{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:34:17Z","timestamp":1760146457009,"version":"build-2065373602"},"reference-count":38,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,11,7]],"date-time":"2024-11-07T00:00:00Z","timestamp":1730937600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Imaging"],"abstract":"<jats:p>A retrospective analysis was conducted to investigate how a bright luminal sign on high b-value diffusion-weighted imaging (DWI) could be considered as a new biomarker for identifying fibrotic strictures in Crohn\u2019s disease (CD). Fibrotic strictures, due to excessive deposition of extracellular matrix following chronic inflammatory processes, can be difficult to distinguish from inflammatory strictures using endoscopy. This study was performed on 65 patients with CD who underwent MRE, and among them 32 patients showed the bright luminal sign on high b-value DWI. DWI findings were compared to pre- and post-contrast MRE data. Luminal bright sign performance results were calculated using a confusion matrix, the relationship between categorical variables was assessed by the \u03c72 test of independence, and the Kruskal\u2013Wallis test (ANOVA) was used for the assessment of statistical significance of differences between groups. The results indicated a high sensitivity (90%) and specificity (85%) of the bright luminal sign for fibro-stenotic CD and a significant correlation between DWI luminal brightness and markers such as the homogeneous enhancement pattern (p &lt; 0.001), increase in enhancement percentage from 70 s to 7 min after gadolinium injection (p &lt; 0.001), and submucosal fat penetration (p = 0.05). These findings indicate that DWI hyperintensity can be considered as a good non-invasive indicator for the detection of severe intestinal fibrosis and may provide an efficient and accurate method for assessing fibrotic strictures. This new non-invasive biomarker could allow an early diagnosis of fibrotic stricture, delaying the onset of complications and subsequent surgery. Moreover, further evaluations through larger prospective trials with histopathological correlation are needed to confirm these results and completely determine the clinical benefits of DWI in treating CD.<\/jats:p>","DOI":"10.3390\/jimaging10110283","type":"journal-article","created":{"date-parts":[[2024,11,7]],"date-time":"2024-11-07T04:22:56Z","timestamp":1730953376000},"page":"283","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Bright Luminal Sign on High b-Value Diffusion-Weighted Magnetic Resonance Enterography Imaging as a New Biomarker to Predict Fibrotic Strictures in Crohn\u2019s Disease Patients: A Retrospective Preliminary Study"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5814-2050","authenticated-orcid":false,"given":"Luca Pio","family":"Stoppino","sequence":"first","affiliation":[{"name":"Department of Medical & Surgical Sciences, Section of Diagnostic Imaging, University of Foggia, Viale Luigi Pinto n. 1, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7865-0225","authenticated-orcid":false,"given":"Stefano","family":"Piscone","sequence":"additional","affiliation":[{"name":"Department of Medical & Surgical Sciences, Section of Diagnostic Imaging, University of Foggia, Viale Luigi Pinto n. 1, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ottavia","family":"Quarta Colosso","sequence":"additional","affiliation":[{"name":"Department of Medical & Surgical Sciences, Section of Diagnostic Imaging, University of Foggia, Viale Luigi Pinto n. 1, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Saccone","sequence":"additional","affiliation":[{"name":"Department of Medical & Surgical Sciences, Section of Diagnostic Imaging, University of Foggia, Viale Luigi Pinto n. 1, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paola","family":"Milillo","sequence":"additional","affiliation":[{"name":"Department of Medical & Surgical Sciences, Section of Diagnostic Imaging, University of Foggia, Viale Luigi Pinto n. 1, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicola","family":"Della Valle","sequence":"additional","affiliation":[{"name":"Department of Medical & Surgical Sciences, Section of Gastroenterology, University of Foggia, Viale Luigi Pinto n. 1, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rodolfo","family":"Sacco","sequence":"additional","affiliation":[{"name":"Department of Medical & Surgical Sciences, Section of Gastroenterology, University of Foggia, Viale Luigi Pinto n. 1, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4809-6235","authenticated-orcid":false,"given":"Alfonso","family":"Reginelli","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine, University of Campania \u201cL. Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Macarini","sequence":"additional","affiliation":[{"name":"Department of Medical & Surgical Sciences, Section of Diagnostic Imaging, University of Foggia, Viale Luigi Pinto n. 1, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberta","family":"Vinci","sequence":"additional","affiliation":[{"name":"Department of Medical & Surgical Sciences, Section of Diagnostic Imaging, University of Foggia, Viale Luigi Pinto n. 1, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s13062-020-00280-5","article-title":"Pathophysiology of Crohn\u2019s disease inflammation and recurrence","volume":"15","author":"Petagna","year":"2020","journal-title":"Biol. Direct."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1001\/jama.2020.18936","article-title":"Management of Crohn Disease: A Review","volume":"325","author":"Cushing","year":"2021","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1016\/j.mayocp.2017.04.010","article-title":"Crohn Disease: Epidemiology, Diagnosis, and Management","volume":"92","author":"Feuerstein","year":"2017","journal-title":"Mayo Clin. Proc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2769","DOI":"10.1016\/S0140-6736(17)32448-0","article-title":"Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: A systematic review of population-based studies","volume":"390","author":"Ng","year":"2017","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1053\/j.gastro.2013.04.007","article-title":"Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn\u2019s and colitis epidemiology study","volume":"145","author":"Ng","year":"2013","journal-title":"Gastroenterology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1111\/apt.14617","article-title":"Risk factors for diagnostic delay in Crohn\u2019s disease and their impact on long-term complications: How do they differ in a tuberculosis endemic region?","volume":"47","author":"Banerjee","year":"2018","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1016\/j.dld.2015.03.004","article-title":"Diagnostic delay in Crohn\u2019s disease is associated with increased rate of abdominal surgery: A retrospective study in Chinese patients","volume":"47","author":"Li","year":"2015","journal-title":"Dig. Liver Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1825","DOI":"10.1097\/MIB.0000000000001257","article-title":"Impact of Diagnostic Delay and Associated Factors on Clinical Outcomes in a U.S. Inflammatory Bowel Disease Cohort","volume":"23","author":"Nguyen","year":"2017","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.disamonth.2017.07.001","article-title":"A comprehensive review and update on Crohn\u2019s disease","volume":"64","author":"Gajendran","year":"2018","journal-title":"Dis. Mon."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3635","DOI":"10.3748\/wjg.v18.i28.3635","article-title":"Cellular and molecular mechanisms of intestinal fibrosis","volume":"18","author":"Speca","year":"2013","journal-title":"World J. Gastroenterol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1038\/nrgastro.2009.31","article-title":"Intestinal fibrosis in IBD\u2014A dynamic, multifactorial process","volume":"6","author":"Rieder","year":"2009","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1093\/ecco-jcc\/jjy114","article-title":"ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 2: IBD scores and general principles and technical aspects","volume":"13","author":"Sturm","year":"2019","journal-title":"J. Crohns Colitis"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1093\/ecco-jcc\/jjw169","article-title":"3rd European Evidence-Based Consensus on the Diagnosis and Management of Crohn\u2019s Disease 2016: Part 2: Surgical Management and Special Situations","volume":"11","author":"Gionchetti","year":"2017","journal-title":"J. Crohns Colitis"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1097\/00054725-200207000-00002","article-title":"Long-term Evolution of Disease Behavior of Crohn\u2019s Disease","volume":"8","author":"Cosnes","year":"2002","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1097\/00000658-200001000-00006","article-title":"Risk Factors for Surgery and Postoperative Recurrence in Crohn\u2019s Disease","volume":"231","author":"Bernell","year":"2000","journal-title":"Ann. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1053\/j.gastro.2016.09.047","article-title":"Mechanisms, Management, and Treatment of Fibrosis in Patients with Inflammatory Bowel Diseases","volume":"152","author":"Rieder","year":"2017","journal-title":"Gastroenterology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1016\/0016-5085(90)90613-6","article-title":"Predictability of the Postoperative Course of Crohn\u2019s Disease","volume":"99","author":"Rutgeerts","year":"1990","journal-title":"Gastroenterology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1016\/j.cgh.2012.03.026","article-title":"Endoscopic skipping of the distal terminal ileum in Crohn\u2019s disease can lead to negative results from ileocolonoscopy","volume":"10","author":"Samuel","year":"2012","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1093\/jcag\/gwaa001","article-title":"Systematic Review: Patient Perceptions of Monitoring Tools in Inflammatory Bowel Disease","volume":"4","author":"Goodsall","year":"2020","journal-title":"J. Can. Assoc. Gastroenterol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1016\/j.crohns.2013.02.020","article-title":"Imaging techniques for assessment of inflammatory bowel disease: Joint ECCO and ESGAR evidence-based consensus guidelines","volume":"7","author":"Panes","year":"2013","journal-title":"J. Crohns Colitis"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1038\/ajg.2014.424","article-title":"Characterization of inflammation and fibrosis in Crohn\u2019s disease lesions by magnetic resonance imaging","volume":"110","author":"Rimola","year":"2015","journal-title":"Am. J. Gastroenterol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"111454","DOI":"10.1016\/j.ejrad.2024.111454","article-title":"Influence of diffusion weighted imaging and contrast enhanced T1 sequences on the diagnostic accuracy of magnetic resonance enterography for Crohn\u2019s disease","volume":"175","author":"Bhatnagar","year":"2024","journal-title":"Eur. J. Radiol."},{"key":"ref_23","first-page":"16","article-title":"DWI ratios: New indexes for Crohn\u2019s disease activity at magnetic resonance enterography?","volume":"128","author":"Cicero","year":"2023","journal-title":"La Radiol. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1677","DOI":"10.1007\/s00330-022-09149-9","article-title":"Apparent diffusion coefficient for assessing Crohn\u2019s disease activity: A meta-analysis","volume":"33","author":"Thormann","year":"2023","journal-title":"Eur. Radiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e19202","DOI":"10.1097\/MD.0000000000019202","article-title":"Can diffusion weighted imaging be used as an alternative to contrast-enhanced imaging on magnetic resonance enterography for the assessment of active inflammation in Crohn disease?","volume":"99","author":"Cansu","year":"2020","journal-title":"Medicine"},{"doi-asserted-by":"crossref","unstructured":"Foti, P.V., Travali, M., Farina, R., Palmucci, S., Coronella, M., Spatola, C., Puzzo, L., Garro, R., Inserra, G., and Riguccio, G. (2021). Can Conventional and Diffusion-Weighted MR Enterography Biomarkers Differentiate Inflammatory from Fibrotic Strictures in Crohn\u2019s Disease?. Medicina, 57.","key":"ref_26","DOI":"10.3390\/medicina57030265"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1002\/ueg2.12343","article-title":"Inflammatory bowel disease cross-sectional imaging: What\u2019s new?","volume":"10","author":"Wang","year":"2022","journal-title":"United Eur. Gastroenterol. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1093\/ecco-jcc\/jjw126","article-title":"Smooth Muscle Hyperplasia\/Hypertrophy Is the Most Prominent Histological Change in Crohn\u2019s Fibrostenosing Bowel Strictures: A Semiquantitative Analysis by Using a Novel Histological Grading Scheme","volume":"11","author":"Chen","year":"2017","journal-title":"J. Crohns Colitis"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1097\/00004836-198306000-00003","article-title":"Prognosis for Nonoperative Management of Small-Bowel Obstruction in Crohn\u2019s Disease","volume":"5","author":"Yaffe","year":"1983","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1002\/jmri.25325","article-title":"Diffusion-weighted MRI in Crohn\u2019s disease: Current status and recommendations","volume":"44","author":"Dohan","year":"2016","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1797","DOI":"10.1148\/rg.296095521","article-title":"Diffusion-weighted imaging in the abdomen and pelvis: Concepts and applications","volume":"29","author":"Qayyum","year":"2009","journal-title":"Radiographics"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.2214\/AJR.06.1403","article-title":"Diffusion-weighted MRI in the body: Applications and challenges in oncology","volume":"188","author":"Koh","year":"2007","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1097\/MIB.0000000000001001","article-title":"Diffusion-weighted MRI Enables to Accurately Grade Inflammatory Activity in Patients of Ileocolonic Crohn\u2019s Disease: Results from an Observational Study","volume":"23","author":"Li","year":"2017","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1148\/radiol.2015150809","article-title":"MR Enterography for the Evaluation of Small-Bowel Inflammation in Crohn Disease by Using Diffusion-weighted Imaging without Intravenous Contrast Material: A Prospective Noninferiority Study","volume":"278","author":"Seo","year":"2016","journal-title":"Radiology"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1007\/s00330-013-3015-7","article-title":"Evaluation of conventional, dynamic contrast enhanced and diffusion weighted MRI for quantitative Crohn\u2019s disease assessment with histopathology of surgical specimens","volume":"24","author":"Tielbeek","year":"2014","journal-title":"Eur. Radiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1007\/s00261-014-0247-1","article-title":"Quantitative apparent diffusion coefficient (ADC) values as an imaging biomarker for fibrosis in pediatric Crohn\u2019s disease: Preliminary experience","volume":"40","author":"Kovanlikaya","year":"2015","journal-title":"Abdom. Imaging"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2465","DOI":"10.1007\/s00330-018-5860-x","article-title":"Ability of DWI to characterize bowel fibrosis depends on the degree of bowel inflammation","volume":"29","author":"Li","year":"2019","journal-title":"Eur. Radiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1002\/ibd.21414","article-title":"Which magnetic resonance imaging findings accurately evaluate inflammation in small bowel Crohn\u2019s disease? A retrospective comparison with surgical pathologic analysis","volume":"17","author":"Zappa","year":"2011","journal-title":"Inflamm. Bowel Dis."}],"container-title":["Journal of Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2313-433X\/10\/11\/283\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:27:52Z","timestamp":1760113672000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2313-433X\/10\/11\/283"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,7]]},"references-count":38,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["jimaging10110283"],"URL":"https:\/\/doi.org\/10.3390\/jimaging10110283","relation":{},"ISSN":["2313-433X"],"issn-type":[{"type":"electronic","value":"2313-433X"}],"subject":[],"published":{"date-parts":[[2024,11,7]]}}}