indexed: 12/17/2022]
Abstract
Intestinal fibrosis, driven by chronic inflammation in Crohn’s disease, can be defined as an excessive
accumulation of extracellular matrix in the affected gut segment ultimately leading to an impaired wound healing
and cumulative tissue damage, possibly resulting in organ dysfunction, formation of stenotic lesions and necessity
of surgical intervention. Despite continuous advances in developing novel treatment modalities targeting different
pathways to control chronic gut inflammation in CD, no effective anti-fibrotic agents have been released, to date.
Thus, a better understanding of the molecular and cellular mechanisms underlying intestinal fibrosis is key to
move this area of investigation forward.
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Affiliation(s)
- Marjorie Argollo
- IBD Centre, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
| | - Daniela Gilardi
- IBD Centre, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
| | - Giulia Roda
- IBD Centre, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
| | - Gionata Fiorino
- IBD Centre, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, Vandoeuvre, France
| | - Silvio Danese
- IBD Centre, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
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47
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Targeting anti-fibrotic pathways in Crohn's disease - The final frontier? Best Pract Res Clin Gastroenterol 2019; 38-39:101603. [PMID: 31327400 DOI: 10.1016/j.bpg.2019.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/14/2019] [Indexed: 02/08/2023]
Abstract
Intestinal fibrosis with stricture formation affects up to half of patients with Crohn's disease (CD), resulting in impaired quality of life, increased risk of surgical intervention, and associated patient morbidity. The underlying pathophysiologic mechansisms responsible for initiating and perpetuating intestinal fibrosis are complex, dynamic, and implicate both inflammation-dependent and independent pathways. Previously thought to be an irreversible complication of long-standing inflammation unresponsive to medical therapy, fibrostenotic CD has been traditionally managed with endoscopic or surgical approaches. However, recent advances in our understanding of the humoral, cellular, and environmental pathways driving intestinal fibrosis has the potential to fundamentally change these management paradigms for CD-related strictures. Furthermore, the promise of fibrosis treatments in other organ systems has encouraged hope that anti-fibrotic treatment approaches for CD may be within reach. Here, we summarize the key breakthroughs in our molecular understanding of intestinal fibrosis, review current medical, endoscopic, and surgical treatment approaches to CD-related strictures, propose future directions for anti-fibrotic therapy in CD, and identify crucial research questions in this field that require additional investigation.
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48
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Maaser C, Sturm A, Vavricka SR, Kucharzik T, Fiorino G, Annese V, Calabrese E, Baumgart DC, Bettenworth D, Borralho Nunes P, Burisch J, Castiglione F, Eliakim R, Ellul P, González-Lama Y, Gordon H, Halligan S, Katsanos K, Kopylov U, Kotze PG, Krustinš E, Laghi A, Limdi JK, Rieder F, Rimola J, Taylor SA, Tolan D, van Rheenen P, Verstockt B, Stoker J. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: Initial diagnosis, monitoring of known IBD, detection of complications. J Crohns Colitis 2019; 13:144-164. [PMID: 30137275 DOI: 10.1093/ecco-jcc/jjy113] [Citation(s) in RCA: 832] [Impact Index Per Article: 166.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Christian Maaser
- Outpatients Department of Gastroenterology, Hospital Lüneburg, Lüneburg, Germany
| | - Andreas Sturm
- Department of Gastroenterology, DRK Kliniken Berlin I Westend, Berlin, Germany
| | | | - Torsten Kucharzik
- Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Lüneburg, Germany
| | - Gionata Fiorino
- Department of Gastroenterology, Humanitas Clinical and Research Institute, Milan, Italy
| | - Vito Annese
- Department of Gastroenterology, Valiant Clinic & American Hospital, Dubai, UAE
| | - Emma Calabrese
- Department of Systems Medicine, University of Rome, Tor Vergata, Italy
| | - Daniel C Baumgart
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Dominik Bettenworth
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
| | - Paula Borralho Nunes
- Department of Anatomic Pathology, Hospital Cuf Descobertas; Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Pierre Ellul
- Department of Medicine, Mater Dei Hospital, Msida, Malta
| | - Yago González-Lama
- Department of Gastroenterology, University Hospital Puerta De Hierro, Majadahonda [Madrid], Spain
| | - Hannah Gordon
- Department of Gastroenterology, Royal London Hospital, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - Konstantinos Katsanos
- Department of Gastroenterology and Hepatology, University and Medical School of Ioannina, Ioannina, Greece
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Paulo G Kotze
- Colorectal Surgery Unit, Catholic University of Paraná [PUCPR], Curitiba, Brazil
| | - Eduards Krustinš
- Department of of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Andrea Laghi
- Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Jimmy K Limdi
- Department of Gastroenterology, Pennine Acute Hospitals NHS Trust, Manchester; Manchester Academic Health Sciences Centre, University of Manchester, UK
| | - Florian Rieder
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jordi Rimola
- Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Damian Tolan
- Clinical Radiology, St James's University Hospital, Leeds, UK
| | - Patrick van Rheenen
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, University Medical Center Groningen, Groningen, The Netherlands
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven and CHROMETA - Translational Research in Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Academic Medical Center [AMC], University of Amsterdam, Amsterdam, The Netherlands
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49
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Deepak P, Fowler KJ, Fletcher JG, Bruining DH. Novel Imaging Approaches in Inflammatory Bowel Diseases. Inflamm Bowel Dis 2019; 25:248-260. [PMID: 30010908 DOI: 10.1093/ibd/izy239] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Indexed: 12/12/2022]
Abstract
Inflammatory bowel diseases are chronic autoimmune conditions of the gastrointestinal tract, mainly grouped into ulcerative colitis or Crohn's disease. Traditionally, symptoms have been used to guide IBD management, but this approach is fatally flawed, as symptoms don't correlate with disease activity and often fail to predict disease complications, especially with Crohn's disease. Hence, there is increasing recognition of the need for treatment algorithms based on objective measures of bowel inflammation. In this review, we will focus on advancements in the endoscopic and radiological imaging armamentarium that allow detailed assessments from intestinal mucosa to mesentery.
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Affiliation(s)
- Parakkal Deepak
- Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Kathryn J Fowler
- Department of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Joel G Fletcher
- Division of Abdominal Imaging, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
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50
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Sollini M, Berchiolli R, Kirienko M, Rossi A, Glaudemans AWJM, Slart R, Erba PA. PET/MRI in Infection and Inflammation. Semin Nucl Med 2018; 48:225-241. [PMID: 29626940 DOI: 10.1053/j.semnuclmed.2018.02.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hybrid positron emission tomography/magnetic resonance imaging (PET/MR) systems are now more and more available for clinical use. PET/MR combines the unique features of MR including excellent soft tissue contrast, diffusion-weighted imaging, dynamic contrast-enhanced imaging, fMRI and other specialized sequences as well as MR spectroscopy with the quantitative physiologic information that is provided by PET. Most of the evidence of the potential clinical utility of PET/MRI is available for neuroimaging. Other areas, where PET/MR can play a larger role include head and neck, upper abdominal, and pelvic tumours. Although the role of PET/MR in infection and inflammation of the cardiovascular system and in musculoskeletal applications are promising, these areas of clinical investigation are still in the early phase and it may be a little longer before these areas reach their full potential in clinical practice. In this review, we outline the potential of hybrid PET/MR for imaging infection and inflammation. A background to the main radiopharmaceuticals and some technical considerations are also included.
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Affiliation(s)
- Martina Sollini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Raffaella Berchiolli
- Vascular Surgery Unit Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Margarita Kirienko
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Alexia Rossi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - A W J M Glaudemans
- University of Groningen, University Medical Center Groningen, Medical Imaging Center, Groningen, The Netherlands
| | - Riemer Slart
- University of Groningen, University Medical Center Groningen, Medical Imaging Center, Groningen, The Netherlands.; University of Twente, Faculty of Science and Technology, Biomedical Photonic Imaging, Enschede, The Netherlands
| | - Paola Anna Erba
- Regional Center of Nuclear Medicine, Department of Translational Research and Advanced, Technologies in Medicine, University of Pisa, Pisa, Italy..
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