背景:爬行脂肪是小肠克罗恩病(CD)的病理特征,有文献表明肠切除术和扩大肠系膜切除术与较少的术后复发有关。常规成像无法准确量化疾病参与(即,纤维化)爬行脂肪。疾病受累的量化可能有助于进一步扩大肠系膜切除术的决策。我们研究了肠系膜磁共振弹性成像(MRE)的可行性,以及MRE是否能够检测活动性CD中肠系膜的纤维化疾病。
方法:多频MRE产生了空间刚度(剪切波速度,SWS,|G*|)和流度图(φ)。将7名CD患者肠系膜的粘弹性特性与年龄和性别匹配的健康志愿者(HV)进行了比较(Mann-WhitneyU检验)。在CD患者中,比较受影响和“可能”未受影响的肠系膜(Wilcoxon符号秩检验)。在15个HV中测试了重复性(Bland-Altman分析,变异系数[CoV])。Spearman等级相关性用于研究显微镜评分的肠系膜纤维化量与粘弹性参数之间的关系。
结果:SWS,|G*|,CD受影响肠系膜的φ高于HV(p=0.017,p=0.001,p=0.017)。发现肠系膜纤维化的面积百分比与SWS和|G*|之间存在很强的相关性(p<0.010)。在受影响和可能未受影响的肠系膜之间的CD内没有发现差异。SWS的可重复性显示(-0.09,0.13m/s)的一致性为95%,受试者内CoV为5.3%。
结论:MRE可能有潜力测量CD中肠系膜的纤维化疾病受累,可能指导关于扩大肠系膜切除术的临床决策。
背景:荷兰审判登记簿,NL9105,2020年12月7日注册。
结论:MRE可能有可能测量活动性克罗恩病中受影响的肠系膜脂肪的肠系膜纤维化量,对疾病进展有更深入的了解,并可能在延长肠系膜切除术的临床决策中发挥作用.
结论:•活动性CD患者肠系膜MRE是可行的。•活跃CD的肠系膜的流动性和刚度增加,而僵硬度与肠系膜纤维化的组织病理学量相关。•MRE提供生物标志物以量化活性CD中的肠系膜疾病活性。
Creeping fat is a pathological feature of small bowel Crohn\'s disease (CD), with literature suggesting that bowel resection with extended mesenteric resection is related to less postoperative recurrences. Conventional imaging is unable to accurately quantify the disease involvement (i.e., fibrosis) of creeping fat. Quantification of disease involvement could be useful in decision-making for additional extended mesenteric resection. We investigated the feasibility of magnetic resonance elastography (MRE) of the
mesentery and if MRE is capable to detect fibrotic disease involvement of
mesentery in active CD.
Multifrequency MRE yielded spatial stiffness (shear wave speed, SWS, |G*|) and fluidity maps (φ). Viscoelastic properties of seven CD patients\' mesentery were compared to age- and sex-matched healthy volunteers (HV) (Mann-Whitney U-test). Within CD patients, the affected and \"presumably\" unaffected mesentery were compared (Wilcoxon-signed rank test). Repeatability was tested in 15 HVs (Bland-Altman analysis, coefficient of variation [CoV]). Spearman rank correlations were used to investigate the relation between microscopically scored amount of mesenteric fibrosis and viscoelastic parameters.
SWS, |G*|, and φ of affected mesentery in CD were higher compared to HV (p = 0.017, p = 0.001, p = 0.017). Strong correlations were found between percentage of area of mesenteric fibrosis and SWS and |G*| (p < 0.010). No differences were found within CD between affected and presumably unaffected
mesentery. Repeatability of SWS showed 95% limits of agreement of (-0.09, 0.13 m/s) and within-subject CoV of 5.3%.
MRE may have the potential to measure fibrotic disease involvement of the mesentery in CD, possibly guiding clinical decision-making with respect to extended mesenteric resection.
Dutch
trial register, NL9105 , registered 7 December 2020.
MRE may have the potential to measure the amount of mesenteric fibrosis of the affected mesenteric fat in active Crohn\'s disease, giving more insight into disease progression and could potentially play a role in clinical decision-making for extended mesenteric resection.
• MRE of the
mesentery in patients with active CD is feasible. • Fluidity and stiffness of the
mesentery increase in active CD, while stiffness correlates with the histopathological amount of mesenteric fibrosis. • MRE provides biomarkers to quantify mesenteric disease activity in active CD.