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 (i.e., non-inflammatory) stricture are highly relevant. The aim of our study was to determine whether it is possible to distinguish inflammatory (i.e., inflammatory and mixed) from chronic (i.e., non-inflammatory) strictures using quantified motility measured on cine-MRI in Crohn's disease (CD) patients. Methods In this prospective cross-sectional study, consecutive CD patients scheduled for small bowel resection underwent 2D cine-MRI prior to surgery. The 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 (i.e., non-inflammatory). For the analysis, strictures were stratified into inflammatory strictures (i.e., predominantly inflammatory and mixed) and chronic (i.e., non-inflammatory) strictures. Results Twenty-eight patients were included with 30 strictures and 15 pre-stricture dilatations. Pre-stricture dilatation motility was higher for chronic (i.e., non-inflammatory) compared to inflammatory (i.e., inflammatory and mixed) strictures (289.5 AU [188.0-362.9] vs. 113.1 AU [83.6-142.4], P =. 004). The area under the curve (AUC) for chronic (i.e., non-inflammatory) stricture detection was 0.93 (95% CI, 0.78-1.0, P =. 01). Within strictures, no difference was found between motility in different histopathology categories (P =. 6). Conclusion Motility in the pre-stricture dilatations of chronic (i.e., non-inflammatory) strictures was higher compared to inflammatory (i.e., 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 (i.e., non-inflammatory) strictures from inflammatory (i.e., inflammatory and mixed) strictures. Advances in knowledge Motility measured with cine-MRI could provide an imaging biomarker for the distinction between chronic (i.e., non-inflammatory) and inflammatory (i.e., inflammatory and mixed) strictures in CD.