Using GIQuant and cine-MRI may support earlier identification of strictures unlikely to respond to medical therapy potentially streamlining decision-making around surgery, dilation, or emerging anti-fibrotic trials.

Excellent work K.J. Beek et al!

This suggests that quantified pre-stricture motility measured via cine-MRI could serve as a non-invasive imaging biomarker to help distinguish stricture subtypes. This could be valuable in fibrostenotic Crohn’s, where differentiating between fibrosis & inflammation is often invasive & ambiguous.

Key findings:
Motility in pre-stricture dilatations was significantly higher in chronic vs. inflammatory strictures (289.5AU vs. 113.1AU, p=0.004). Notably, no significant difference was seen within the strictures themselves.
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👉 Cine or motility MRI was performed prior to stricture surgery
👉 Motility of 30 strictures and 15 pre-stricture dilatations was quantified using GIQuant
👉 Resection specimens were scored histologically as predominantly inflammatory, mixed, or chronic (non-inflammatory)

Practically, overlooking the range of motion that a stricture and dilation is capable of with a limited number of anatomical snap-shots can lead us to underestimating or even missing the disease.

All strictures are created different and remember...
👉Strictures aren't always structural

Bowel peristalsis becomes abnormal both at the stricture and in the upstream at the dilation which can reflect chronicity, reversibility and even explanation of symptoms.

💪 All on Entrolytics

Come see us at Digestive Disease Week® (DDW) or get in touch to learn more 👉 we are here to help with your trials, clinic or research.

References STAR Radiology: pubs.rsna.org/doi/10.1148/...

- But we can't get imaging... Oncology, cardiology, and neurology have solved this problem. The scanners are out there. We need to work together to create compelling data to get access.

- Can't you just measure fibrosis? No! While advanced methods are on the way we need to focus on what we can measure (length, volume, peristalsis) and use validated scores like MaRIA where possible to assess the inflammatory component.

🤔 FAQ's
- What about IUS? Great is skilled hands but the lack of bowel prep (to distend the lesion) and difficulty in measuring lesion length may harm repeatability. In practice, MRI and IUS work wonderfully together.

At the moment you need to measure:
1) Length of the lesion ICC 0.85
2) Bowel wall thickness ICC 0.58
3) Size of pre-stricture dilation ICC 0.74

Collectively these provide objective scores to assess stricture morphology during treatment. The best part is this is routinely done in clinical practice!

You need cross-sectional imaging - specifically MRI

Objective, cross-sectional and safe non-invasive imaging is the key to 1) identifying, 2) staging and 3) monitoring treatment response in fibrostenotic Crohn's.

#clinicaltrials