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Mural Crohn disease: correlation of dynamic contrast-enhanced MR imaging findings with angiogenesis and inflammation
Stuart A Taylor1, Shonit Punwani, Manuel Rodriguez-Justo
1Department of Specialist Radiology, University College London Hospitals National Health Service Foundation Trust, 235 Euston Road, London NW12BU, England. csytaylor@yahoo.co.uk
Insights
Dynamic contrast-enhanced MRI reveals that mural hemodynamic parameters in Crohn disease correlate with disease chronicity and angiogenesis. However, these parameters do not correlate with inflammation markers, suggesting increased microvessel permeability with chronicity.
Area of Science:
- Gastroenterology
- Radiology
- Pathology
Background:
- Crohn disease is a chronic inflammatory bowel disease affecting the gastrointestinal tract.
- Accurate assessment of disease activity and its underlying pathophysiology is crucial for effective management.
- Dynamic contrast-enhanced magnetic resonance (MR) imaging offers a non-invasive method to evaluate tissue perfusion and vascular characteristics.
Purpose of the Study:
- To investigate mural perfusion dynamics in Crohn disease using dynamic contrast-enhanced MR imaging.
- To correlate these perfusion parameters with histopathologic markers of inflammation and angiogenesis.
- To understand the relationship between disease chronicity and vascular changes in Crohn disease.
Main Methods:
- Eleven patients with Crohn disease underwent preoperative dynamic contrast-enhanced MR imaging of the small bowel segment scheduled for resection.
- Quantitative parameters including slope of enhancement, time to maximum enhancement, enhancement ratio, K(trans), and v(e) were calculated.
- Ex vivo imaging of surgical specimens and histopathologic analysis determined microvascular density (MVD) and inflammation scores for correlation.
Main Results:
- Disease chronicity positively correlated with the enhancement ratio (r=0.82, P=.002).
- Slope of enhancement showed a significant negative correlation with microvascular density (MVD) (r=-0.86, P<.001).
- C-reactive protein (CRP) levels negatively correlated with the slope of enhancement (r=-0.77, P=.006), while inflammation scores did not correlate with imaging parameters.
Conclusions:
- Dynamic contrast-enhanced MR imaging-derived hemodynamic parameters correlate with disease chronicity and angiogenesis in Crohn disease.
- These MR imaging findings suggest increased microvessel permeability with disease chronicity.
- Tissue MVD appears inversely related to mural blood flow in Crohn disease, challenging previous assumptions.
Purpose:
To determine mural perfusion dynamics in Crohn disease by using dynamic contrast material-enhanced magnetic resonance (MR) imaging and to correlate these with histopathologic markers of inflammation and angiogenesis.
Materials And Methods:
Ethical permission was given by the University College London Hospital ethics committee, and informed consent was obtained from all participants. Eleven consecutive patients with Crohn disease (eight female patients, three men; mean age, 39.5 years; range, 16.4-66.6 years) undergoing elective small-bowel resection were recruited between July 2006 and December 2007. Harvey-Bradshaw index, C-reactive protein (CRP) level, and disease chronicity were recorded. Preoperatively, dynamic contrast-enhanced MR imaging was performed through the section of bowel destined for resection, and slope of enhancement, time to maximum enhancement, enhancement ratio, the volume transfer coefficient K(trans), and the extracellular volume fraction v(e) were calculated for the affected segment. Ex vivo surgical specimens were imaged to facilitate imaging-pathologic correlation. Histopathologic sampling of the specimen was performed through the imaged tissue, and microvascular density (MVD) was determined, together with acute and chronic inflammation scores. Correlations between clinical, MR imaging, and histopathologic data were made by using the Kendall rank correlation and linear regression.
Results:
Disease chronicity was positively correlated with enhancement ratio (correlation coefficient, 0.82; P = .002). Slope of enhancement demonstrated a significant negative correlation with MVD (correlation coefficient, -0.86; P < .001). There was a negative correlation between CRP level and slope of enhancement (correlation coefficient, -0.77; P = .006). Neither acute nor chronic inflammation score correlated with any other parameter.
Conclusion:
Certain MR imaging-derived mural hemodynamic parameters correlate with disease chronicity and angiogenesis in Crohn disease, but not with histologic and clinical markers of inflammation. Data support the working hypothesis that microvessel permeability increases with disease chronicity and that tissue MVD is actually inversely related to mural blood flow.
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