OC.06.4 AGREEMENT BETWEEN REAL-TIME ELASTOGRAPHY AND DELAYED ENHANCEMENT MAGNETIC RESONANCE ENTEROGRAPHY ON QUANTIFYING BOWEL WALL FIBROSIS IN CROHN’S DISEASE

BACKGROUND Human imaging research transitions from mapping local effects to developing predictive models that integrate information distributed across various MRI modalities. OBJECTIVE We hypothesised that based on magnetic resonance enterography (MRE) layered bowel wall enhancement and apparent diffusion coefficient (ADC), measured in the affected parts of the intestine, one would be able to effectively differentiate active and chronic phases of Crohn’s disease. The aim of this study was to create a multidimensional diagnostic model for differentiating between Crohn’s disease phases. METHODS This study included 125 patients, 55 women (44.0%; aged 19 to 66 years) and 70 men (56.0%; aged 12 to 67 years), who underwent MRE and ADC measurement for the first time. No patients had been previously treated for Crohn’s disease. The group of potential explanatory variables comprised 11 variables, including the thickness of the occupied section, length of the occupied section, number of lymph nodes present, layered bowel wall enhancement, total transitions on fat tissue, features of restricted diffusion in diffusion-weighted imaging (DWI), and ADC values. RESULTS The final discrimination model was based on only two variables, namely ADC (A) and layered bowel wall enhancement (W). Active Crohn’s disease was defined as -6.339 + 4.747 × W + 0.008 × A, while chronic Crohn’s disease was defined as -11.365 + 2.812 × W + 0.012 × A. CONCLUSIONS The predictive model described here could identify the active form of Crohn’s disease with a probability of 93.06% and the chronic form with a probability of 75.57%. The use of classic MRE layered bowel wall enhancement and a DWI-based ADC metric eliminates the main shortcomings of both approaches. CLINICALTRIAL Not applicable

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Predicting Risk of Surgery in Patients With Small Bowel Crohn’s Disease Strictures Using Computed Tomography and Magnetic Resonance Enterography

Inflammatory Bowel Diseases ◽

10.1093/ibd/izab332 ◽

2022 ◽

Author(s):

Akitoshi Inoue ◽

David J Bartlett ◽

Narges Shahraki ◽

Shannon P Sheedy ◽

Jay P Heiken ◽

...

Keyword(s):

Computed Tomography ◽

Crohn’S Disease ◽

Magnetic Resonance ◽

Small Bowel ◽

Crohn's Disease ◽

Bowel Wall ◽

Univariate Analysis ◽

Magnetic Resonance Enterography ◽

Imaging Findings ◽

Near Term

Abstract Background We aimed to determine if patient symptoms and computed tomography enterography (CTE) and magnetic resonance enterography (MRE) imaging findings can be used to predict near-term risk of surgery in patients with small bowel Crohn’s disease (CD). Methods CD patients with small bowel strictures undergoing serial CTE or MRE were retrospectively identified. Strictures were defined by luminal narrowing, bowel wall thickening, and unequivocal proximal small bowel dilation. Harvey-Bradshaw index (HBI) was recorded. Stricture observations and measurements were performed on baseline CTE or MRE and compared to with prior and subsequent scans. Patients were divided into those who underwent surgery within 2 years and those who did not. LASSO (least absolute shrinkage and selection operator) regression models were trained and validated using 5-fold cross-validation. Results Eighty-five patients (43.7 ± 15.3 years of age at baseline scan, majority male [57.6%]) had 137 small bowel strictures. Surgery was performed in 26 patients within 2 years from baseline CTE or MRE. In univariate analysis of patients with prior exams, development of stricture on the baseline exam was associated with near-term surgery (P = .006). A mathematical model using baseline features predicting surgery within 2 years included an HBI of 5 to 7 (odds ratio [OR], 1.7 × 105; P = .057), an HBI of 8 to 16 (OR, 3.1 × 105; P = .054), anastomotic stricture (OR, 0.002; P = .091), bowel wall thickness (OR, 4.7; P = .064), penetrating behavior (OR, 3.1 × 103; P = .096), and newly developed stricture (OR: 7.2 × 107; P = .062). This model demonstrated sensitivity of 67% and specificity of 73% (area under the curve, 0.62). Conclusions CTE or MRE imaging findings in combination with HBI can potentially predict which patients will require surgery within 2 years.

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