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MR enterography–histology comparison in resected pediatric small bowel Crohn disease strictures: can imaging predict fibrosis?

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Abstract

Background

Crohn disease is a chronic inflammatory condition that can lead to intestinal strictures. The presence of fibrosis within strictures alters optimal management but is not reliably detected by current imaging methods.

Objective

To correlate the MRI features of surgically resected small-bowel strictures in pediatric Crohn disease with histological inflammation and fibrosis scoring.

Materials and methods

We included children with Crohn disease who had symptomatic small-bowel strictures requiring surgical resection and had preoperative MR enterography (MRE) within 3 months of surgery (n = 20). Two blinded radiologists reviewed MRE examinations to document stricture-related findings. A pediatric pathologist scored stricture histological specimens for fibrosis (0–4) and inflammation (0–4). MRE findings were correlated with histological data using Spearman correlation (ρ) and exact logistic regression analysis.

Results

There was significant positive correlation between histological bowel wall fibrosis and inflammation in resected strictures (ρ = 0.55; P = 0.01). Confluent transmural histological fibrosis was associated with pre-stricture upstream small-bowel dilatation >3 cm at univariate (odds ratio [OR] = 51.7; 95% confidence interval [CI]: 7.6– > 999.9; P = 0.0002) and multivariate (OR = 43.4; 95% CI: 6.1– > 999.9; P = 0.0006, adjusted for age) analysis. The degree of bowel wall T2-weighted signal intensity failed to correlate with histological bowel wall fibrosis or inflammation (P-values >0.05). There were significant negative correlations between histological fibrosis score and patient age at resection (ρ = −0.48, P = 0.03), and time from diagnosis to surgery (ρ = −0.73, P = 0.0002).

Conclusion

Histological fibrosis and inflammation co-exist in symptomatic pediatric Crohn disease small-bowel strictures and are positively correlated. Pre-stenotic upstream small-bowel dilatation greater than 3 cm is significantly associated with confluent transmural fibrosis.

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References

  1. Baldassano RN, Piccoli DA (1999) Inflammatory bowel disease in pediatric and adolescent patients. Gastroenterol Clin N Am 28:445–458

    Article  CAS  Google Scholar 

  2. Malaty HM, Fan X, Opekun AR et al (2010) Rising incidence of inflammatory bowel disease among children: a 12-year study. J Pediatr Gastroenterol Nutr 50:27–31

    Article  PubMed  Google Scholar 

  3. Baker ME, Hara AK, Platt JF et al (2015) CT enterography for Crohn’s disease: optimal technique and imaging issues. Abdom Imaging 40:938–952

    Article  PubMed  Google Scholar 

  4. Bellolio F, Cohen Z, MacRae HM et al (2012) Strictureplasty in selected Crohn’s disease patients results in acceptable long-term outcome. Dis Colon Rectum 55:864–869

    Article  PubMed  Google Scholar 

  5. Broering DC, Eisenberger CF, Koch A et al (2001) Quality of life after surgical therapy of small bowel stenosis in Crohn’s disease. Dig Surg 18:124–130

    Article  CAS  PubMed  Google Scholar 

  6. Cosnes J, Cattan S, Blain A et al (2002) Long-term evolution of disease behavior of Crohn’s disease. Inflamm Bowel Dis 8:244–250

    Article  PubMed  Google Scholar 

  7. Alves A, Panis Y, Bouhnik Y et al (2007) Risk factors for intra-abdominal septic complications after a first ileocecal resection for Crohn’s disease: a multivariate analysis in 161 consecutive patients. Dis Colon Rectum 50:331–336

    Article  PubMed  Google Scholar 

  8. Yamamoto T, Allan RN, Keighley MR (2000) Risk factors for intra-abdominal sepsis after surgery in Crohn’s disease. Dis Colon Rectum 43:1141–1145

    Article  CAS  PubMed  Google Scholar 

  9. Gupta N, Bostrom AG, Kirschner BS et al (2010) Incidence of stricturing and penetrating complications of Crohn’s disease diagnosed in pediatric patients. Inflamm Bowel Dis 16:638–644

    Article  PubMed  PubMed Central  Google Scholar 

  10. Adler J, Punglia DR, Dillman JR et al (2012) Computed tomography enterography findings correlate with tissue inflammation, not fibrosis in resected small bowel Crohn’s disease. Inflamm Bowel Dis 18:849–856

    Article  PubMed  Google Scholar 

  11. Rimola J, Planell N, Rodriguez S et al (2015) Characterization of inflammation and fibrosis in Crohn’s disease lesions by magnetic resonance imaging. Am J Gastroenterol 110:432–440

    Article  PubMed  Google Scholar 

  12. Lichtenstein GR, Hanauer SB, Sandborn WJ (2009) Management of Crohn’s disease in adults. Am J Gastroenterol 104:465–483

    Article  PubMed  Google Scholar 

  13. Samimi R, Flasar MH, Kavic S et al (2010) Outcome of medical treatment of stricturing and penetrating Crohn’s disease: a retrospective study. Inflamm Bowel Dis 16:1187–1194

    Article  PubMed  Google Scholar 

  14. Adler J, Swanson SD, Schmiedlin-Ren P et al (2011) Magnetization transfer helps detect intestinal fibrosis in an animal model of Crohn disease. Radiology 259:127–135

    Article  PubMed  PubMed Central  Google Scholar 

  15. Dillman JR, Swanson SD, Johnson LA et al (2014) Comparison of noncontrast MRI magnetization transfer and T2-weighted signal intensity ratios for detection of bowel wall fibrosis in a Crohn’s disease animal model. J Magn Reson Imaging 42:801–810

    Article  PubMed  Google Scholar 

  16. Gee MS, Nimkin K, Hsu M et al (2011) Prospective evaluation of MR enterography as the primary imaging modality for pediatric Crohn disease assessment. AJR Am J Roentgenol 197:224–231

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kovanlikaya A, Beneck D, Rose M et al (2015) Quantitative apparent diffusion coefficient (ADC) values as an imaging biomarker for fibrosis in pediatric Crohn’s disease: preliminary experience. Abdom Imaging 40:1068–1074

    Article  CAS  PubMed  Google Scholar 

  18. Menys A, Helbren E, Makanyanga J et al (2013) Small bowel strictures in Crohn’s disease: a quantitative investigation of intestinal motility using MR enterography. Neurogastroenterol Motil 25:967–e775

    Article  CAS  PubMed  Google Scholar 

  19. Quencer KB, Nimkin K, Mino-Kenudson M et al (2013) Detecting active inflammation and fibrosis in pediatric Crohn’s disease: prospective evaluation of MR-E and CT-E. Abdom Imaging 38:705–713

    Article  PubMed  PubMed Central  Google Scholar 

  20. Fukuya T, Hawes DR, Lu CC et al (1992) CT diagnosis of small-bowel obstruction: efficacy in 60 patients. AJR Am J Roentgenol 158:765–769

    Article  CAS  PubMed  Google Scholar 

  21. Silva AC, Pimenta M, Guimaraes LS (2009) Small bowel obstruction: what to look for. Radiographics 29:423–439

    Article  PubMed  Google Scholar 

  22. Pazahr S, Blume I, Frei P et al (2013) Magnetization transfer for the assessment of bowel fibrosis in patients with Crohn’s disease: initial experience. MAGMA 26:291–301

    Article  CAS  PubMed  Google Scholar 

  23. Dillman JR, Stidham RW, Higgins PD et al (2014) Ultrasound shear wave elastography helps discriminate low-grade from high-grade bowel wall fibrosis in ex vivo human intestinal specimens. J Ultrasound Med 33:2115–2123

    Article  PubMed  Google Scholar 

  24. Dillman JR, Stidham RW, Higgins PD et al (2013) US elastography-derived shear wave velocity helps distinguish acutely inflamed from fibrotic bowel in a Crohn disease animal model. Radiology 267:757–766

    Article  PubMed  Google Scholar 

  25. Xu J, Tripathy S, Rubin JM et al (2012) A new nonlinear parameter in the developed strain-to-applied strain of the soft tissues and its application in ultrasound elasticity imaging. Ultrasound Med Biol 38:511–523

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Jonathan R. Dillman.

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Barkmeier, D.T., Dillman, J.R., Al-Hawary, M. et al. MR enterography–histology comparison in resected pediatric small bowel Crohn disease strictures: can imaging predict fibrosis?. Pediatr Radiol 46, 498–507 (2016). https://doi.org/10.1007/s00247-015-3506-6

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  • DOI: https://doi.org/10.1007/s00247-015-3506-6

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