Quantified motility in Crohn's disease to evaluate stricture composition using cine-MRI.

Objectives: The histopathological composition of a stricture impacts clinical treatment choice. Therefore, imaging biomarkers that can distinguish a predominantly inflammatory from a chronic (ie non-inflammatory) stricture are highly relevant. The aim of our study was to determine whether it is possible to distinguish inflammatory (ie inflammatory and mixed) from chronic (ie non-inflammatory) strictures using quantified motility measured on cine-MRI in CD patients.

Methods: In this prospective cross-sectional study consecutive CD patients scheduled for small bowel resection underwent 2D cine-MRI prior to surgery. Motility of small bowel strictures and pre-stricture dilatations was quantified using a validated post-processing method (GIQuant). The resection specimens were scored by two pathologists as either: predominantly inflammatory, mixed or predominantly chronic (ie non-inflammatory). For the analysis, strictures were stratified into inflammatory strictures (ie predominantly inflammatory and mixed) and chronic (ie non-inflammatory) strictures.

Results: Twenty-eight patients were included with thirty strictures and fifteen pre-stricture dilatations. Pre-stricture dilatation motility was higher for chronic (ie non-inflammatory) compared to inflammatory (ie inflammatory and mixed) strictures (289.5AU [188.0-362.9] vs.113.1AU [83.6-142.4], p=0.004). Area under the curve (AUC) for chronic (ie non-inflammatory) stricture detection was 0.93 (95% CI 0.78-1.0, p=0.01). Within strictures, no difference was found between motility in different histopathology categories (p=0.6).

Conclusion: Motility in the pre-stricture dilatations of chronic (ie non-inflammatory) strictures was higher compared to inflammatory (ie inflammatory and mixed) strictures. No difference in motility was observed in stricture motility among stricture subtypes. Our findings suggest that quantified motility-measured with cine-MRI-of pre-stricture dilatations could possibly distinguish chronic (ie non-inflammatory) strictures from inflammatory (ie inflammatory and mixed) strictures.

Advances in knowledge: Motility measured with cine-MRI could possibly provide an imaging biomarker for the distinction between chronic (ie non-inflammatory) and inflammatory (ie inflammatory and mixed) strictures in CD.