OBJECTIVES Identifying inflammation- or fibrosis-predominant strictures in Crohn's disease (CD) is crucial for treatment strategies. We evaluated the additive value of magnetisation transfer (MT) to conventional MRI for differentiating CD strictures using surgical histopathology as a reference standard. METHODS Twenty-eight consecutive CD patients who underwent MRI preoperatively were recruited. MRI parameters included T2-weighted imaging (T2WI) hyperintensity, bowel wall thickness, enhancement pattern changes over time, enhancement pattern and gain ratio in dynamic contrast-enhanced phases, and MT ratio. Correlation analysis was performed using Spearman's rank test. Receiver operating characteristic curve analysis and Cohen's κ were used. A model with combined MRI variables characterising intestinal strictures was proposed and validated in 14 additional CD patients. RESULTS Significant correlations with histological inflammation scores were shown for wall thickness (r = 0.361, p = 0.001) and T2WI hyperintensity (r = 0.396, p < 0.001), whereas histological fibrosis scores were significantly correlated with MT ratio (r = 0.681, p < 0.001) and wall thickness (r = 0.461, p < 0.001). T2WI hyperintensity could differentiate mild from moderate-to-severe inflammation with a sensitivity of 0.871 and a specificity of 0.800. MT ratio could discriminate mild from moderate-to-severe fibrosis with a sensitivity and a specificity of 0.913 and 0.923, respectively. Combining MT ratio and T2WI hyperintensity, the MRI classification moderately agreed with the pathological stricture classification (p < 0.01, κ = 0.549). In the validation set, the diagnostic accuracy of T2WI hyperintensity and MT ratio were 86% and 89%, with good agreement between MRI and histopathological classification (p < 0.01, κ = 0.665). CONCLUSIONS MT ratio combined with conventional MRI improves the differentiation of fibrotic from inflammatory components of small-bowel strictures in CD patients. KEY POINTS • MT ratio from magnetisation transfer imaging combined with T2WI from conventional MRI can simultaneously characterise bowel fibrosis and inflammation in adult Crohn's disease.

中文翻译：

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磁化转移成像为常规 MRI 添加信息，以区分克罗恩病小肠狭窄的炎症和纤维化成分。

目标 识别克罗恩病 (CD) 中以炎症或纤维化为主的狭窄对于治疗策略至关重要。我们使用手术组织病理学作为参考标准，评估了磁化转移 (MT) 对传统 MRI 用于区分 CD 狭窄的附加值。方法 连续招募了 28 名术前接受过 MRI 检查的 CD 患者。MRI 参数包括 T2 加权成像 (T2WI) 高信号、肠壁厚度、增强模式随时间的变化、动态对比增强阶段的增强模式和增益比以及 MT 比。使用斯皮尔曼等级检验进行相关分析。使用接受者操作特征曲线分析和 Cohen's κ。提出了一个具有表征肠狭窄的组合 MRI 变量的模型，并在另外 14 名 CD 患者中进行了验证。结果 壁厚 (r = 0.361, p = 0.001) 和 T2WI 高信号 (r = 0.396, p < 0.001) 与组织学炎症评分显着相关，而组织学纤维化评分与 MT 比率显着相关 (r = 0.681, p < 0.001) 和壁厚 (r = 0.461, p < 0.001)。T2WI 高信号可以区分轻度炎症和中度至重度炎症，灵敏度为 0.871，特异性为 0.800。MT 比率可以区分轻度和中度至重度纤维化，灵敏度和特异性分别为 0.913 和 0.923。结合 MT 比率和 T2WI 高信号，MRI 分类与病理性狭窄分类适度一致（p < 0.01，κ = 0.549）。在验证集中，T2WI 高信号和 MT 比率的诊断准确率分别为 86% 和 89%，MRI 与组织病理学分类之间具有良好的一致性（p < 0.01，κ = 0.665）。结论 MT 比率结合常规 MRI 可改善 CD 患者小肠狭窄的纤维化与炎症成分的鉴别。要点 • 磁化传输成像的 MT 比率与传统 MRI 的 T2WI 相结合可以同时表征成人克罗恩病的肠纤维化和炎症。MRI 和组织病理学分类之间具有良好的一致性（p < 0.01，κ = 0.665）。结论 MT 比率结合常规 MRI 可改善 CD 患者小肠狭窄的纤维化与炎症成分的鉴别。要点 • 磁化传输成像的 MT 比率与传统 MRI 的 T2WI 相结合可以同时表征成人克罗恩病的肠纤维化和炎症。MRI 和组织病理学分类之间具有良好的一致性（p < 0.01，κ = 0.665）。结论 MT 比率结合常规 MRI 可改善 CD 患者小肠狭窄的纤维化与炎症成分的鉴别。要点 • 磁化传输成像的 MT 比率与传统 MRI 的 T2WI 相结合可以同时表征成人克罗恩病的肠纤维化和炎症。