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Vol. 43. Issue 4.
Pages 179-187 (April 2020)
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Vol. 43. Issue 4.
Pages 179-187 (April 2020)
Original article
DOI: 10.1016/j.gastre.2019.11.007
Relevance of dynamic studies with magnetic resonance enterography in Crohn's disease
Relevancia de los estudios dinámicos en Resonancia Entérica en la Enfermedad de Crohn
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Salvador Pousa, Matteo Frassona, Raquel Jiméneza, José Pamiésb, Icíar Puchadesa, Margarita Llavadorc, Eduardo García-Graneroa, Pilar Nosd,e,
Corresponding author
pilarnos@gmail.com

Corresponding author.
a Department of General Surgery, Colorectal Unit, La Fe University Hospital, University of Valencia, Spain
b Department of Radiology, La Fe University Hospital, Spain
c Department of Pathology, La Fe University Hospital, Spain
d Department of Gastroenterology, Inflammatory Bowel Disease Unit, La Fe University Hospital, Spain
e CIBEREHD (Networked Biomedical Research Center for Hepatic and Digestive Disease), Spain
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Figures (2)
Tables (6)
Table 1. Protocol for magnetic resonance enterography image acquisition.
Table 2. Histological Chiorean classification modified by the authors.
Table 3. Demographic and clinical data of patients (N=28). Age at diagnosis, disease location and behavior were defined according to the Montreal classification.19,20
Table 4. Results of correlation between dynamic curve pattern with histological study.
Table 5. Correlation between dynamic curve pattern with the inflammation degree in the histological study.
Table 6. Correlation between the dynamic curve pattern with the fibrosis degree in the histological study.
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Abstract
Introduction

A proper quantification of the inflammatory activity in Crohn's disease (CD) lesions is needed to establish the appropriate management for each patient. The aim of this study is to evaluate the inflammatory activity of affected segments in small bowel lesions using dynamic studies of magnetic resonance enterography (MRE) in patients undergoing surgery, and their correlation with the level of inflammation and histological fibrosis of the surgical piece.

Methods

A prospective, consecutive, observational, clinical study was conducted that included all the patients with small bowel CD that underwent surgery in this center between March 2011 and September 2013. Diagnosis was established according to Lennard–Jones criteria and the Montreal classification. All the patients underwent MRE within three months before surgery, using a routine protocol involving Liver Acquisition with Volume Acceleration-Extended Volume (LAVA-XV) sequence for the dynamic studies before intravenous administering of gadolinium and 30, 70, 120, and 420s after administering this. The results allowed the designing of graphics with different uptake patterns. The Chiorean classification was used in the histological analysis, as well as a modified version published previously by this study group.

Results

A total of 28 patients with 47 lesions were analyzed. There was a significant correlation between both curve patterns, including the modified Chiorean classification (P<0.0001) as well as the level of inflammation (P<0.0001) and fibrosis (P<0.002). Inflammatory patterns of dynamic studies are related to histological findings with 80.9% accuracy (sensitivity=75.7%; specificity=100%).

Conclusion

There is a high correlation between dynamic enhancement studies and the level of inflammatory activity. MRE is a suitable tool to differentiate between inflammatory and fibrotic lesions, making it useful to decide the appropriate management of each patient.

Keywords:
MRI enterography
Calprotectin
Surgery
Crohn's disease
Activity
Diagnosis
Resumen
Introducción

Se necesita una cuantificación adecuada de la actividad inflamatoria en las lesiones de la enfermedad de Crohn (EC) para establecer el tratamiento adecuado para cada paciente. El objetivo de este estudio es evaluar la actividad inflamatoria de los segmentos afectados en las lesiones del intestino delgado mediante estudios dinámicos de enterografía por resonancia magnética (ERM).

Métodos

Estudio prospectivo, consecutivo, observacional y clínico, que incluye a todos los pacientes con EC del intestino delgado que se sometieron a cirugía en nuestro centro entre marzo de 2011 y septiembre de 2013. El diagnóstico se estableció de acuerdo con los criterios de Lennard-Jones y la clasificación de Montreal. Todos los pacientes se sometieron a una ERM dentro de los 3 meses previos a la cirugía, aplicando el protocolo de rutina y secuencias preestablecidas. Para el estudio dinámico se empleó la secuencia Adquisición hepática con aceleración de volumen-Volumen extendido (LAVA-XV), antes de la administración intravenosa (iv) de gadolinio, y 30, 70, 120 y 420s después de esta administración. Los resultados permiten diseñar gráficos con diferentes patrones de captación. En el análisis histológico se utilizó la clasificación de Chiorean, así como una versión modificada creada por nuestro grupo de estudio.

Resultados

En total se analizaron 28 pacientes con 47 lesiones. Se detectó una correlación significativa entre ambos patrones de curva, incluyendo la clasificación de Chiorean modificada (p<0,0001), así como el grado inflamatorio (p<0,0001) y de fibrosis (p<0,002). Los patrones inflamatorios de los estudios dinámicos se relacionaron con los hallazgos histológicos con una precisión del 80,9% (S=75,7%; E=100%).

Conclusión

Existe una alta correlación entre los estudios dinámicos y el grado de actividad inflamatoria. La ERM constituye una herramienta adecuada para diferenciar entre lesiones inflamatorias y fibróticas, siendo útil para colaborar en la decisión terapéutica.

Palabras clave:
Enterografía de resonancia magnética
Calprotectina
Cirugía
Enfermedad de Crohn
Actividad
Diagnóstico

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