Research progress on noninvasive quantitative diagnosis of intestinal fibrosis in Crohn's disease

doi:10.16150/j.1671-2870.2025.04.004

Abstract

Abstract:

Crohn's disease (CD) is a chronic, non-specific inflammatory bowel disease with complex etiology, often accompanied by progressive intestinal fibrosis during its course, which can ultimately lead to severe complications such as luminal stricture, obstruction, and fistula. The development of intestinal fibrosis is irreversible and shows limited response to anti-inflammatory therapies. Therefore, early identification and precise quantitative assessment of intestinal fibrosis are crucial for optimizing therapeutic strategies, delaying disease progression, reducing surgical risks, and improving long-term prognosis. In recent years, with the rapid development of imaging technologies, multiple noninvasive diagnostic modalities—including computed tomography enterography (CTE), magnetic resonance enterography (MRE), intestinal ultrasound (IUS), and positron emission tomography (PET)-CT/PET-MRE have become increasingly mature in clinical application. By integrating multidimensional approaches such as structural parameters, functional imaging, elastography, and radiomics-artificial intelligence models, the efficiency and accuracy of quantitative assessment of intestinal fibrosis have been significantly improved. This review systematically summarizes the research progress on quantitative imaging assessment techniques for CD-associated intestinal fibrosis,aiming to provide a theoretical basis and practical reference for the precise clinical management of CD fibrosis and the development of novel anti-fibrotic therapies.

Key words: Crohn's disease, Intestinal fibrosis, Quantitative diagnosis, Non-invasive assessment, Imaging evaluation

CLC Number:

R574.62
R445

ZHANG Pingxin, YANG Jie, WANG Yangdi, CHEN Minhu, LI Xuehua, MAO Ren. Research progress on noninvasive quantitative diagnosis of intestinal fibrosis in Crohn's disease[J]. Journal of Diagnostics Concepts & Practice, 2025, 24(04): 383-392.

Figures/Tables 4

Figure 1

Figure 2

Table 1

Table 2

Summary of quantitative imaging metrics and predictive models for assessing intestinal fibrosis in CD

作者（年份）	分类体系	样本量	预测参数	参考标准	纤维化分级	效能评估
作者（年份）	分类体系	样本量	预测参数	参考标准	纤维化分级	AUC	灵敏度	特异度
CTE
Huang, et al. （2025）^[21]	肠道纤维化诊断模型	训练集：6 验证集：6	·电子密度 ·HU值	组织病理学	模型概率 ≤0.484，无/轻度纤维化模型概率 >0.484，中/重度纤维化	0.828	77.3%	82.4%
Li, et al. （2021）^[22]	放射组学模型	训练集：98 验证集：114	影像学特征值	组织病理学	模型概率 ≤0.811，轻度纤维化模型概率 >0.811，中/重度纤维化	0.888	81.5%	93.9%
Meng, et al. （2022）^[23]	深度学习模型	训练集：159 验证集：153	·肠壁厚度 ·壁层分层 ·狭窄前扩张 ·管腔大小	组织病理学	模型概率 ≤0.623，轻度纤维化模型概率 >0.623，中/重度纤维化	0.828	78.0%	85.7%
Li, et al. （2021）^[24]	肠系膜爬行脂肪指数	训练集：91 验证集：30	肠系膜爬行脂肪指数（MFCI）	组织病理学	MCFI ≤ 3分,轻度纤维化 MCFI >3分,中/重度纤维化	0.799	92.3%	58.8%
Meng, et al. （2022）^[25]	列线图	训练集：91 验证集：83	·MFCI ·肠系膜水肿程度 ·病程	组织病理学	无/轻度纤维化中/重度纤维化	0.832	-	-
MRE
Coimbra, et al.（2022）^[28]	综合诊断模型	61	·表观扩散系数 ·磁共振活动指数 ·延迟强化增益	组织病理学	MRE纤维化评分 ≤2.1，轻度纤维化 MRE纤维化评分 >2.1，中/重度纤维化	0.910	68.1%	100%
Du, et al. （2021）^[29]	表观扩散丰度成像	训练集：31 验证集：9	表观扩散峰度	组织病理学	Kapp <0.775，无/轻度纤维化 Kapp ≥0.775，中/重度纤维化	0.896	95.9%	78.1%
Du, et al. （2020）^[30]	表观扩散丰度成像	训练集：31 验证集：9	·表观扩散峰度 ·非高斯分布的表观扩散系数	组织病理学	总分对应纤维化概率 ≤0.594，轻度纤维化总分对应纤维化概率 >0.594，重度纤维化	Harrell一致性指数0.901
Zhang, et al. （2019）^[31]	体素内不相干运动参数	95	体素微循环灌注分数（f）	组织病理学	f ≥ 0.33，轻中度纤维化 f < 0.33，重度纤维化	0.876	92.6%	82.4%
Huang, et al. （2018）^[32]	T2*WI成像	102	T2*WI值	组织病理学	T2WI ≥18.06 ms，轻度纤维化 T2WI < 18.06 ms，中度或重度纤维化	0.951	94.7%	78.3%
Jordi, et al. （2015）^[33]	动态对比增强成像	44	70 s至7 min增强增益百分比（%Gain）	组织病理学	%Gain ≤ 23.5%，无/轻度纤维化 %Gain > 23.5%，中重度纤维化	0.930	94.0%	89.0%
Li, et al. （2018）^[35]	磁化传递成像	训练集：97 验证集：18	磁化传递率（MTR）	组织病理学	MTR ≤ 0.71，无/轻度纤维化 MTR > 0.71，中重度纤维化	0.919	84.4%	90.0%
Zhang, et al. （2024）^[36]	放射组学模型	训练集：93 验证集：30	·T2WI ·增强T1WI ·DWI ·ADC ·MTI	组织病理学	模型概率 ≤ 0.36，无/轻度纤维化模型概率 > 0.36，中重度纤维化	0.930	84.0%	100%
IUS
Maconi, et al. （2003）^[42]	Maconi 评分	43	超声下肠壁回声形态	组织病理学	低回声模式：无/轻度纤维化，以炎症为主混合回声模式：中度纤维化，炎症和纤维化混合存在分层回声模式：中/重度纤维化，以纤维化为主	-	100%	63.3%
Rispo, et al. （2017）^[45]	Lèmann 指数	71	·肠壁厚度 ·壁层分层 ·狭窄前扩张 ·管腔大小	组织病理学	1 级：BWT > 3.0 mm，或节段性强化而无狭窄前扩张 2 级：BWT > 4.0 mm，或肠壁分层而无狭窄前扩张 3 级：BWT > 4.0 mm，管腔狭窄，且增厚肠管上方的肠袢呈液性扩张或有回声内容物填充	-	-	-
Chen, at al.（2018）^[46]	剪切波弹性成像（SWE）	35	SWE值	组织病理学	SWE值 > 22.55 kPa,重度纤维化 SWE值 ≤ 22.55 kPa,轻/中度纤维化	-	69.6%	91.7%
PET-MRE
Scharitzer, et al.（2023）^[54]	⁶⁸Ga-FAPI-PET/MRE	14	最大标准摄取值（SUVmax）	组织病理学	SUVmax ≤ 4.4，无/轻微纤维化 4.4 < SUVmax ≤ 7.5，轻/中度纤维化 SUVmax>7.5，重度纤维化	0.940	93.0%	83.0%

Table 2

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	检查前准备复杂程度*	检查耗时	检查成本*	实施难点	适用场景
CTE	4	1~2 h	3	·设备可及性 ·患者配合度和依从性	·评估肠道全局病变 ·术前精准评估纤维化程度
MRE	4	2~3 h	4	·设备可及性 ·患者配合度和依从性	·评估肠道全局病变 ·术前精准评估纤维化程度 ·有CTE检查禁忌
IUS	1	15~30 min	2	·检查实施者技术经验	·狭窄患者初步筛查 ·门诊检查 ·病情随访
PET-CT / PET-MRE	4	1~3 h	5	·设备可及性 ·患者配合度和依从性 ·检查实施者技术水平 ·检查成本	·术前精准分型 ·新药疗效评估 ·临床科研