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Seo N, Park SH, Kim KJ, Kang BK, Lee Y, Yang SK, Ye BD, Park SH, Kim SY, Baek S, Han K, Ha HK. MR Enterography for the Evaluation of Small-Bowel Inflammation in Crohn Disease by Using Diffusion-weighted Imaging without Intravenous Contrast Material: A Prospective Noninferiority Study. Radiology 2015; 278:762-72. [PMID: 26348103 DOI: 10.1148/radiol.2015150809] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To determine whether magnetic resonance (MR) enterography performed with diffusion-weighted imaging (DWI) without intravenous contrast material is noninferior to contrast material-enhanced (CE) MR enterography for the evaluation of small-bowel inflammation in Crohn disease. MATERIALS AND METHODS Institutional review board approval and informed consent were obtained for this prospective noninferiority study. Fifty consecutive adults suspected of having Crohn disease underwent clinical assessment, MR enterography, and ileocolonoscopy within 1 week. MR enterography included conventional imaging and DWI (b = 900 sec/mm(2)). In 44 patients with Crohn disease, 171 small-bowel segments that were generally well distended and showed a wide range of findings, from normalcy to severe inflammation (34 men, 10 women; mean age ± standard deviation, 26.9 years ± 6.1), were selected for analysis. Image sets consisting of (a) T2-weighted sequences with DWI and (b) T2-weighted sequences with CE T1-weighted sequences were reviewed by using a crossover design with blinding and randomization. Statistical analyses included noninferiority testing regarding proportional agreement between DWI and CE MR enterography for the identification of bowel inflammation with a noninferiority margin of 80%, correlation between DWI and CE MR enterography scores of bowel inflammation severity, and comparison of accuracy between DWI and CE MR enterography for the diagnosis of terminal ileal inflammation by using endoscopic findings as the reference standard. RESULTS The agreement between DWI and CE MR enterography for the identification of bowel inflammation was 91.8% (157 of 171 segments; one-sided 95% confidence interval: ≥88.4%). The correlation coefficient between DWI and CE MR enterography scores was 0.937 (P < .001). DWI and CE MR enterography did not differ significantly regarding the sensitivity and specificity for the diagnosis of terminal ileal inflammation (P > .999). DWI and CE MR enterography concurred in the diagnosis of penetrating complications in five of eight segments. CONCLUSION DWI MR enterography was noninferior to CE MR enterography for the evaluation of inflammation in Crohn disease in generally well-distended small bowel, except for the diagnosis of penetration.
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Affiliation(s)
- Nieun Seo
- From the Department of Radiology and Research Institute of Radiology (N.S., Seong H. Park, S.Y.K., H.K.H.), Department of Gastroenterology (K.J.K., S.K.Y., B.D.Y., Sang H. Park), and Department of Clinical Epidemiology and Biostatistics (S.B.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea; Department of Radiology, Hanyang University Medical Center, Seoul, South Korea (B.K.K.); Department of Radiology, Inje University College of Medicine, Busan, South Korea (Y.L.); and Biostatistics Collaboration Unit, Gangnam Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea (K.H.)
| | - Seong Ho Park
- From the Department of Radiology and Research Institute of Radiology (N.S., Seong H. Park, S.Y.K., H.K.H.), Department of Gastroenterology (K.J.K., S.K.Y., B.D.Y., Sang H. Park), and Department of Clinical Epidemiology and Biostatistics (S.B.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea; Department of Radiology, Hanyang University Medical Center, Seoul, South Korea (B.K.K.); Department of Radiology, Inje University College of Medicine, Busan, South Korea (Y.L.); and Biostatistics Collaboration Unit, Gangnam Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea (K.H.)
| | - Kyung-Jo Kim
- From the Department of Radiology and Research Institute of Radiology (N.S., Seong H. Park, S.Y.K., H.K.H.), Department of Gastroenterology (K.J.K., S.K.Y., B.D.Y., Sang H. Park), and Department of Clinical Epidemiology and Biostatistics (S.B.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea; Department of Radiology, Hanyang University Medical Center, Seoul, South Korea (B.K.K.); Department of Radiology, Inje University College of Medicine, Busan, South Korea (Y.L.); and Biostatistics Collaboration Unit, Gangnam Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea (K.H.)
| | - Bo-Kyeong Kang
- From the Department of Radiology and Research Institute of Radiology (N.S., Seong H. Park, S.Y.K., H.K.H.), Department of Gastroenterology (K.J.K., S.K.Y., B.D.Y., Sang H. Park), and Department of Clinical Epidemiology and Biostatistics (S.B.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea; Department of Radiology, Hanyang University Medical Center, Seoul, South Korea (B.K.K.); Department of Radiology, Inje University College of Medicine, Busan, South Korea (Y.L.); and Biostatistics Collaboration Unit, Gangnam Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea (K.H.)
| | - Yedaun Lee
- From the Department of Radiology and Research Institute of Radiology (N.S., Seong H. Park, S.Y.K., H.K.H.), Department of Gastroenterology (K.J.K., S.K.Y., B.D.Y., Sang H. Park), and Department of Clinical Epidemiology and Biostatistics (S.B.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea; Department of Radiology, Hanyang University Medical Center, Seoul, South Korea (B.K.K.); Department of Radiology, Inje University College of Medicine, Busan, South Korea (Y.L.); and Biostatistics Collaboration Unit, Gangnam Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea (K.H.)
| | - Suk-Kyun Yang
- From the Department of Radiology and Research Institute of Radiology (N.S., Seong H. Park, S.Y.K., H.K.H.), Department of Gastroenterology (K.J.K., S.K.Y., B.D.Y., Sang H. Park), and Department of Clinical Epidemiology and Biostatistics (S.B.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea; Department of Radiology, Hanyang University Medical Center, Seoul, South Korea (B.K.K.); Department of Radiology, Inje University College of Medicine, Busan, South Korea (Y.L.); and Biostatistics Collaboration Unit, Gangnam Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea (K.H.)
| | - Byong Duk Ye
- From the Department of Radiology and Research Institute of Radiology (N.S., Seong H. Park, S.Y.K., H.K.H.), Department of Gastroenterology (K.J.K., S.K.Y., B.D.Y., Sang H. Park), and Department of Clinical Epidemiology and Biostatistics (S.B.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea; Department of Radiology, Hanyang University Medical Center, Seoul, South Korea (B.K.K.); Department of Radiology, Inje University College of Medicine, Busan, South Korea (Y.L.); and Biostatistics Collaboration Unit, Gangnam Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea (K.H.)
| | - Sang Hyoung Park
- From the Department of Radiology and Research Institute of Radiology (N.S., Seong H. Park, S.Y.K., H.K.H.), Department of Gastroenterology (K.J.K., S.K.Y., B.D.Y., Sang H. Park), and Department of Clinical Epidemiology and Biostatistics (S.B.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea; Department of Radiology, Hanyang University Medical Center, Seoul, South Korea (B.K.K.); Department of Radiology, Inje University College of Medicine, Busan, South Korea (Y.L.); and Biostatistics Collaboration Unit, Gangnam Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea (K.H.)
| | - So Yeon Kim
- From the Department of Radiology and Research Institute of Radiology (N.S., Seong H. Park, S.Y.K., H.K.H.), Department of Gastroenterology (K.J.K., S.K.Y., B.D.Y., Sang H. Park), and Department of Clinical Epidemiology and Biostatistics (S.B.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea; Department of Radiology, Hanyang University Medical Center, Seoul, South Korea (B.K.K.); Department of Radiology, Inje University College of Medicine, Busan, South Korea (Y.L.); and Biostatistics Collaboration Unit, Gangnam Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea (K.H.)
| | - Seunghee Baek
- From the Department of Radiology and Research Institute of Radiology (N.S., Seong H. Park, S.Y.K., H.K.H.), Department of Gastroenterology (K.J.K., S.K.Y., B.D.Y., Sang H. Park), and Department of Clinical Epidemiology and Biostatistics (S.B.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea; Department of Radiology, Hanyang University Medical Center, Seoul, South Korea (B.K.K.); Department of Radiology, Inje University College of Medicine, Busan, South Korea (Y.L.); and Biostatistics Collaboration Unit, Gangnam Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea (K.H.)
| | - Kyunghwa Han
- From the Department of Radiology and Research Institute of Radiology (N.S., Seong H. Park, S.Y.K., H.K.H.), Department of Gastroenterology (K.J.K., S.K.Y., B.D.Y., Sang H. Park), and Department of Clinical Epidemiology and Biostatistics (S.B.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea; Department of Radiology, Hanyang University Medical Center, Seoul, South Korea (B.K.K.); Department of Radiology, Inje University College of Medicine, Busan, South Korea (Y.L.); and Biostatistics Collaboration Unit, Gangnam Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea (K.H.)
| | - Hyun Kwon Ha
- From the Department of Radiology and Research Institute of Radiology (N.S., Seong H. Park, S.Y.K., H.K.H.), Department of Gastroenterology (K.J.K., S.K.Y., B.D.Y., Sang H. Park), and Department of Clinical Epidemiology and Biostatistics (S.B.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea; Department of Radiology, Hanyang University Medical Center, Seoul, South Korea (B.K.K.); Department of Radiology, Inje University College of Medicine, Busan, South Korea (Y.L.); and Biostatistics Collaboration Unit, Gangnam Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea (K.H.)
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Qi F, Jun S, Qi QY, Chen PJ, Chuan GX, Jiong Z, Rong XJ. Utility of the diffusion-weighted imaging for activity evaluation in Crohn's disease patients underwent magnetic resonance enterography. BMC Gastroenterol 2015; 15:12. [PMID: 25653007 PMCID: PMC4323053 DOI: 10.1186/s12876-015-0235-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 01/19/2015] [Indexed: 02/07/2023] Open
Abstract
Background Cross-sectional imaging techniques as magnetic resonance enterography (MRE) may offer additional information on transmural inflammation, stricturing and fistulising complications in Crohn’s disease (CD). The purpose of our study was to evaluate the diagnostic accuracy of Magnetic Resonance Imaging (MRI) combined with Diffusion-weighted Imaging (DWI) and MRE for determination of inflammation in small bowel CD. Methods MR imaging examination was performed with a GE Signa EXCITE 3.0 T MRI scanner. The optimal b value in DWI with a learning cohort of patients was determined. The diagnostic accuracy for active lesions and disease activity were accessed by MRE combined with DWI. Results The b value 800 s/mm2 group showed the highest diagnostic sensitivity (74.19%) for diagnostic assessment of active Crohn’s lesions on DWI. MRE combined with DWI showed the highest sensitivity (93.55%), specificity (89.47%) and diagnostic accuracy (92%) compared with MRE or DWI alone. The segmental MR score (MR-score-S) showed a significantly positive correlation with the Capsule Endoscopy Crohn’s Disease Activity Index Score (CECDAI-S) (r = 0.717, p < 0.01). The total MR score (MR-score-T) showed significant association with C-reactive protein (CRP) (r = 0.445, p = 0.019) and erythrocyte sedimentation rate (ESR) (r = 0.688, p < 0.01). Conclusions MRE combined with DWI improves the diagnostic accuracy for active lesions and correlates the endoscopic disease activity. MRE with DWI could represent a non-invasive tool in assessing active inflammation in CD.
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Affiliation(s)
- Feng Qi
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Shen Jun
- Shanghai Institute of Digestive Disease, Shanghai Inflammatory Bowel Disease Research Center, Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Qiao Yu Qi
- Shanghai Institute of Digestive Disease, Shanghai Inflammatory Bowel Disease Research Center, Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Peng Jiang Chen
- Shanghai Institute of Digestive Disease, Shanghai Inflammatory Bowel Disease Research Center, Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Geng Xiao Chuan
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Zhu Jiong
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Xu Jian Rong
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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