Agreement between real-time elastography and delayed enhancement magnetic resonance enterography on quantifying bowel wall fibrosis in Crohn's disease

Background: the assessment of fibrosis in Crohn's disease (CD) bowel lesions helps to guide therapeutic decisions. Real-time elastography (RTE) and delayed-enhancement magnetic resonance enterography (DE-MRE) have demonstrated good accuracy in quantifying CD-related ileal fibrosis as compared with histological examination. To date no study has compared DE-MRE and RTE. Aims: we aimed to evaluate the agreement between RTE and DE-MRE on quantifying CD-related ileal fibrosis. Methods: consecutive patients with ileal or ileocolonic CD underwent RTE and DE-MRE. Ileal fibrosis was quantified by calculating the strain ratio (SR) at RTE and the 70s-7 min percentage of enhancement gain (%EG) of both mucosa and submucosa at DE-MRE. A SR >2 was applied to define severe fibrosis. Clinically relevant outcomes occurring at follow-up were recorded. Results: 40 CD patients were enrolled. A significant linear correlation was observed between SR and submucosal %EG ( r = 0.594, p < 0.001). Patients with severe fibrosis (SR >2) had significantly higher submucosal %EG values than patients with low/moderate fibrosis (median values 26.4% vs . 9.5%, p < 0.001). During a median 43.8-month follow-up relevant disease outcomes occurred more frequently in the severefibrosis group (75% vs . 36%, HR 5.4, 95% CI 1.2-24.6, p = 0.029). Conclusions: the study demonstrates an excellent agreement between RTE and DE-MRE in assessing ileal fibrosis in CD. (c) 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Automated summary

The study compared RTE and DE-MRE in assessing ileal fibrosis in CD patients, finding excellent agreement between the two methods. Patients with severe fibrosis experienced relevant disease outcomes more frequently during follow-up.