Intestinal sub-regionalization improves the diagnostic accuracy of MR enterography for fibrosis in ileal Crohn’s disease

Motivation: Due to spatial heterogeneity, accurate diagnosis of intestinal fibrosis is an unmet need for patients with Crohn's disease (CD). Goal(s): To investigate whether sub-regionalization improves diagnostic accuracy of MRE for CD fibrosis and develop optimal MRE models. Approach: Longitudinal co-registration of MRE with pathology was achieved using 3D printing, while axial co-registration of MCFI on MRE and pathology. Optimal multivariable MRE models were constructed. The diagnostic ability was evaluated by AUC. Results: After sub-regionalization, histological fibrosis scores were highest in mesenteric border region(all P<.05). The optimal models showed the highest diagnostic accuracy for mesenteric border (AUC=0.91). Impact: In CD patients, there is a notable fibrosis heterogeneity in the gut. This heterogeneity is pivotal in affecting diagnostic accuracy of fibrosis. Consequently, it is imperative to adopt a sub-regional diagnostic approach to ensure precision in medical assessment and treatment.