1
|
Tarchi SM, Salvatore M, Lichtenstein P, Sekar T, Capaccione K, Luk L, Shaish H, Makkar J, Desperito E, Leb J, Navot B, Goldstein J, Laifer S, Beylergil V, Ma H, Jambawalikar S, Aberle D, D'Souza B, Bentley-Hibbert S, Marin MP. Radiology of fibrosis part II: abdominal organs. J Transl Med 2024; 22:610. [PMID: 38956593 PMCID: PMC11218138 DOI: 10.1186/s12967-024-05346-w] [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: 02/12/2024] [Accepted: 05/25/2024] [Indexed: 07/04/2024] Open
Abstract
Fibrosis is the aberrant process of connective tissue deposition from abnormal tissue repair in response to sustained tissue injury caused by hypoxia, infection, or physical damage. It can affect almost all organs in the body causing dysfunction and ultimate organ failure. Tissue fibrosis also plays a vital role in carcinogenesis and cancer progression. The early and accurate diagnosis of organ fibrosis along with adequate surveillance are helpful to implement early disease-modifying interventions, important to reduce mortality and improve quality of life. While extensive research has already been carried out on the topic, a thorough understanding of how this relationship reveals itself using modern imaging techniques has yet to be established. This work outlines the ways in which fibrosis shows up in abdominal organs and has listed the most relevant imaging technologies employed for its detection. New imaging technologies and developments are discussed along with their promising applications in the early detection of organ fibrosis.
Collapse
Affiliation(s)
- Sofia Maria Tarchi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA.
| | - Mary Salvatore
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Philip Lichtenstein
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Thillai Sekar
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Kathleen Capaccione
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Lyndon Luk
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Hiram Shaish
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jasnit Makkar
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Elise Desperito
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jay Leb
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Benjamin Navot
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jonathan Goldstein
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Sherelle Laifer
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Volkan Beylergil
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Hong Ma
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Sachin Jambawalikar
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Dwight Aberle
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Belinda D'Souza
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Monica Pernia Marin
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
2
|
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.
Collapse
Affiliation(s)
- Edel Noriega-Álvarez
- Nuclear Medicine Department, University General Hospital of Ciudad Real, Ciudad Real, Spain.
| | | |
Collapse
|
3
|
Wang Y, Zhang R, Mao R, Li X. Inflammatory bowel disease cross-sectional imaging: What's new? United European Gastroenterol J 2022; 10:1179-1193. [PMID: 36461914 PMCID: PMC9752287 DOI: 10.1002/ueg2.12343] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/13/2022] [Indexed: 12/07/2022] Open
Abstract
Cross-sectional imaging-ultrasonography, computed tomography enterography, and magnetic resonance enterography-is a routine and indispensable tool for patients with Crohn's disease (CD) that helps to detect or monitor disease characteristics before, during, and after CD treatment. New emerging radiological technologies may have further clinical applications in the management of CD. In this review article, we focus on the latest developments in cross-sectional imaging in CD research, including its role in intra- and extra-luminal lesion detection, intestinal inflammation and fibrosis grading, therapeutic response assessment and outcome prediction, postoperative recurrence detection and prediction, and the gut-brain axis.
Collapse
Affiliation(s)
- Yang‐di Wang
- Department of RadiologyThe First Affiliated Hospital, Sun Yat‐Sen UniversityGuangzhouPeople's Republic of China
| | - Ruo‐nan Zhang
- Department of RadiologyThe First Affiliated Hospital, Sun Yat‐Sen UniversityGuangzhouPeople's Republic of China
| | - Ren Mao
- Department of GastroenterologyThe First Affiliated Hospital, Sun Yat‐Sen UniversityGuangzhouPeople's Republic of China
| | - Xue‐hua Li
- Department of RadiologyThe First Affiliated Hospital, Sun Yat‐Sen UniversityGuangzhouPeople's Republic of China
| |
Collapse
|
4
|
Loch FN, Kamphues C, Beyer K, Klauschen F, Schineis C, Weixler B, Lauscher JC, Dorenbeck M, Bayerl C, Reiter R. Diagnostic Accuracy of Magnetic Resonance Enterography for the Evaluation of Active and Fibrotic Inflammation in Crohn’s Disease. Front Surg 2022; 9:872596. [PMID: 35647009 PMCID: PMC9136038 DOI: 10.3389/fsurg.2022.872596] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/21/2022] [Indexed: 01/01/2023] Open
Abstract
Background Despite the success of standard magnetic resonance enterography (MRE) in detecting Crohn’s disease (CD), characterization of strictures and, thus, therapy guidance is still limited. The aim of the study was to determine diagnostic accuracy of MRE in detecting or ruling out active inflammation and identifying fibrotic lesions in patients with terminal ileal CD with histopathology as reference. Methods Sixty-seven consecutive patients (median age 32 years, range 19–79 years) with terminal ileal CD were retrospectively enrolled between January 2015 and October 2020. The median interval between MRE and surgery was 9 days (range 0–86 days). Sensitivity, specificity, positive and negative predictive value (PPV and NPV, respectively), and area under the curve (AUC) with 95% confidence intervals (CIs) were calculated for the MRE-based AIS (acute inflammation score) using the histopathology of surgical specimens as the reference standard. Results Sensitivity, specificity, PPV, and NPV for detecting or ruling out active inflammation were 100% (CI, 0.94–1.00; 0.44–1.00; 0.93–1.00; 0.31–1.00) using an AIS cut-off of >4.1. AUC was 1.00 (CI, 1.00–1.00; p < 0.01). In all patients with fibrotic changes only and no active inflammation, AIS was <4.1. Interobserver agreement was substantial (κ = 0.65, p < 0.01). Conclusion Our study has shown an excellent diagnostic performance of the MRE-based AIS for determining whether active inflammation is present or lesions are due to chronic changes in ileal CD using the histopathology of surgical specimens as reference. These findings indicate that the MRE-based AIS allows a better determination of the inflammatory stage of terminal ileal CD, which facilitates the decision to perform surgery.
Collapse
Affiliation(s)
- Florian N. Loch
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Department of Surgery, Berlin, Germany
- Correspondence: Florian N. Loch
| | - Carsten Kamphues
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Department of Surgery, Berlin, Germany
| | - Katharina Beyer
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Department of Surgery, Berlin, Germany
| | - Frederick Klauschen
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Insitute for Pathology, Berlin, Germany
| | - Christian Schineis
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Department of Surgery, Berlin, Germany
| | - Benjamin Weixler
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Department of Surgery, Berlin, Germany
| | - Johannes C. Lauscher
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Department of Surgery, Berlin, Germany
| | - Marc Dorenbeck
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Department of Surgery, Berlin, Germany
| | - Christian Bayerl
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Department of Radiology, Berlin, Germany
| | - Rolf Reiter
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Department of Radiology, Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
5
|
Okuhira T, Yoden A, Kaji E, Otani-Akamatsu M, Inoue K, Aomatsu T, Takitani K, Ashida A. Usefulness of ultrasonography for small intestinal evaluations in pediatric Crohn's disease. Pediatr Int 2022; 64:e15206. [PMID: 35704459 DOI: 10.1111/ped.15206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/18/2022] [Accepted: 03/30/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Small bowel capsule endoscopy (SBCE) for Crohn's disease is useful; however, its use has some limitations, such as invasiveness when endoscopic assistance is required in patients who cannot swallow the capsule, and the burden of interpretation on a physician. In contrast, intestinal ultrasonography (IUS) is a non-invasive modality for children. The purpose of this study is to evaluate the accuracy of IUS for pediatric patients with established Crohn's disease. METHODS Small bowel capsule endoscopy and IUS findings from the same period in pediatric patients with established Crohn's disease were analyzed retrospectively. First, we compared the Lewis score (LS), small bowel endoscopic activity, and IUS findings by small bowel wall thickness (SBWT) and mesenteric lymph node size (MLNS). Second, we compared the performance of IUS findings with those of some biomarkers. RESULTS In 22 procedures, SBWT and MLNS were correlated with LS (r = 0.52, P < 0.05, and r = 0.45, P < 0.05, respectively). Small bowel wall thickness, erythrocyte sedimentation rate, and fecal calprotectin levels had the highest accuracy (81.8%, 81.8%, and 81.8%, respectively). The combination of SBWT and MLNS had the highest positive predictive value and negative predictive value (100% and 83.3%, respectively). CONCLUSIONS Intestinal ultrasonography findings, including SBWT and MLNS, are useful for monitoring small bowel lesions in pediatric patients with established Crohn's disease. We suggest first evaluating small bowel inflammation by IUS in pediatric patients with Crohn's disease before SBCE because IUS is less invasive than SBCE.
Collapse
Affiliation(s)
- Takeru Okuhira
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.,Department of Pediatrics, Osaka Saiseikai Suita Hospital, Suita, Osaka, Japan
| | - Atsushi Yoden
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.,Department of Pediatrics, Dainikyoritsu Hospital, Kawanishi, Hyogo, Japan
| | - Emiri Kaji
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | | | - Keisuke Inoue
- Department of Pediatrics, Hirakata City Hospital, Hirakata, Osaka, Japan
| | - Tomoki Aomatsu
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Kimitaka Takitani
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Akira Ashida
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| |
Collapse
|
6
|
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.
Collapse
|
7
|
Cicero G, Mazziotti S. Crohn's disease at radiological imaging: focus on techniques and intestinal tract. Intest Res 2020; 19:365-378. [PMID: 33232590 PMCID: PMC8566824 DOI: 10.5217/ir.2020.00097] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/02/2020] [Indexed: 11/05/2022] Open
Abstract
Over recent years, inflammatory bowel diseases have become an issue of increased attention in daily clinical practice, due to both a rising incidence and improved imaging capability in detection. In particular, the diagnosis of Crohn's disease is based on clinical picture, laboratory tests and colonoscopy with biopsy. However, colonoscopic evaluation is limited to the mucosal layer. Thus, imaging modalities play a pivotal role in enriching the clinical picture, delivering information on intestinal and extraintestinal involvement. All the imaging modalities can be employed in evaluation of Crohn's disease patients, each of them with specific strengths as well as limitations. In this wide selection, the choice of a proper diagnostic framework can be challenging for the clinician. Therefore, the aim of this work is to offer an overview of the different imaging techniques, with brief technical details and diagnostic potential related to each intestinal tract.
Collapse
Affiliation(s)
- Giuseppe Cicero
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Silvio Mazziotti
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| |
Collapse
|
8
|
Celentano V, Beable R, Ball C, Flashman KG, Reeve R, Holmes A, Fogg C, Harper M, Higginson A. The Portsmouth protocol for intra-operative ultrasound of the small bowel in Crohn's disease. Colorectal Dis 2020; 22:342-345. [PMID: 31652389 DOI: 10.1111/codi.14888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/30/2019] [Indexed: 12/27/2022]
Abstract
AIM Bowel preservation is paramount in Crohn's disease surgery as affected patients are typically young adults at risk of having several abdominal surgical procedures during their lifetime. Intra-operative assessment of the extent and location of Crohn's disease is not standardized and is left to a mixture of the surgeon's experience, tactile feedback, macroscopic appearance and preoperative imaging. The aim of this study was to describe the technical steps of a standardized protocol for intra-operative ultrasound assessment of the small bowel in patients undergoing surgery for ileocolic Crohn's disease. METHOD After laparoscopic mobilization of the bowel, a periumbilical incision is performed for extracorporeal division of the mesentery and the resection and anastomosis. A gastrointestinal consultant radiologist, with expertise in Crohn's disease imaging and abdominal ultrasound, performs full intra-operative assessment of the small bowel by applying a sterile ultrasound probe directly to the bowel, prior to resection being performed by the surgeon. The bowel is assessed through the wound protector with a sterile technique and the length, location and number of segments is documented together with further quantitative assessment using the METRIC (MR enterography or ultrasound in Crohn's disease) scoring guide. RESULTS A step-by-step protocol for intra-operative ultrasound evaluation of the entire small bowel is described. CONCLUSIONS A standardized approach to intra-operative evaluation of the extent and location of Crohn's disease is desirable. Intra-operative ultrasound may provide added value for assessment of proximal and multifocal Crohn's disease.
Collapse
Affiliation(s)
- V Celentano
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK.,University of Portsmouth, Portsmouth, UK
| | - R Beable
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK
| | - C Ball
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK
| | - K G Flashman
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK
| | - R Reeve
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK
| | - A Holmes
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK
| | - C Fogg
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK
| | - M Harper
- University of Portsmouth, Portsmouth, UK
| | - A Higginson
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK
| |
Collapse
|
9
|
Straksyte V, Kiudelis G, Gineikiene I, Janciauskas D, Basevicius A, Lukosevicius S, Kupcinskas L. Lemann Index for Assessment of Crohn's Disease: Correlation with the Quality of Life, Endoscopic Disease Activity, Magnetic Resonance Index of Activity and C- Reactive Protein. Open Med (Wars) 2019; 14:785-791. [PMID: 31737782 PMCID: PMC6843552 DOI: 10.1515/med-2019-0092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 09/03/2019] [Indexed: 02/06/2023] Open
Abstract
Aim Crohn's disease (CD) is characterized by continuing inflammation and progressive gut damage. Despite many scoring indices of CD, there is a lack of more global assessment tools for the evaluation of the total disease impact on the gut. Methods Fift y-three adult patients with proven CD underwent magnetic resonance enterocolonography (MR-EC), colonoscopy, and clinical activity assessment, including CRP. Quality of life was assessed using IBDQ. MR-EC was used to evaluate the Magnetic Resonance Index of Activity (MaRIA- global (G)) and the Lemann Index (LI). The CD Endoscopic Index of Severity (CDEIS) was used to score the endoscopic activity of the disease. Results A signifi cant correlation between the LI and IBDQ was found (r=-0.812, P<0.01). LI and MaRIA-G correlated moderately, while the LI did not correlate significantly with CRP and CDEIS. For the detection of endoscopically active CD, MaRIA-G was more sensitive and specific (83.3%; 73.3%) compared to the LI (66.7%; 60.0%). There was a moderate correlation between CRP and MaRIA-G, as well as CRP and CDEIS (r=0.496; r=0.527,<0.01). Conclusion A signifi cant negative correlation between the LI and quality of life, measured by IBDQ, was found in our study, suggesting that the LI could resemble more global features of the disease, besides inflammatory activity of the gut.
Collapse
Affiliation(s)
- Vestina Straksyte
- Department of Radiology, Lithuanian University of Health Sciences, Eivenių str. 2, Kaunas, Lithuania
| | - Gediminas Kiudelis
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Irina Gineikiene
- Department of Radiology, Lithuanian University of Health Sciences, Eivenių str. 2, Kaunas, Lithuania
| | - Dainius Janciauskas
- Department of Pathological Anatomy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Algidas Basevicius
- Department of Radiology, Lithuanian University of Health Sciences, Eivenių str. 2, Kaunas, Lithuania
| | - Saulius Lukosevicius
- Department of Radiology, Lithuanian University of Health Sciences, Eivenių str. 2, Kaunas, Lithuania
| | - Limas Kupcinskas
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| |
Collapse
|
10
|
Grass F, Fletcher JG, Alsughayer A, Petersen M, Bruining DH, Bartlett DJ, Mathis KL, Lightner AL. Development of an Objective Model to Define Near-Term Risk of Ileocecal Resection in Patients with Terminal Ileal Crohn Disease. Inflamm Bowel Dis 2019; 25:1845-1853. [PMID: 31050733 DOI: 10.1093/ibd/izz079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The decision to either escalate medical therapy or proceed to ileocecal resection (ICR) in patients with terminal ileal Crohn disease (CD) remains largely subjective. We sought to develop a risk score for predicting ICR at 1 year from computed tomography or magnetic resonance enterography (CTE/MRE). METHODS We conducted a retrospective cohort study including all consecutive adult (> 18 years) patients with imaging findings of terminal ileal CD (Montreal classification: B1, inflammatory predominant; B2, stricturing; or B3, penetrating) on CTE/MRE between January 1, 2016, and December 31, 2016. The risk for ICR at 6 months and at 1 year of CTE/MRE and risk factors associated with ICR, including demographics, CD-specific immunosuppressive therapeutics, and disease presentation at the time of imaging, were determined. RESULTS Of 559 patients, 121 (21.6%) underwent ICR during follow-up (1.4 years [IQR 0.21-1.64 years]); the risk for ICR at 6 months and at 1 year was 18.2% (95% CI 14.7%-21.6%) and 20.5% (95% CI 16.8%-24.1%), respectively. Multivariable analysis revealed Montreal classification (B2, hazard ratio [HR] 2.73, and B3, HR 6.80, both P < 0.0001), upstream bowel dilation (HR 3.06, P < 0.0001), and younger age (19-29 years reference, 30-44 years, HR 0.83 [P = 0.40]; 45-59 years, HR 0.58 [P = 0.04], and 60+ years, HR 0.45 [P = 0.01]) to significantly increase the likelihood of ICR. A predictive nomogram for interval ICR was developed based on these significant variables. CONCLUSIONS The presence of CD strictures, penetrating complications, and upstream bowel dilation on CTE/MRE, combined with young age, significantly predict ICR. The suggested risk model may facilitate objective therapeutic decision-making.
Collapse
Affiliation(s)
- Fabian Grass
- Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Joel G Fletcher
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ahmad Alsughayer
- Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Molly Petersen
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - David H Bruining
- Department of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kellie L Mathis
- Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Amy L Lightner
- Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
11
|
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: 166] [Impact Index Per Article: 33.2] [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.
Collapse
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
| | | |
Collapse
|
12
|
Baliyan V, Kordbacheh H, Serrao J, Gee MS, Yajnik V, Sahani DV, Kambadakone AR. Survey on practice patterns in imaging utilization in patients with Crohn's disease. Clin Imaging 2019; 54:91-99. [DOI: 10.1016/j.clinimag.2018.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 11/02/2018] [Accepted: 12/08/2018] [Indexed: 12/20/2022]
|
13
|
Ajose TA, Olanipekun T, Effoe VS, Bakinde N. Intestinal ultrasound in assessment of suspected Crohn's disease in patients with negative ileocolonoscopy: a paradigm shift? Therap Adv Gastroenterol 2018; 11:1756284818787397. [PMID: 30023005 PMCID: PMC6047238 DOI: 10.1177/1756284818787397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 06/12/2018] [Indexed: 02/04/2023] Open
Affiliation(s)
| | - Titilope Olanipekun
- Department of General Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Valery S. Effoe
- Department of General Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Nicolas Bakinde
- Department of General Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| |
Collapse
|