Abstract
The natural history of Crohn's disease (CD) involves chronic intestinal inflammation leading to fibrosis and stricture formation. Inflammation is readily identified, but no noninvasive method of identifying fibrosis exists. We previously demonstrated that magnetization transfer MRI (mtMRI), a specialized MRI sequence that detects tissue stiffness, quantitatively detects intestinal fibrosis in an animal model of CD. We hypothesize that mtMRI can quantitatively detect fibrosis in intestinal tissue in human CD. METHODS: Patients with CD scheduled for surgical resection of intestinal strictures were identified. Samples of resected intestinal tissue were obtained from the thickest portion of the stricture, and from the least involved tissue margin. Ex vivo tissue was scanned in Varian Inova 2.0 T, 31 cm clear bore system with Acustar S-180 actively shielded gradients at 10 kHz (Msat) and 100 kHz (M0) offresonance. MT ratio (MTR) of bowel wall was calculated as 100*(1-Msat/ M0). Tissue was sectioned and stained with Mason's trichrome stain and scored for fibrosis by two GI pathologists. The area of collagen per tissue length was determined on trichrome stained sections by image analysis using MatLab. RESULTS: 12 samples of intestinal tissue were obtained from 6 patients with CD undergoing intestinal resection. Mean MTR was 15.6 ± 0.9. The mean histologic fibrosis score was 2.8 ± 0.3. MTR and fibrosis scores did not differ significantly between tissue from mid-stricture and margin. MTR correlated extremely well with tissue fibrosis score (R2=0.75; p=0.006) and with MatLab collagen quantification (R2= 0.58; p=0.04). The histologic fibrosis score correlated well with the Matlab collagen quantification (R2=0.71; p=0.01). CONCLUSION:Magnetization transfer MRI is sensitive to tissue fibrosis in human CD ex vivo tissue and correlates with histologic assessment of fibrosis, and with collagen quantification by image analysis. This is consistent with our findings in an animal model of intestinal fibrosis, and supports our hypothesis that mtMRI can be used to quantitatively detect intestinal fibrosis and could be a useful tool for monitoring the natural history of CD.
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