Title: Mesenteric Fat Proliferation on Magnetic Resonance Enterography Is a Predictor of Long-
Term Disease Complications in Crohn’s Disease
Version: 4 Date: 19 May 2025
Reviewer's report:
Koifman et al. sought to identify if mesenteric fat proliferation on MR enterography is a
predictor of complications in Crohn’s disease, particularly hospital admissions and surgery. In a
retrospective fashion, they studied 175 patients who had undergone MRE and had GI follow up
in clinic. They found that the presence of mesenteric fat proliferation on MRE was associated
with an increase in hospitalizations and surgery on both univariate and multivariate analysis.
Strengths:
- Size of the study
- The role of mesenteric fat is of increasing interest in Crohn’s disease, and the possibility of
a radiographic finding providing added diagnostic information to make therapeutic decisions is
exciting, given MRE is less invasive than endoscopy.
Comments:
- Mesenteric fat proliferation is not a quantifiable measurement, rather a subjective assessment
of the presence of increased fibrofatty tissue around the bowel loop. This categorization, which
lies at the center of this paper’s question and results, was only performed by a single radiologist.
This major limitation of intra/inter-observer variability is not mentioned.
- Interestingly, mesenteric edema, which IS a quantifiable variable (defined as increased signal
intensity in the T2-weighted imaging of the mesenteric fat) was associated with increased risk
of hospitalization and surgery on univariate analysis but did not hold up in multivariate analysis.
The limitation of power is mentioned, but this discrepancy questions the true connection between
mesenteric fat and Crohn’s complications.
- Given the high proportion of patients who have mesenteric fatty proliferation that persists over
time, does the ongoing MFP represent a significant ongoing inflammatory process that requires
intervention or rather just a lagging of the radiographic findings?
- From this data I am not sure one can conclude that mesenteric fat plays a role in incurring
damage in Crohn’s disease. Prior work has suggested a protective effect of mesenteric/creeping
fat in creating a barrier to prevent dissemination of bacteria in areas of active inflammation.
Therefore, the presence of mesenteric fat proliferation may be a protective response that is
present in areas of active disease, but not necessarily a promoter of long-term damage in and
of itself.
Title: Mesenteric Fat Proliferation on Magnetic Resonance Enterography Is a Predictor of Long-
Term Disease Complications in Crohn’s Disease
Version: 4 Date: 19 May 2025
Reviewer's report:
Koifman et al. sought to identify if mesenteric fat proliferation on MR enterography is a
predictor of complications in Crohn’s disease, particularly hospital admissions and surgery. In a
retrospective fashion, they studied 175 patients who had undergone MRE and had GI follow up
in clinic. They found that the presence of mesenteric fat proliferation on MRE was associated
with an increase in hospitalizations and surgery on both univariate and multivariate analysis.
Strengths:
- Size of the study
- The role of mesenteric fat is of increasing interest in Crohn’s disease, and the possibility of
a radiographic finding providing added diagnostic information to make therapeutic decisions is
exciting, given MRE is less invasive than endoscopy.
Comments:
- Mesenteric fat proliferation is not a quantifiable measurement, rather a subjective assessment
of the presence of increased fibrofatty tissue around the bowel loop. This categorization, which
lies at the center of this paper’s question and results, was only performed by a single radiologist.
This major limitation of intra/inter-observer variability is not mentioned.
- Interestingly, mesenteric edema, which IS a quantifiable variable (defined as increased signal
intensity in the T2-weighted imaging of the mesenteric fat) was associated with increased risk
of hospitalization and surgery on univariate analysis but did not hold up in multivariate analysis.
The limitation of power is mentioned, but this discrepancy questions the true connection between
mesenteric fat and Crohn’s complications.
- Given the high proportion of patients who have mesenteric fatty proliferation that persists over
time, does the ongoing MFP represent a significant ongoing inflammatory process that requires
intervention or rather just a lagging of the radiographic findings?
- From this data I am not sure one can conclude that mesenteric fat plays a role in incurring
damage in Crohn’s disease. Prior work has suggested a protective effect of mesenteric/creeping
fat in creating a barrier to prevent dissemination of bacteria in areas of active inflammation.
Therefore, the presence of mesenteric fat proliferation may be a protective response that is
present in areas of active disease, but not necessarily a promoter of long-term damage in and
of itself.
Please review this paper.
user
Title: Mesenteric Fat Proliferation on Magnetic Resonance Enterography Is a Predictor of Long-
Term Disease Complications in Crohn’s Disease
Version: 4 Date: 19 May 2025
Reviewer's report:
Koifman et al. sought to identify if mesenteric fat proliferation on MR enterography is a
predictor of complications in Crohn’s disease, particularly hospital admissions and surgery. In a
retrospective fashion, they studied 175 patients who had undergone MRE and had GI follow up
in clinic. They found that the presence of mesenteric fat proliferation on MRE was associated
with an increase in hospitalizations and surgery on both univariate and multivariate analysis.
Strengths:
- Size of the study
- The role of mesenteric fat is of increasing interest in Crohn’s disease, and the possibility of
a radiographic finding providing added diagnostic information to make therapeutic decisions is
exciting, given MRE is less invasive than endoscopy.
Comments:
- Mesenteric fat proliferation is not a quantifiable measurement, rather a subjective assessment
of the presence of increased fibrofatty tissue around the bowel loop. This categorization, which
lies at the center of this paper’s question and results, was only performed by a single radiologist.
This major limitation of intra/inter-observer variability is not mentioned.
- Interestingly, mesenteric edema, which IS a quantifiable variable (defined as increased signal
intensity in the T2-weighted imaging of the mesenteric fat) was associated with increased risk
of hospitalization and surgery on univariate analysis but did not hold up in multivariate analysis.
The limitation of power is mentioned, but this discrepancy questions the true connection between
mesenteric fat and Crohn’s complications.
- Given the high proportion of patients who have mesenteric fatty proliferation that persists over
time, does the ongoing MFP represent a significant ongoing inflammatory process that requires
intervention or rather just a lagging of the radiographic findings?
- From this data I am not sure one can conclude that mesenteric fat plays a role in incurring
damage in Crohn’s disease. Prior work has suggested a protective effect of mesenteric/creeping
fat in creating a barrier to prevent dissemination of bacteria in areas of active inflammation.
Therefore, the presence of mesenteric fat proliferation may be a protective response that is
present in areas of active disease, but not necessarily a promoter of long-term damage in and
of itself.
assistant