scholarly journals Assessing The Inflammatory Severity of The Terminal Ileum In Crohn Disease Using Radiomics Based On MRI

2022 ◽  
Author(s):  
Honglei Ding ◽  
Jiaying Li ◽  
Kefang Jiang ◽  
Chen Gao ◽  
Liangji Lu ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Terminal Ileum ◽  
Intraclass Correlation ◽  
Region Of Interest ◽  
Training Group ◽  
Severity Index ◽  
Receiver Operating Curve ◽  
Relative Contrast ◽  
Testing Group

Abstract Background: Evaluating inflammatory severity using imaging is essential for Crohn’s disease (CD), but it is limited by potential interobserver variation and subjectivity. We compared the efficiency of magnetic resonance index of activity (MaRIA) collected by radiologists and a radiomics model in assessing the inflammatory severity of terminal ileum (TI).Methods: 121 patients were collected from two centers. Patients were divided into ulcerative group and mucosal remission group based on the TI Crohn's disease Endoscopic Severity Index (tCDEIS). The consistency of bowel wall thickness (BWT), relative contrast enhancement (RCE), edema, ulcer, MaRIA and features of the region of interest (ROI) between radiologists were described by weighted k coefficient and intraclass correlation coefficient (ICC), and developed receiver operating curve (ROC) of MaRIA. The radiomics model was established using reproducible features of logistic regression based on arterial staging of T1WI sequences. Delong test was used to compare radiomics with MaRIA.Results: The consistency between radiologists were moderate in BWT (ICC=0.638), fair in edema (k=0.541), RCE (ICC=0.461), MaRIA (ICC=0.579) and poor in ulcer (k=0.271). Radiomics model was developed by 6 reproducible features (ICC=0.93-0.96) and equivalent to MaRIA which evaluated by the senior radiologist(0.872 vs 0.883 in training group, 0.824 vs 0.783 in testing group, P=0.847, 0.471), both of which were significant higher than MaRIA evaluated by junior radiologist(AUC: 0.621 in training group, 0.557 in testing group, all, PB0.05).

scholarly journals Synchronous adenocarcinoma and carcinoid tumor of the terminal ileum in a Crohn's disease patient

BMC Cancer ◽  
2005 ◽  
Vol 5 (1) ◽  
Author(s):  
Ugo Cioffi ◽  
Matilde De Simone ◽  
Stefano Ferrero ◽  
Michele M Ciulla ◽  
Alessandro Lemos ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Carcinoid Tumor ◽  
Terminal Ileum ◽  
Disease Patient

P054 The impact of intestinal stenosis on the expression of Crohn’s disease in young mice with genetic predisposition

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S161-S161
Author(s):  
I Georgopoulos ◽  
E Mavrigiannaki ◽  
S Stasinopoulou ◽  
G Renieris ◽  
G NIkolakis ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Terminal Ileum ◽  
Suture Technique ◽  
Intraluminal Pressure ◽  
Control Group ◽  
Intestinal Stenosis ◽  
The Creation ◽  
And Control ◽  
The Impact

Abstract Background In the majority of patients, the areas of the intestine affected in Crohn’s disease (CD) are the terminal ileum and less commonly the rectum. The terminal ileum is affected in the majority of genetic animal models of CD as well. Additionally, CD recurs at sites of tight anastomosis or strictures postoperatively. These observations lead to the assumption that increased intraluminal pressure related to the presence of a valve, sphincter or stenosis is associated with CD pathogenesis. We investigated the hypothesis that the creation of a partial intestinal stenosis could have an impact on disease severity, in a genetic animal model of CD (TNFΔare/+). TNFΔare/+ mice overexpress TNFα leading to a Crohn-like colitis in the terminal ileum. Methods Twenty-nine TNFΔare/+ mice, 6 weeks old, were divided into three intervention groups: stenosis, sham and control. In the stenosis group (n = 11), a partial small bowel obstruction was created via a novel triple suture technique, approximately 3 cm from the ileocecal valve. In the control group (n = 9), a loose single suture was placed at the aforementioned site to test the direct effect of the foreign material on the intestinal wall. The sham group (n = 9) received a sham operation. The triple suture stenosis was also performed on wild-type (WT) C57BL/6 mice (group WT, n = 9). 6 weeks post-surgery all animals were sacrificed and samples from the ileum 3 cm proximal and 3 cm distal to the intervention site were collected for histopathological evaluation. The Crohn-like changes were assessed using a modified colitis histological scoring system (based on Katakura et al., JCI 2005; 115: 695–702). Results Proximal to the intervention, the mean colitis score of stenosis group (10.18 ± 0.87) was significantly higher compared with sham (6.33 ± 0.97, p: 0.009) and control group (5.00 ± 0.91, p: 0.001). There was no difference between sham and control group (p: 0.332). No significant differences between the groups were reported distal to the intervention. The triple suture technique led to Crohn-like inflammatory lesions only in the TNFΔare/+ mice, as shown from the significantly increased score compared with WT mice proximal and distal to the stenosis (10.18 ± 0.87 vs. 0.67 ± 0.37, p < 0.001 and 9.20 ± 1.09 vs. 0.33 ± 0.24, p < 0.001). Conclusion The creation of a stenotic segment in the intestine of TNFΔare/+ mice, led to higher colitis score than expected. The probable mechanism is the increased intraluminal pressure proximal to the stenosis. This suggests that mechanical forces contribute as important co-factors in the pathophysiology of CD, in genetically predisposed populations.

scholarly journals Experiences with the Kono-S anastomosis in Crohn’s disease of the terminal ileum—a cohort study

2020 ◽  
Author(s):  
K. Horisberger ◽  
D. L. Birrer ◽  
A. Rickenbacher ◽  
M. Turina
Keyword(s):  
Cohort Study ◽  
Crohn’S Disease ◽  
Postoperative Complications ◽  
Crohn's Disease ◽  
Terminal Ileum ◽  
Ileocecal Resection ◽  
Anastomotic Recurrence ◽  
Short Term ◽  
Recurrence Rates

Abstract Purpose The most frequent long-term complication after ileocecal resection in Crohn’s disease is anastomotic recurrence and subsequent stenosis. Recurrence typically begins at the site of the anastomosis, raising the question of whether the surgical technique of the anastomosis could affect recurrence rates. Kono-S anastomosis is a hand-sewn antimesenteric functional end-to-end anastomosis that offers a wide lumen that is well accessible for endoscopic dilatation. The purpose of our study is to review the rate of postoperative complications almost 2 years after the introduction of this technique. Materials and methods This is a prospective single-center cohort study of all consecutive patients with Crohn’s disease undergoing ileocecal resection. Patients’ characteristics as well as specific data for the surgical procedure and short-term outcome were evaluated. Results Thirty patients were operated for Crohn’s disease of the terminal ileum (n = 24) or anastomotic recurrence (n = 6). Postoperative complications with a Clavien-Dindo Score ≥ IIIb were observed in three patients. One patient showed a hemorrhage and underwent surgical hemostasis. Two patients developed anastomotic leakage; in both cases, ileostomy was created after resection of the anastomosis. The median hospital stay was 9 days (IQR 7–12). A comparison with a historic group of conventionally operated patients of our hospital revealed no differences in short-term results except for the duration of surgery. Conclusion The Kono-S anastomosis is associated with acceptable short-term results, complications, and recurrence rates comparable with the established anastomotic techniques. Longer operation times are observed, but the few published studies concerning long-term recurrence are promising.

scholarly journals Panenteric capsule endoscopy versus ileocolonoscopy plus magnetic resonance enterography in Crohn’s disease: a multicentre, prospective study

2020 ◽  
Vol 7 (1) ◽  
pp. e000365 ◽  
Author(s):  
David Henry Bruining ◽  
Salvatore Oliva ◽  
Mark R Fleisher ◽  
Monika Fischer ◽  
Joel G Fletcher
Keyword(s):  
Crohn’S Disease ◽  
Magnetic Resonance ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Capsule Endoscopy ◽  
Terminal Ileum ◽  
Imaging Modality ◽  
Disease Diagnosis ◽  
Magnetic Resonance Enterography ◽  
Proximal Small Bowel

IntroductionCrohn’s disease diagnosis and monitoring remains a great clinical challenge and often requires multiple testing modalities. Assessing Crohn’s disease activity in the entire gastrointestinal (GI) tract using a panenteric capsule endoscopy (CE) system could be used as an alternative to colonoscopy and cross-sectional imaging. This study assessed the accuracy and safety of panenteric CE in Crohn’s disease as compared with ileocolonoscopy (IC) and/or magnetic resonance enterography (MRE).MethodsA prospective, multicentre study was performed in subjects with established Crohn’s disease. Individuals with proven small bowel patency underwent a standardised bowel preparation, followed by CE ingestion and IC either the same or following day. MRE, IC, and CE interpretations were performed by blinded central readers using validated scoring systems. The primary endpoint was the overall sensitivity of CE vs MRE and/or IC in Crohn’s disease subjects.ResultsStudy enrolment included 158 subjects from 21 sites in the USA, Austria, and Israel. Of those, 99 were included in the analysis. Imaging modality scores indicated none to mild inflammation in the proximal small bowel and colon, but discrepant levels of inflammation in the terminal ileum. Overall sensitivity for active enteric inflammation (CE vs MRE and/or IC) was 94% vs 100% (p=0.125) and specificity was 74% vs 22% (p=0.001). Sensitivity of CE was superior to MRE for enteric inflammation in the proximal small bowel (97% vs 71%, p=0.021), and similar to MRE and/or IC in the terminal ileum and colon (p=0.500–0.625). There were seven serious adverse advents of which three were related to the CE device.ConclusionPanenteric CE is a reliable tool for assessing Crohn’s disease mucosal activity and extent compared with more invasive methods. This study demonstrates high performance of the panenteric CE as compared to MRE and/or IC without the need for multiple tests in non-stricturing Crohn’s disease.Trial registration numberClinicalTrials.gov NCT03241368

scholarly journals A novel collagen area fraction index to quantitatively assess bowel fibrosis in patients with Crohn’s disease

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Xue-hua Li ◽  
Zhuang-nian Fang ◽  
Tian-ming Guan ◽  
Jin-jiang Lin ◽  
Can-hui Sun ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Intraclass Correlation ◽  
Area Under The Curve ◽  
Area Fraction ◽  
Strongly Correlated ◽  
Fibrosis Score ◽  
High Repeatability

Abstract Background A validated histopathological tool to precisely evaluate bowel fibrosis in patients with Crohn’s disease is lacking. We attempted to establish a new index to quantify the severity of bowel fibrosis in patients with Crohn’s disease-associated fibrostenosis. Methods We analyzed the histopathological data of 31 patients with Crohn’s disease strictures undergoing surgical resection. The most representative sections of resected strictured segments were stained with Masson trichrome to manifest bowel fibrosis. The collagen area fraction and histological fibrosis score were simultaneously calculated for the same section to evaluate the severity of bowel fibrosis. Results Collagen area fraction strongly correlated with histological fibrosis scores (r = 0.733, P < 0.001). It showed a stronger correlation (r = 0.561, P < 0.001) with the degree of bowel strictures than the histological fibrosis score did (r = 0.468, P < 0.001). It was also shown to be more accurate for diagnosing Crohn’s disease strictures (area under the receiver operating characteristic curve = 0.815, P < 0.001) compared with the histological fibrosis score (area under the curve = 0.771, P < 0.001). High repeatability was observed for the collagen area fraction, with an intraclass correlation coefficient of 0.915 (P < 0.001). Conclusions Collagen area fraction is a simple and reliable index to quantify the severity of bowel fibrosis in patients with Crohn’s disease-associated fibrostenosis.

scholarly journals P188 Crohn's disease of the terminal Ileum: PET-MRE results correlate well with biomarkers

2017 ◽  
Vol 11 (suppl_1) ◽  
pp. S172-S172 ◽  
Author(s):  
H. Leibovitzh ◽  
I. Avni-Biron ◽  
L. Lichtenstein ◽  
D. Groshar ◽  
H. Bernstine ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Terminal Ileum
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