What question did this study set out to answer?

This study aims to develop an automated method to quantify mesenteric hyperaemia in Crohn’s disease using time-of-flight MR angiography.

February 9, 2026Open Access

Automated quantification of mesenteric hyperaemia in Crohn’s disease using time-of-flight magnetic resonance angiography

INIyad NaimMott MacDonald (United Kingdom)CHCaroline L. HoadMansfield University PGPenny GowlandUniversity of Nottingham

Key Points

This study aims to develop an automated method to quantify mesenteric hyperaemia in Crohn’s disease using time-of-flight MR angiography.
Conducted MRI scans on 23 patients with active Crohn's disease and 17 healthy controls.
Developed an automated pipeline for segmenting mesenteric vessels and computing the Arborisation Index.
Performed analyses including BMI-matched cohorts and assessed repeatability over short-term scans.
The Arborisation Index was significantly higher in Crohn's disease patients compared to healthy controls (p = 0.02).
In BMI-matched pairs, the Arborisation Index difference remained significant (p = 0.008).
No influence of prior bowel resection on the Arborisation Index was observed (p = 0.42).
Good repeatability was confirmed with low coefficients of variation in both groups.

Abstract

Abstract Background Mesenteric hypervascularity (“comb sign”) reflects active inflammation in Crohn’s disease (CD) but is judged qualitatively on cross-sectional imaging. Despite its clinical relevance, no objective, quantitative MRI-based measures exist to assess this feature. This study aims to develop and evaluate an automated, contrast-free time-of-flight MR angiography (ToF-MRA) method for quantifying mesenteric vascularity in CD by comparing these measurements with healthy controls and assess the method’s repeatability and susceptibility to confounding by adiposity or prior bowel resection surgery. Methods Twenty-three patients with active CD and seventeen healthy controls underwent abdominal ToF-MRA scans. A fully automated pipeline was developed to segment mesenteric vessels on 18 rotating maximum-intensity projections, skeletonised vessels, and count branching points to compute an Arborisation Index. Secondary analyses included a BMI-matched sub-cohort, a prior-resection comparison, and associations with BMI and visceral adipose tissue from Dixon MRI scans. Repeatability was assessed using repeated scans acquired during the same visit. Results The Arborisation Index was higher in CD patients than in healthy controls (122.7 ± 37.1 vs. 98.4 ± 24.6; p = 0.02; d = 0.7) and this difference persisted in 10 BMI-matched pairs (145 ± 36 vs. 103 ± 24; p = 0.008; d = 1.4). Prior bowel resection ( n = 11) did not influence the measure ( p = 0.42). Short-term repeatability was good, with coefficients of variation of 8.9 ± 6% in CD and 8.5 ± 5% in controls. The Arborisation Index showed no significant correlation with BMI or visceral adipose volume. Conclusion The Arborisation Index demonstrated significant group-level differences between CD patients and healthy controls, showed good short-term repeatability, and appears technically robust to adiposity and surgical history. Larger longitudinal studies are required to establish its biological meaning, clinical relevance, and responsiveness to inflammatory activity. Graphical Abstract

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Cite This Study

Naim et al. (Fri,) studied this question.

synapsesocial.com/papers/698979a6f0ec2af6756e76df https://doi.org/https://doi.org/10.1007/s00261-026-05384-6

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