Intest Res > Volume 18(2); 2020 > Article |
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Author (year) | Technique | Nature of the study | Main clinically relevant findings | |
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Magnetic resonance | ||||
Punwani et al. (2009) [11] | MRE (morphologic and enhancement features) | Single-center study | The study aimed to determine the association between MRI features of CD activity against a histopathologic reference. | |
Prospective | Different MR features were correlated with inflammation was found in both studies including wall thickness, T2 hypersignal and layered enhancement of gadolinium. | |||
Wall thickness was not correlated with the degree of fibrosis. | ||||
Zappa et al. (2011) [9] | MRE (morphologic and enhancement features) | Single-center study | The study aimed to evaluate the value of MRI findings in CD in correlation with pathological scores of inflammation and fibrosis. | |
Retrospective | Different MR features were correlated with inflammation including wall thickness, T2 hypersignal and layered enhancement of gadolinium. Layered enhancement was not associated with the degree of fibrosis. | |||
Both inflammation and fibrosis scores were positively correlated (r = 0.63, P = 0.0001). | ||||
Wilkens et al. (2018) [21] | MRE (morphologic and enhancement features) | Single-center study | Authors investigated the perfusion by MRE as objective marker to distinguishing between the inflammation and fibrosis. | |
Prospective | Wall thickness correlated with the degree of inflammation. | |||
No significant correlation between the severity of inflammation or fibrosis on histopathology, and mural enhancement (r = -0.13, P = 0.54 for inflammation and r = 0.41, P = 0.05 for fibrosis). | ||||
Tielbeek et al. (2014) [13] | MRE with DWI and perfusion analysis of contrast injection | Single-center study | Different advanced MR techniques were applied before surgical resection, including diffusion- weighted image, perfusion analysis including time-intensity curves, and morphological assessment as well. | |
Retrospective | Mural thickness, maximum intravenous contrast enhancement and the slope of increase after its injection correlated significantly with histological inflammation (r = 0.63, 0.41, 0.53, respectively; P< 0.05). | |||
The quantification of diffusion-weighted imaging by mean of ADC correlated significantly with fibrosis (all P< 0.05). | ||||
Rimola et al. (2015) [10] | MRE using DCE (gain of enhancement between early and late phases) | Single-center study | Different imaging acquisitions were obtained after gadolinium injection. The hypothesis of this study was that dense fibrotic typically show a slow enhancement of gadolinium contrast over time. | |
Retrospective | Using percentage of enhancement gain between early and late phases after gadolinium injection, MRI is able to discriminate between mild-moderate and severe fibrosis deposition with a sensitivity of 0.94 and a specificity of 0.89. | |||
T2 hypersignal (edema) has a high and significant predictive value for detecting severe inflammation. | ||||
Li et al. (2018) [14] | MRE using MTR, ADC and gain of enhancement | Single-center study | MT sequence attempts to identify tissue with water linked to macromolecules (such as collagen). The study compared MT with diffusion and the gain of gadolinium enhancement. | |
Prospective | Differentiating moderately to severely fibrotic bowel walls from those non-to-mildly fibrotic with an AUC of 0.919 (P = 0.000) for MT measurements; AUC of 0.747 (P = 0.001) for ADC; and AUC of 0.592 (P = 0.209) for the percentage of enhancement gain. | |||
Repeated measurements | ||||
Wagner et al. (2018) [15] | MRE using DWI | Single-center study | Authors hypothesized that muscular hypertrophy is an additional lesion that reduces bowel lumen in strictures and should be differentiated from fibrosis. Analyzing the bowel wall thickness on T2W (> 7.4 mm) had a sensitivity of 61% and a specificity of 89% to differentiate fibrosis from muscular hypertrophy. | |
Retrospective | ||||
Ultrasound | ||||
Dillman et al. (2014) [22] | USE (SWE) | Single-center study | The study aimed to determine if US elastography could discriminate low- from high-grade fibrosis in the bowel. The authors used 2 different methods of SWE. | |
Prospective | Significant correlation between shear wave speed and bowel fibrosis (P = 0.01). USE using 2 different methods of USE it is possible to differentiate low- from high-fibrosis score bowel segments with AUC of 0.77-0.91. No significant differences in USE in mean shear wave speed between high- and low-inflammation score bowel segments. | |||
Fraquelli et al. (2015) [23] | USE (strain ratio) | Single-center study | The aim was to evaluate the feasibility of USE toward the assessment of ileal fibrosis in CD patients. USE strain ratio measurement was significantly correlated with the severity of bowel fibrosis 0.917 (95% CI, 0.788-1.000). | |
Prospective | ||||
Wilkens et al. (2018) [21] | Bowel US and CEUS | Single-center study | Authors investigated the perfusion by CEUS as objective marker to distinguishing between the inflammation and fibrosis. | |
Prospective | No correlation was found between the severity of inflammation or fibrosis on histopathology and the degree of enhancement (P =0.45 for inflammation and P =0.19 for fibrosis); Wall thickness assessed by US correlated with both, histological inflammation (P =0.001) and fibrosis (P =0.048). | |||
Chen et al. (2018) [24] | USE (SWE) | Single-center study | The aim of this study was to investigated whether the quantification of stiffness using USE is able to distinguishing between the inflammation and fibrotic component of strictures. | |
Prospective | A cutoff of 22.55 kPa can discriminate mild to moderate and severe fibrosis (sensitivity 69.6%, specificity 91.7% with AUC of 0.822; P =0.002). | |||
Ding et al. (2019) [25] | USE (SWE, strain ratio, ARFI) | Single-center study | To evaluate the diagnostic performance of USE (different modalities) for assessment of the predominant types of intestinal stenosis. | |
Prospective | The optimal cutoff value to discriminate predominantly fibrotic strictures on point-SWE was >2.73 m/s (sensitivity, 75%; specificity, 100%; accuracy, 96%; AUROC, 0.833; P<0.05). | |||
Point-SWE outperforms ARFI and strain ratio for strictures characterization. |
MRE, magnetic resonance enterography; DWI, diffusion-weighted imaging; ADC, apparent diffusion coefficient; DCE, dynamic contrast enhancement; MTR, magnetization transfer ratio; MT, magnetization transfer; AUC, area under received operating characteristic curve; USE, ultrasound elastography; US, ultrasound; SWE, shear wave elastography; CEUS, contrast-enhanced ultrasound; ARFI, acoustic radiation force impulse.