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MRI texture analysis of T2-weighted images is preferred over magnetization transfer imaging for readily longitudinal quantification of gut fibrosis

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To investigate the value of magnetization transfer (MT) MRI and texture analysis (TA) of T2-weighted MR images (T2WI) in the assessment of intestinal fibrosis in a mouse model.

Methods

Chronic colitis was induced in mice by cyclic administration of dextran sodium sulphate (DSS) resulting in chronic inflammation and progressive bowel fibrosis. Mice underwent 7-T MR imaging at various time points. Bowel wall MT ratio (MTR) and textural features (skewness, kurtosis, entropy), extracted by a filtration histogram technique, were correlated with histopathology. Performance of both techniques were validated using antifibrotic therapy. Finally, a retrospective study was conducted in five patients with Crohn’s disease (CD) who underwent bowel surgery.

Results

MTR and texture entropy correlated with histopathological fibrosis (r = .85 and .81, respectively). Entropy was superior to MTR for monitoring bowel fibrosis in the presence of coexisting inflammation (linear regression R2 = .93 versus R2 = .01). Furthermore, texture entropy was able to assess antifibrotic therapy response (placebo mice versus treated mice at endpoint scan; Δmean = 0.128, p < .0001). An increase in entropy was indicative of fibrosis accumulation in human CD strictures (inflammation: 1.29; mixed strictures: 1.4 and 1.48; fibrosis: 1.73 and 1.9).

Conclusion

MT imaging and TA of T2WI can both noninvasively detect established intestinal fibrosis in a mouse model. However, TA is especially useful for the longitudinal quantification of fibrosis in mixed inflammatory-fibrotic tissue, as well as for antifibrotic treatment response evaluation. This accessible post-processing technique merits further validation as the benefits for clinical practice as well as antifibrotic trial design would be numerous.

Key Points

• Magnetization transfer MRI and texture analysis of T2-weighted MR images can detect established bowel fibrosis in an animal model of gut fibrosis.

• Texture entropy is able to identify and monitor bowel fibrosis progression in an inflammatory context and can assess the response to antifibrotic treatment.

• A proof-of-concept study in five patients with Crohn’s disease suggests that texture entropy can detect and grade fibrosis in human intestinal strictures.

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Abbreviations

CD:

Crohn’s disease

DAI:

Disease Activity Index

DSS:

Dextran sulfate sodium

IncrEn:

Incremental entropy

MRE:

MR enterography

MT:

Magnetization transfer

MTR:

Magnetization transfer ratio

NormEn:

Normalized entropy

T2WI:

T2-weighted images

TA:

Texture analysis

TI:

Terminal ileum

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Acknowledgements

The antifibrotic compound (REDX08397) that was used in this study was provided by Redx Pharma Plc.

Statistical analyses were performed by Dr Ellen Deschepper (Biostatistics Unit, Ghent University, Ghent, Belgium).

Histopathologic evaluation was co-executed by professor emeritus Dr Karel Geboes (University Hospital KULeuven, Leuven, Belgium).

Figures were partially created with BioRender.

Funding

This study was supported by research grants from the Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium. Sophie Van Welden is supported by a fellowship from Ghent University, Ghent, Belgium [BOF20/PDO/047].

Author information

Authors and Affiliations

  1. Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium

    Isabelle De Kock, Louke Delrue & Geert Villeirs

  2. Department of Internal Medicine and Pediatrics, Ghent University, Corneel Heymanslaan 10, 0MRB2, B-9000, Ghent, Belgium

    Simon Bos, Sophie Van Welden & Debby Laukens

  3. VIB Center for Inflammation Research, Ghent, Belgium

    Simon Bos, Sophie Van Welden & Debby Laukens

  4. Redx Pharma Plc, Macclesfield, UK

    Peter Bunyard

  5. Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium

    Pieter Hindryckx & Martine De Vos

Authors
  1. Isabelle De Kock
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  2. Simon Bos
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  4. Sophie Van Welden
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Corresponding author

Correspondence to Debby Laukens.

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Guarantor

The scientific guarantor of this publication is Prof Dr Debby Laukens.

Conflict of interest

Peter Bunyard is an employee of Redx Pharma Plc but had no control of the data nor control of information that might present a conflict of interest. The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Dr Ellen Deschepper provided statistical advice for this manuscript and performed statistical analyses.

One of the authors, Simon Bos, has significant statistical expertise.

Informed consent

Written informed consent was waived because of the retrospective nature of the proof-of-concept study.

Ethical approval

The proof-of-concept study was approved by the Ethics Committee of Ghent University Hospital (EC/2018/1493, Belgian study registration number B670201838339). Approval from the institutional animal care committee was obtained.

Methodology

•Animal study: prospective; human proof-of-concept study: retrospective

•Experimental

•Performed at one institution

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Isabelle De Kock and Simon Bos share equal first authorship contribution.

Geert Villeirs and Debby Laukens share equal senior authorship contribution.

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Supplementary file1 (DOCX 845 KB)

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De Kock, I., Bos, S., Delrue, L. et al. MRI texture analysis of T2-weighted images is preferred over magnetization transfer imaging for readily longitudinal quantification of gut fibrosis. Eur Radiol 33, 5943–5952 (2023). https://doi.org/10.1007/s00330-023-09624-x

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  • DOI: https://doi.org/10.1007/s00330-023-09624-x

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