title: Characterization of inflammation and fibrosis in Crohn's disease lesions by magnetic resonance imaging.
abstract: OBJECTIVE
  Measurement of the component of fibrosis in Crohn's disease (CD) may have important therapeutic implications. The aim of this study was to characterize the Magnetic Resonance Imaging (MRI) findings that are differentially associated with the presence of fibrosis and those associated with inflammatory activity, using the pathological analysis of surgically resected intestinal lesions as reference standard.
  
  
  METHODS
  MRI studies with identical imaging protocol of 41 CD patients who underwent elective bowel resection within 4 months before surgery were reviewed. MRI evaluated wall thickening, edema, ulcers, signal intensity at submucosa at 70 s and 7 min after gadolinium injection, stenosis, and pattern of enhancement in each phase of the dynamic study and changes on this pattern over time. Pathological inflammatory and fibrosis scores were classified into three grades of severity.
  
  
  RESULTS
  In all, 44 segments from 41 patients were analyzed. The pathological intensity of inflammation was associated with the following MRI parameters: hypersignal on T2 (P=0.02), mucosal enhancement (P=0.03), ulcerations (P=0.01), and blurred margins (P=0.05). The degree of fibrosis correlated with the percentage of enhancement gain (P<0.01), the pattern of enhancement at 7 min (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.
  
  
  CONCLUSIONS
  MRI is accurate for detecting the presence of severe fibrosis in CD lesions on the basis of the enhancement pattern.
authors.affiliation: Department of Radiology, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rimola
authors.affiliation: 1] Bioinformatics Platform, CIBERehd, Barcelona, Spain [2] Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
authors.forename: Núria
authors.initials: N
authors.lastname: Planell
authors.affiliation: Department of Radiology, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Sonia
authors.initials: S
authors.lastname: Rodríguez
authors.affiliation: 1] Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain [2] Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Salvadora
authors.initials: S
authors.lastname: Delgado
authors.affiliation: 1] Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain [2] Department of Gastroenterology, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Ordás
authors.affiliation: 1] Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain [2] Department of Gastroenterology, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Ramírez-Morros
authors.affiliation: 1] Department of Radiology, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain [2] Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Ayuso
authors.affiliation: Department of Gastroenterology, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Montse
authors.initials: M
authors.lastname: Aceituno
authors.affiliation: 1] Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain [2] Department of Gastroenterology, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Ricart
authors.affiliation: 1] Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain [2] Department of Gastroenterology, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Aranzazu
authors.initials: A
authors.lastname: Jauregui-Amezaga
authors.affiliation: 1] Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain [2] Department of Gastroenterology, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Julián
authors.initials: J
authors.lastname: Panés
authors.affiliation: 1] Department of Pathology-CDB, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain [2] Tumour Bank, Biobank Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Míriam
authors.initials: M
authors.lastname: Cuatrecasas
mesh_terms: D000328:Adult; D003082:Colectomy / Q000379:methods*; D003287:Contrast Media; D003424:Crohn Disease / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005355:Fibrosis / Q000473:pathology*; D005682:Gadolinium; D006801:Humans; D007249:Inflammation / Q000473:pathology*; D007422:Intestines / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D010347:Patient Care Planning; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013223:Statistics as Topic
chemical_list: D003287:Contrast Media; D005682:Gadolinium