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A novel identification system combining diffusion kurtosis imaging with conventional magnetic resonance imaging to assess intestinal strictures in patients with Crohn’s disease

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Abstract

Purpose

To determine the utility of diffusion kurtosis imaging (DKI) for assessing bowel fibrosis and to establish a new magnetic resonance imaging (MRI)-based classification based on DKI and conventional MRI parameters for characterizing intestinal strictures in Crohn’s disease (CD) using the histological evaluation of resected intestine samples as the reference standard.

Methods

Thirty-one patients with CD undergoing preoperative conventional MRI and diffusion-weighted imaging (DWI) (b values = 0–2000 s/mm2) were consecutively enrolled. We classified the mural T2-weighted signal intensity and arterial-phase enhancement patterns on conventional MRI. We also measured DWI-derived apparent diffusion coefficients (ADCs) and DKI-derived apparent diffusion for non-Gaussian distribution (Dapp) and apparent diffusional kurtosis (Kapp). A new MRI-based classification was established to characterize intestinal strictures in CD. Its performance was validated in nine additional patients with CD.

Results

Histological inflammation grades were significantly correlated to T2-weighted signal intensity (r = 0.477; P < 0.001) and ADC (r = − 0.226; P = 0.044). Histological fibrosis grades were moderately correlated to Kapp (r = 0.604, P < 0.001); they were also correlated to Dapp (r = − 0.491; P < 0.001) and ADC (r = − 0.270; P = 0.015). T2-weighted signal intensity could differentiate between no-to-mild and moderate-to-severe bowel inflammation (sensitivity, 0.970; specificity, 0.479). Kapp could differentiate between no-to-mild and moderate-to-severe bowel fibrosis (sensitivity, 0.959; specificity, 0.781). The agreement between the new MRI-based classification and the histological classification was moderate in the test (κ = 0.507; P < 0.001) and validation (κ = 0.530; P < 0.001) sets.

Conclusions

DKI can be used to assess bowel fibrosis. The new MRI-based classification can help to distinguish between fibrotic and inflammatory intestinal strictures in patients with CD.

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Data availability

The data that support the findings of this study are available on request from the corresponding author (Xue-hua Li). The data are not publicly available because the aforementioned data contain information that could compromise the privacy of the research participants.

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Acknowledgements

This study was funded by the National Natural Science Foundation of China (Grant Numbers 81600508, 81770654, 81870451, and 81771908).

Author information

Author notes

  1. **-fang Du and Bao-lan Lu contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People’s Republic of China

    **-fang Du, Bao-lan Lu, Si-yun Huang, Can-hui Sun, Shi-ting Feng, Zi-** Li, Li Huang & Xue-hua Li

  2. Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People’s Republic of China

    Ren Mao

  3. Mallinckrodt Institute of Radiology, Washington University, 510 South Kingshighway Boulevard, St. Louis, MO, 63110, USA

    Zhong-wei Zhang

  4. Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People’s Republic of China

    Qing-hua Cao

  5. Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People’s Republic of China

    Zhi-hui Chen

  6. Faculty of Engineering & Information Sciences, University of Wollongong, Wollongong, Australia

    Shuo-yang Li

  7. Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, People’s Republic of China

    Qing-lian Qin

Authors
  1. **-fang Du
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  2. Bao-lan Lu
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  12. Zi-** Li
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  13. Li Huang
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  14. Xue-hua Li
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Contributions

Conceptualization: XL; Data curation: RM, BL; Formal Analysis: SL, QQ; Funding acquisition: CS, SF, ZL, XL; Investigation: JD, QC, LH, SH; Methodology: JD, CS, SF; Project administration: XL, LH; Resources: ZL, ZC; Software: ZZ; Supervision: XL, LH; Validation: XL, LH; Writing – original draft: JD; Writing – review & editing: BL, LH, XL.

Corresponding authors

Correspondence to Li Huang or Xue-hua Li.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

Approval was obtained from the ethics committee of the First Affiliated Hospital, Sun Yat-sen University. The procedures used in this study adhere to the tenets of the 1964 Declaration of Helsinki and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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Du, Jf., Lu, Bl., Huang, Sy. et al. A novel identification system combining diffusion kurtosis imaging with conventional magnetic resonance imaging to assess intestinal strictures in patients with Crohn’s disease. Abdom Radiol 46, 936–947 (2021). https://doi.org/10.1007/s00261-020-02765-3

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  • DOI: https://doi.org/10.1007/s00261-020-02765-3

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