TABLE 2.
Imaging technology contributions to intestinal fibrosis assessment in 2023.
| Techniques/markers | Superiority | Utility | Reference | |
|---|---|---|---|---|
| Magnetic resonance imaging (MRI) | MTR and TA | MTR and TA were linked to histopathological fibrosis. | Evaluate the efficacy of antifibrotic therapy. | De Kock I, et al 50 |
| 68Ga‐FAPI PET/MR enterography | FAPI uptake is positive correlated with histopathological confirmed fibrosis in the bowel wall. | Differentiate fibrotic from mixed strictures. | Scharitzer M, et al 51 | |
| Radiomics | Radiomic features were associated with fibrosis but not inflammation in CD strictures | Evaluate fibrosis and guide anti‐fibrotic therapies. | Sleiman J, et al 52 | |
| Computed tomography (CT) | [68Ga] Ga‐FAPI‐04 PET/CT | Measuring FAP uptake allows for quantitative and precise localization of fibrosis. | High sensitivity, better performance than CTE. | Chen L, et al 53 |
| CT‐based VAT features | The developed VAT‐radiomics model blended 1130 radiomics features VAT and offers notable advantages for identifying high‐risk patients. | Predict disease progression (strictures, penetrations, or surgery) better than a SAT‐radiomics model. | Li X, et al 54 | |
| ES, RS and upstream dilatation in RS | Strictures with upstream dilation and those that meet both RS and ES are associated with a higher risk of CAO. | Radiology is crucial in identifying strictures. Upstream dilation significantly impacts RS outcomes. | Shi L, et al 55 | |
| Intestinal ultrasound (IUS) | Ultrasound elastography | Ultrasound elastography demonstrated moderate to good overall accuracy in diagnosing intestinal fibrosis. | Emphasize the importance of ultrasound elastography. | Xu C, et al 56 |
| Point shear wave elastography showed higher accuracy in this regard. | ||||
| Ileocecal valve | Children with CD may display imaging features of the ileocecal valve, such as loss of mural stratification and severe fibrofatty proliferation. | Associated with both active inflammation and chronic fibrosis, and future surgical resection. | Manzotti C, et al 57 | |
| IUS | Younger patients with ileocolonic disease had higher stenosis‐detection rates by IUS. | A detection rate of 70.0% sensitivity, 98.2% specificity, and 88.4% accuracy. | Takeuchi K, et al 58 | |
| Endoscopy | The number, severity, length of strictures, and the presence of prestenotic dilatation and surrounding fistulas or abscesses | Endoscopy allows direct visualization of the narrowing bowel and can be used as a therapeutic tool. | Critical when evaluating stricture. | Shen B, et al 59 |
| Pennazio M, et al 60 | ||||
| The patency capsule procedure | Those CD patients with failed patency capsule procedure tended to suffer worse outcomes such as intestinal surgery and endoscopic dilation than those without. | Rule out small bowel stenosis | Ukashi O, et al 61 | |
| Consensus on escalation and de‐escalation treatment decisions | It is recommended to complete colonoscopy, even if imaging tests, such as MRE, are negative, especially when patients have obstructive symptoms. | Determine the necessity for intervention. | Nakase H, et al 62 |
Abbreviations: CAO, clinical adverse outcomes; CTE, computed tomography enterography; ES, endoscopic stricture; FAP, fibroblast activation protein; FAPI, fibroblast activation protein inhibitor; MCFI, mesenteric creeping fat index; MRE, magnetic resonance enterography; MTR, magnetization transfer MRI; RM, radiomics model; RS, radiological stricture; SAT, subcutaneous adipose tissue; TA, texture analysis; VAT, visceral adipose tissue.