MRI differentiates degrees of coexisting fibrosis, inflammation in Crohn's

Last Updated: 2015-02-25

By Reuters Staff

NEW YORK (Reuters Health) - A new study confirms that fibrosis and inflammation often coexist in patients with Crohn's disease (CD) and shows that magnetic resonance imaging (MRI) can identify and differentiate degrees of each component.

An accurate assessment of bowel fibrosis and inflammation in patients with CD is important for proper management, and MRI is "gaining acceptance" for this purpose, the study team notes in a report online now in the American Journal of Gastroenterology.

Dr. Jordi Rimola from University of Barcelona, Spain, and colleagues set out to characterize the MRI findings that are differentially associated with the presence of fibrosis and those associated with inflammatory activity.

They reviewed MRI studies that used the same imaging protocol from 41 patients with CD who underwent elective bowel resection, using surgical resection specimens for reference.

They found that the "pathological intensity of inflammation" was markedly associated with seven MRI parameters: hypersignal on T2 (p=0.02), mucosal enhancement (p=0.03), ulcerations (p=0.01), and blurred margins (p=0.05).

In addition, the degree of fibrosis correlated with the percentage of gadolinium enhancement gain (p<0.01), the pattern of enhancement (p<0.01), and the presence of stenosis (p=0.05).

"Using percentage of enhancement gain, MRI is able to discriminate between mild-moderate and severe fibrosis deposition with a sensitivity of 0.94 and a specificity of 0.89," Dr. Rimola and colleagues report.

"The assessment of gadolinium enhancement over time allows the identification of segments with a high component of fibrosis, regardless of the degree of coexisting inflammation," they note in their article.

"In clinical practice, identification of lesions with higher degrees of fibrosis may improve CD management; in clinical research, an accurate assessment of the degree of fibrosis may be key for the development of anti-fibrotic drugs in CD," they add.

The study had no commercial funding and the authors declared no conflicts of interest. They did not respond to request for comment by press time.

SOURCE: http://bit.ly/1LnQJXh

Am J Gastroenterol 2015.