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Sinan Lin, Xiaoqin Lin, Xuehua Li, Minhu Chen, Ren Mao, Making Qualitative Intestinal Stricture Quantitative: Embracing Radiomics in IBD, Inflammatory Bowel Diseases, Volume 26, Issue 5, May 2020, Pages 743–745, https://doi.org/10.1093/ibd/izz197
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Crohn’s disease (CD) is a type of inflammatory bowel disease with multiple manifestations that could affect any part of the gastrointestinal tract. Influenced by an array of inflammatory factors, both immune and nonimmune cells (predominantly mesenchymal cells including fibroblasts, myofibroblasts, and smooth muscle cells) are activated, triggering extracellular matrix accumulation, subsequent intestinal fibrosis, and stricture formation.1 More than half of CD patients develop fibrosis-induced intestinal obstruction, with debilitating symptoms throughout the disease course.2 Recently, awareness has been elevated in the area of intestinal fibrosis, notably in the development and evaluation of anti-fibrotic drug candidates in stricturing CD. However, before such a pursuit, key challenges need to be overcome: i) characterizing and quantifying intestinal fibrosis in patients with predominate strictures and ii) deciding on an accurate endpoint for clinical trials involving antifibrotic drugs in CD.3
Assessing transmural lesions in the bowel, cross-sectional imaging modalities including computed tomography enterography (CTE) and magnetic resonance enterography (MRE) have been investigated to characterize intestinal strictures.4 Using surgical histology as a reference standard, new techniques such as magnetic transfer imaging (MT) were reported to accurately evaluate intestinal fibrosis.5 However, subjectivity, interobserver variation and nonstandardized reporting have always been challenging issues when applying imaging modalities in clinical practice. A recent systematic review by Stenosis Therapy and Anti-Fibrotic Research Consortium (STAR) demonstrated that definitions for strictures on cross-sectional imaging are heterogeneous among studies, and conventional cross-sectional imaging techniques are not sufficiently accurate for use in routine clinical practice to distinguish inflammation from fibrosis and grade their severity.3
