Ability of DWI to characterize bowel fibrosis depends on the degree of bowel inflammation

ObjectivesAlthough diffusion-weighted imaging (DWI) is reported to be accurate in detecting bowel inflammation in Crohn's disease (CD), its ability to assess bowel fibrosis remains unclear. This study assessed the role of DWI in the characterization of bowel fibrosis using surgical histopathology as the reference standard.MethodsAbdominal DWI was performed before elective surgery in 30 consecutive patients with CD. The apparent diffusion coefficients (ADCs) in pathologic bowel walls were calculated. Region-by-region correlations between DWI and the surgical specimens were performed to determine the histologic degrees of bowel fibrosis and inflammation.ResultsADCs correlated negatively with bowel inflammation (r=-0.499, p<0.001) and fibrosis (r=-0.464, p<0.001) in 90 specimens; the ADCs in regions of nonfibrosis and mild fibrosis were significantly higher than those in regions of moderate-severe fibrosis (p=0.008). However, there was a significant correlation between the ADCs and bowel fibrosis (r=-0.641, p=0.001) in mildly inflamed segments but not in moderately (r=-0.274, p=0.255) or severely (r=-0.225, p=0.120) inflamed segments. In the mildly inflamed segments, the ADCs had good accuracy with an area under the receiver-operating characteristic curve of 0.867 (p=0.004) for distinguishing nonfibrosis and mild fibrosis from moderate-severe fibrosis.ConclusionsADC can be used to assess bowel inflammation in patients with CD. However, it only enables the accurate detection of the degree of bowel fibrosis in mildly inflamed bowel walls. Therefore, caution is advised when using ADC to predict the degree of intestinal fibrosis.Key Points center dot Diffusion-weighted imaging was used to assess bowel inflammation in patients with Crohn's disease.center dot The ability of diffusion-weighted imaging to evaluate bowel fibrosis decreased with increasing bowel inflammation.center dot Diffusion-weighted imaging enabled accurate detection of the degree of fibrosis only in mildly inflamed bowel walls.