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Digital archive of theses discussed at the University of Pisa

 

Thesis etd-10172023-091321


Thesis type
Tesi di specializzazione (4 anni)
Author
BORGESE, ALESSANDRA
URN
etd-10172023-091321
Thesis title
“Usefulness of MRI in the evaluation of degree of intestinal fibrosis in patients with Crohn’s Disease by using surgical histopathologic analysis as the reference standard”
Department
RICERCA TRASLAZIONALE E DELLE NUOVE TECNOLOGIE IN MEDICINA E CHIRURGIA
Course of study
RADIODIAGNOSTICA
Supervisors
relatore Prof. Neri, Emanuele
correlatore Dott. Boraschi, Piero
Keywords
  • crohn
  • strictures
  • fibrosis
  • mri
  • mural thickness
  • mural enhancement
  • surgery
Graduation session start date
07/11/2023
Availability
Withheld
Release date
07/11/2026
Summary
ABSTRACT
Purpose
Our study was aimed to assess the usefulness of magnetic resonance imaging (MRI) in the evaluation of degree of intestinal fibrosis in patients with Crohn’s disease (CD) urdergoing surgery, using histopathology analisys as the reference standard.
Materials and methods
A series of 65 patients with Crohn’s disease undergoing surgery and previously performing MRI of the small bowel were retrospectively enrolled. An hour before MR examination a fixed amount of 1500-2000 ml of isoosmotic polyethylene glycol (SELG®) electrolyte-balanced solution was orally administered. After the preliminary acquisition of coronal/axial T2-weighted SS-FSE and FIESTA sequences, our imaging protocol included T1-weighted 3D LAVA sequence in the coronal and axial plane, before and after intravenous administration of gadolinium-chelate. Axial diffusion-weighted imaging (DWI) was obtained using a b value of 1000 in 41 out of 65 patients. Two observers in consensus reviewed MR images to evaluate the following parameters: extent of bowel involvement from the ileo-cecal valve; mural thickness; mural T2-weighted signal; presence and entity of strictures; presence of ulcerations, blurred margins, comb sign and fibrofatty proliferation/creeping fat; penetrating disease (simple/complex fistula, sinus tract, inflammatory mass, abscess); lymph nodes; mural enhancement pattern; enhancement degree; signal intensity on DWI and ADC value. MR findings were correlated with surgical histopathology analysis.
Results
The mural thickness, the mural enhancement pattern and the degree of stenosis showed a significant correlation with the mild/moderate/severe degree of intestinal fibrosis, evaluated with the Higgins' score. All the other parameters did not reveal a significant correlation.
Conclusion
MR imaging is a promising tool in distinguishing varying degrees of bowel fibrosis. This technique could potentially be utilized as a method to differentiate fibrotic from inflammatory intestinal strictures in patients with CD.
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