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Capozzi N, Ordás I, Fernandez-Clotet A, Castro-Poceiro J, Rodríguez S, Alfaro I, Sapena V, Masamunt MC, Ricart E, Panés J, Rimola J. Validation of the Simplified Magnetic Resonance Index of Activity [sMARIA] Without Gadolinium-enhanced Sequences for Crohn's Disease. J Crohns Colitis 2020; 14:1074-1081. [PMID: 32080712 DOI: 10.1093/ecco-jcc/jjaa030] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Gadolinium-enhanced sequences are not included in the simplified Magnetic Resonance Index of Activity [sMARIA], but in the derivation of this index readers had access to these sequences. The current study aimed to validate the sMARIA without gadolinium-enhanced sequences for assessing disease activity, severity, and response to treatment in patients with Crohn's disease. METHODS We prospectively included patients with active Crohn's disease and at least one segment with severe inflammation [ulcers] at ileocolonoscopy, who required treatment with biologic drugs. Patients were evaluated by both magnetic resonance enterography [MRE] and ileocolonoscopy at baseline and 46 weeks after initiation of medical treatment. We compared the quantification of disease activity and response to treatment with sMARIA versus with ileocolonoscopy Crohn's Disease Index of Severity [CDEIS], considered the gold standard. RESULTS Data from both MRE and ileocolonoscopy 46 weeks after treatment initiation were available for 39 of the 50 patients. As in the derivation study, the optimal cutoffs were sMARIA ≥1 for predicting active disease (area under the curve [AUC] 0.92) and sMARIA ≥2 for predicting the presence of ulcers at ileocolonoscopy [AUC 0.93]. In evaluating the response to treatment, the sMARIA detected endoscopic ulcer healing at the segment level [sMARIA <2] with 89.5% sensitivity and 87.5% specificity. The sMARIA decreased significantly [p <0.001] in segments achieving endoscopic ulcer healing, but did not change [p = 0.222] in segments with persistent ulceration. CONCLUSIONS The sMARIA is accurate and reliable in quantifying disease activity and response to treatment in luminal Crohn's disease, without the need for gadolinium-enhanced sequences.
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Affiliation(s)
- Nunzia Capozzi
- Radiology Department IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Radiology Department, Policlinico Universitario Sant'Orsola-Malpighi, Bologna, Italy
| | - Ingrid Ordás
- Gastroenterology Department. IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Hepaticas y Digestivas [CIBERehd], Spain.,University of Barcelona, Barcelona, Spain
| | | | - Jesús Castro-Poceiro
- Gastroenterology Department. IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Sonia Rodríguez
- Radiology Department IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ignacio Alfaro
- Gastroenterology Department. IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Gastroenterology Department, Hospital Regional de Concepción, Concepción, Chile
| | - Víctor Sapena
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria Carme Masamunt
- Gastroenterology Department. IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Elena Ricart
- Gastroenterology Department. IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Hepaticas y Digestivas [CIBERehd], Spain.,University of Barcelona, Barcelona, Spain
| | - Julian Panés
- Gastroenterology Department. IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Hepaticas y Digestivas [CIBERehd], Spain.,University of Barcelona, Barcelona, Spain
| | - Jordi Rimola
- Radiology Department IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Hepaticas y Digestivas [CIBERehd], Spain
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Lee DH, Kim B, Lee ES, Kim HJ, Min JH, Lee JM, Choi MH, Seo N, Choi SH, Kim SH, Lee SS, Park YS, Chung YE. Radiologic Evaluation and Structured Reporting Form for Extrahepatic Bile Duct Cancer: 2019 Consensus Recommendations from the Korean Society of Abdominal Radiology. Korean J Radiol 2020; 22:41-62. [PMID: 32901457 PMCID: PMC7772383 DOI: 10.3348/kjr.2019.0803] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 12/15/2022] Open
Abstract
Radiologic imaging is important for evaluating extrahepatic bile duct (EHD) cancers; it is used for staging tumors and evaluating the suitability of surgical resection, as surgery may be contraindicated in some cases regardless of tumor stage. However, the published general recommendations for EHD cancer and recommendations guided by the perspectives of radiologists are limited. The Korean Society of Abdominal Radiology (KSAR) study group for EHD cancer developed key questions and corresponding recommendations for the radiologic evaluation of EHD cancer and organized them into 4 sections: nomenclature and definition, imaging technique, cancer evaluation, and tumor response. A structured reporting form was also developed to allow the progressive accumulation of standardized data, which will facilitate multicenter studies and contribute more evidence for the development of recommendations.
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Affiliation(s)
- Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Bohyun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyoung Jung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Nieun Seo
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hyun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seong Hyun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yang Shin Park
- Department of Radiology, Korea University Guro Hospital, Seoul, Korea
| | - Yong Eun Chung
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.
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Yu H, Wang Y, Wang Z, Li J, Lu J, Hu D. Prospective comparison of diffusion-weighted magnetic resonance enterography and contrast enhanced computed tomography enterography for the detection of ileocolonic Crohn's disease. J Gastroenterol Hepatol 2020; 35:1136-1142. [PMID: 31785602 DOI: 10.1111/jgh.14945] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 11/20/2019] [Accepted: 11/26/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Crohn's disease (CD) is a chronic and relapsing course with various status of different segments, and there were no investigations comparing the lesion detection between magnetic resonance (MR) and computed tomography (CT) in term of the severity of CD. We aim to assess the performances of diffusion-weighted MR enterography (DW-MRE) and contrast enhanced CT enterography (CTE) for detecting different grade lesions in ileocolonic CD. METHODS Forty-one consecutive patients finally diagnosed with ileocolonic CD were included. All the patients prospectively underwent DW-MRE, contrast enhanced CTE, and ileocolonoscopy within 2 weeks. DW-MRE and CTE images were interpreted for the presence or absence of active CD segments by two experienced radiologists independently. Ileocolonic segments (terminal ileum, right colon, transverse colon, left colon, and rectum) were graded as inactive (0-2), mild (3-6), or moderate-severe (≥ 7) by the simplified endoscopic score for CD (SES-CD). Diagnostic efficiencies of DW-MRE and CTE for mild and/or moderate-severe CD segments were calculated and compared, using ileocolonoscopy as reference standard. RESULTS According to SES-CD, 190 ileocolonic segments from 41 CD patients were scored as 91 inactive, 68 mild, and 31 moderate-severe CD lesions. The sensitivity of DW-MRE for detecting active from inactive segments was higher than that of CTE, and the specificities of them had no significant differences. As for the subgroup analysis, DW-MRE was more sensitive for mild CD lesions than CTE (76.5% vs 60.3%; P = 0.019), while the sensitivities for moderate-severe CD were similar between these two modalities (96.8% for DW-MRE and 93.5% for CTE; P = 1.00). CONCLUSIONS Both DW-MRE and CTE had comparably excellent performances for moderate-severe CD detection; DW-MRE demonstrated better sensitivity in mild lesions compared with CTE and could be more suitable for the diagnosis of mild CD.
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Affiliation(s)
- Hao Yu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yanchun Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zi Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianjun Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingyu Lu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Luo Y, Yu H, Hu D, Li J, Hu X, Li Z, Shen Y. Manganese threonine chelate-a new enteric contrast agent for MRI: a pilot study on rats. NMR IN BIOMEDICINE 2020; 33:e4293. [PMID: 32175654 DOI: 10.1002/nbm.4293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 02/24/2020] [Accepted: 02/27/2020] [Indexed: 06/10/2023]
Abstract
Enteric contrast agents are important in gastrointestinal MRI. However, no currently available agent is well established as the standard of care. In this study, in vitro relaxivities of manganese threonine chelate (Mn-Thr), a common nutritional food supplement, were measured at 1.5 T and 3 T with further investigation of its efficacy and safety in vivo as an enteric contrast agent. According to the calculated relaxivities, T1 W and T2 W TSE sequences of Mn-Thr solutions at different concentrations were acquired, and the optimal concentration for dark lumen imaging on both T1 W and T2 W images was determined in vitro. To validate the optimal concentration in vivo, eight Sprague-Dawley rats were randomly divided into two groups. Each group received rectal injection of either 2.00 g/L (about 3.80 mM) Mn-Thr or saline as an enteric contrast agent and underwent MRI. After a time interval of one week, the same procedures were repeated with the alternative contrast agent. Animals were sacrificed after the second MRI. Tissue manganese quantification and histopathological examination were obtained. Qualitative MR image quality assessments were performed and compared between Mn-Thr and saline. Measured T1 and T2 relaxivities of Mn-Thr were significantly higher than those of MnCl2 in vitro (p < 0.05). At the concentration of 2.00 g/L (about 3.80 mM), Mn-Thr produced a dark lumen on T1 W and T2 W images both in vitro and in vivo. Compared with saline, Mn-Thr showed significantly more homogenous luminal signal and increased bowel wall conspicuity in image quality assessments. Tissue manganese concentrations were not significantly different between two groups. Histopathological examinations were normal in both groups. Our data suggest that Mn-Thr possesses favorable paramagnetic properties and can create a homogenous dark lumen on T1 W and T2 W images without obvious side effects in healthy rats. As a commercially available nutritional food supplement, Mn-Thr appears to be a promising enteric contrast agent for MRI.
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Affiliation(s)
- Yan Luo
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hao Yu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiali Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuemei Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yaqi Shen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Scharitzer M, Koizar B, Vogelsang H, Bergmann M, Primas C, Weber M, Schima W, Mang T. Crohn's disease: prevalence, MR features, and clinical significance of enteric and colonic sinus tracts. Eur Radiol 2020; 30:5358-5366. [PMID: 32458171 PMCID: PMC7476978 DOI: 10.1007/s00330-020-06935-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/15/2020] [Accepted: 05/04/2020] [Indexed: 12/11/2022]
Abstract
Objectives Enteric and colonic sinus tracts are inflammatory complications that precede intestinal fistulas in patients with Crohn’s disease (CD). The aim of this study was to retrospectively determine the prevalence, morphologic features, and outcome of sinus tracts using MR imaging. Methods A consecutive cohort of 642 patients with known CD, referred for MR enterography or MR enteroclysis (study period 01/2014–09/2019), was evaluated retrospectively for the presence of sinus tracts, their locations, presence and length of coexisting strictures, bowel wall thickness, CDMI score, upstream dilation, and bowel distension. Clinical outcome was assessed using medical records. For metric data, means and standard deviation, as well as one-way ANOVA and Pearson’s correlation coefficient, were calculated. Results In 36/642 patients with CD undergoing MRE, 49 sinus tracts (forty in small intestine, nine in left-sided colon) were detected with a prevalence of 6.9% in patients with MR-visible signs of CD (n = 519, overall prevalence of 5.6%). Mean segmental bowel wall thickness was 8.9 mm, and mean CDMI score was 9.3. All sinus tracts were located within a stenotic segment, showing mesenteric orientation within the small bowel and upstream dilation in 13 patients. Of 36 patients, 19 underwent immediate surgery and seven developed clinical progression within the segment containing the sinus tract. Conclusions Sinus tracts occur in 6.9% of patients with visible signs of CD. They are located within stenotic, severely thickened bowel segments with high MR inflammation scores. Their detection is clinically important, because they indicate a more aggressive phenotype and, if left untreated, may show severe progression. Key Points • Sinus tracts occur in 6.9% of patients with MR-visible signs of Crohn’s disease. • Sinus tracts are a radiological indicator of early penetrating Crohn’s disease, with a high risk of progression, and require dedicated treatment. • Sinus tracts can be recognized by characteristic findings and typically occur in stenotic, severely thickened bowel segments with high MR inflammation scores.
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Affiliation(s)
- Martina Scharitzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Bernd Koizar
- Department of Internal Medicine I, Klinikum Wels-Grieskirchen, Grieskirchner Straße 42, 4600, Wels, Austria
| | - Harald Vogelsang
- Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Michael Bergmann
- Department of Surgery, Division of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christian Primas
- Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Wolfgang Schima
- Department of Diagnostic and Interventional Radiology, KH Goettlicher Heiland, KH der Barmherzigen Schwestern, St. Josef-KH, Dornbacher Straße 20-30, 1170, Vienna, Austria
| | - Thomas Mang
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Cicero G, Mondello S, Wichmann JL, Albrecht MH, Vogl TJ, Cavallaro M, Frosina L, D'Angelo T, Mazziotti S. Fast Magnetic Resonance Enterography Protocol for the Evaluation of Patients with Crohn's Disease: A Pilot Study. J Clin Imaging Sci 2020; 10:25. [PMID: 32363087 PMCID: PMC7193210 DOI: 10.25259/jcis_18_2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/16/2020] [Indexed: 12/26/2022] Open
Abstract
Objective Magnetic resonance enterography has achieved an increasingly importance in the evaluation of patients with Crohn's disease, although it is limited by high costs and prolonged scanning times. The aim of our work was to design a "fast" abbreviated MRE protocol and to compare it with the standard one. Materials and Methods A single-center retrospective study was performed on 73 patients with Crohn's disease who underwent MRE with standard protocol over a 7-month period. The images of the standard protocol were separated from those included in the proposed abbreviated one and independently evaluated by two radiologists with different years of experience in MRE imaging. Statistical analysis was performed with the Cohen kappa (κ) value, used to assess the agreement in case of categorical variables, the Lin's concordance correlation coefficient and Bland-Altman plot, in assessing the degree of agreement between numerical measurements, while the non- parametric Mann-Whitney U-test was used in comparing the evaluation times of the two protocols. Results The intraobserver evaluation showed a perfect agreement between the two protocols for presence, number and extension of lesions, abdominal complications, and excellent/perfect in identification of active inflammation.The interobserver reproducibility was excellent for overall presence and number of lesions, for the presence and number of lesions in any abdominal quadrant, inflammation, intestinal and extraintestinal complications, and lesions extension. Conclusion The proposed protocol achieves comparable performance with standard MRE. Furthermore, it would carry potential benefits in terms of patient's comfort, time, and health-care costs savings.
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Affiliation(s)
- Giuseppe Cicero
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria, Messina, Italy
| | - Stefania Mondello
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria, Messina, Italy
| | - Julian L Wichmann
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, Frankfurt am Main, Germany
| | - Moritz H Albrecht
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, Frankfurt am Main, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, Frankfurt am Main, Germany
| | - Marco Cavallaro
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria, Messina, Italy
| | - Luciano Frosina
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria, Messina, Italy
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria, Messina, Italy
| | - Silvio Mazziotti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria, Messina, Italy
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Cucchiara S, D'Arcangelo G, Isoldi S, Aloi M, Stronati L. Mucosal healing in Crohn's disease: new insights. Expert Rev Gastroenterol Hepatol 2020; 14:335-345. [PMID: 32315209 DOI: 10.1080/17474124.2020.1759416] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Traditional management of patients with Crohn's disease includes symptoms and quality of life improvement. With the advent of biological agents, mucosal healing has become an achievable goal, documented through endoscopy. However, due to the transmural nature of inflammation, the prevention of bowel damage should be included in the aims of a targeted therapeutic strategy. AREAS COVERED Updated literature has been searched in PubMed from 2008 to 2020. This review focuses on the state of the art in the innovative therapeutic goals in Crohn's disease, also considering still controversial aspects and future research topics in the management of Crohn's disease. EXPERT OPINION Although a widely agreed view supports the notion that mucosal healing and bowel damage control may promote beneficial outcomes (i.e. reduction in hospitalization and surgical rates, avoidance of steroids), long-term robust data are still missing. On the other hand, the development of -omics techniques has expanded our knowledge of the pathogenetic mechanism underlying inflammatory bowel disease and opened up new horizons in precision or personalized medicine.
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Affiliation(s)
- Salvatore Cucchiara
- Women's and Children's Health Department, Pediatric Gastroenterology and Hepatology Unit, Sapienza University of Rome , Rome, Italy
| | - Giulia D'Arcangelo
- Women's and Children's Health Department, Pediatric Gastroenterology and Hepatology Unit, Sapienza University of Rome , Rome, Italy
| | - Sara Isoldi
- Women's and Children's Health Department, Pediatric Gastroenterology and Hepatology Unit, Sapienza University of Rome , Rome, Italy
| | - Marina Aloi
- Women's and Children's Health Department, Pediatric Gastroenterology and Hepatology Unit, Sapienza University of Rome , Rome, Italy
| | - Laura Stronati
- Department of Molecular Medicine, Sapienza University of Rome , Rome, Italy
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Rao A, Sitheeque F, Gustafson S, Lu M, Prior M. MR enterography - Impact on image quality between single- versus split-dose Buscopan. J Med Imaging Radiat Oncol 2020; 64:331-337. [PMID: 32346993 DOI: 10.1111/1754-9485.13033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/04/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION MR enterography (MRE) is the most common imaging modality used to assess small bowel pathology, particularly patients with suspected Crohn's disease. Spasmolytic agents, most commonly Buscopan, are routinely used to reduce or cease movement/bowel activity in order to reduce blurring of the images which would otherwise reduce its diagnostic quality. The purpose of this study was to determine if administering an evenly split dose of Buscopan would improve the quality of images obtained relative to the standard single dose performed at our institution. METHODS Cine sequences through the anterior and mid-abdomen were performed to assess and document small bowel peristalsis. Additional analysis was performed by the use of digital subtraction and measuring the signal-to-noise ratio value on the subtracted image, which was used to compare the amount of small bowel movement. RESULTS A total of 34 patients who presented to the Department of Medical Imaging between October 2018 and April 2019 were included. In the anterior section, those in the split-dose group had a mean difference of 2.4 lower number of peristalsing bowel loops compared to the single-dose group (P = 0.001), while in the mid-section, those in the split-dose group had a mean difference of 2.5 lower number of peristalsing bowel loops compared to the single-dose group (P-value = 0.001). CONCLUSION Our findings indicate that split-dose Buscopan significantly reduced peristalsis compared to single-dose Buscopan, and a reduction in peristalsis reduces one aspect of motion artefact, which translates to better images.
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Affiliation(s)
- Akshay Rao
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Fariha Sitheeque
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Sonja Gustafson
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Macy Lu
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Marita Prior
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Ramos López L, Hernández Camba A, Rodríguez-Lago I, Carrillo Palau M, Cejas Dorta L, Elorza A, Alonso Abreu I, Vela M, Hidalgo A, Hernández Álvarez-Builla N, Rodríguez GE, Rodríguez Y, Tardillo C, Díaz-Flórez L, Eiroa D, Aduna M, Garrido MS, Larena JA, Cabriada JL, Quintero Carrion E. Usefulness of magnetic resonance enterography in the clinical decision-making process for patients with inflammatory bowel disease. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 43:439-445. [PMID: 32349904 DOI: 10.1016/j.gastrohep.2020.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/04/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the impact of magnetic resonance enterography (MRE) diagnosis on clinical decision-making regarding treatment choice and maintenance of treatment over time in patients with inflammatory bowel disease (IBD). METHODS A cohort of patients who underwent MRE for IBD assessment between 2011 and 2014 was analyzed. From clinical records, we retrospectively retrieved their demographic data and clinical data on their IBD at the time of MRE, the results of MRE and the patient's clinical course. Medical management decisions made during the three months following MRE and at the 15-month follow-up were assessed. RESULTS In total, 474 MREs were reviewed. In the first three-month period, MRE results led to changes in the medical management of 266 patients (56.1%). Of those, maintenance therapy was altered in 140 patients (68.3%) (90.7% step-up and 9.3% top-down strategy), 65 (24.4%) were prescribed a course of steroids and 61 (22.9%) underwent surgery. MRE confirmed a CD diagnosis in 14/41 patients (34.1%) previously diagnosed with indeterminate colitis or ulcerative colitis and in 4/18 patients (22.2%) with suspected IBD. At the 15-month follow-up, treatment remained unchanged in 289 patients (65.8%). CONCLUSIONS These results suggest that MRE is a diagnostic tool that provides valid information for the clinical-decision making process for patients with CD.
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Affiliation(s)
- Laura Ramos López
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Tenerife, Spain
| | - Alejandro Hernández Camba
- Servicio de Aparato Digestivo, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz De Tenerife, Spain.
| | | | - Marta Carrillo Palau
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Tenerife, Spain
| | - Luis Cejas Dorta
- Servicio de Aparato Digestivo, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz De Tenerife, Spain
| | - Ainara Elorza
- Servicio de Aparato Digestivo, Hospital de Galdakao, Galdakao, Spain
| | | | - Milagros Vela
- Servicio de Aparato Digestivo, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz De Tenerife, Spain
| | - Alba Hidalgo
- Servicio de Aparato Digestivo, Hospital de Galdakao, Galdakao, Spain
| | | | - G Esther Rodríguez
- Servicio de Aparato Digestivo, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz De Tenerife, Spain
| | - Yolanda Rodríguez
- Servicio de Aparato Digestivo, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz De Tenerife, Spain
| | - Carlos Tardillo
- Servicio de Aparato Digestivo, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz De Tenerife, Spain
| | - Lucio Díaz-Flórez
- Servicio de Radiología, Hospital Universitario de Canarias, Tenerife, Spain
| | - Daniel Eiroa
- Servicio de Radiología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz De Tenerife, Spain
| | - Marta Aduna
- Osatek, Hospital de Galdakao, Galdakao, Spain
| | - María S Garrido
- Servicio de Radiología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz De Tenerife, Spain
| | | | - José L Cabriada
- Servicio de Aparato Digestivo, Hospital de Galdakao, Galdakao, Spain
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Radiologische Diagnostik chronisch-entzündlicher Darmerkrankungen bei Kindern und Jugendlichen. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-00854-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ZusammenfassungDank der technischen Fortschritte nehmen bildgebende Methoden eine immer wichtigere Rolle sowohl in der Diagnostik als auch im klinischen Management chronisch-entzündlicher Darmerkrankungen (CED), insbesondere in der Pädiatrie, ein. Dieser Beitrag fokussiert charakteristische Erscheinungsformen der CED und jeweils relevante bildgebende Verfahren (Ultraschall und MRT). Außerdem werden Forschungstrends und aktueller Wissensstand zu verschiedenen bildgebenden Modalitäten dargestellt.
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Li Y, Langhorst J, Koch AK, Demircioglu A, Schaarschmidt B, Theysohn JM, Martin O, Herrmann K, Catalano O, Umutlu L. Comparison of acceptance of PET/MR enterography and ileocolonoscopy in patients with inflammatory bowel diseases. Clin Imaging 2020; 64:11-17. [PMID: 32200275 DOI: 10.1016/j.clinimag.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/21/2020] [Accepted: 03/11/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aim of this study was to compare PET/MR enterography with ileocolonoscopy regarding patients' acceptance and their future preference. METHODS Between October 2014 and February 2018 one-hundred-eleven patients underwent PET/MR enterography and ileocolonoscopy within 2 weeks. Overall acceptance of each modality was rated using a 10-point Likert scale with higher score indicating worse experience. Wilcoxon test was used to assess difference. Patients' acceptance of bowel cleansing and oral intake of contrast agent was analyzed in the same way. Furthermore, to find out if diagnosis, gender and age might influence patients' acceptance and future preference, Mann-Whitney U test for ordinal and Chi-squared test for categorical parameters were applied. RESULTS 77 patients (47 females) with a mean age of 44.5 years and diagnosed ulcerative colitis (UC; n = 46) and Crohn's disease (CD; n = 31), were included in the analysis. Overall, ileocolonoscopy was significantly better rated than PET/MR enterography (p < 0.001). Bowel cleansing was worse tolerated than oral intake of liquid (p < 0.001). Patients with CD preferred PET/MR enterography as future screening method, while UC patients favored ileocolonoscopy (p = 0.012). PET/MR enterography tended to be better accepted by CD patients (p = 0.08). Females tolerated both bowel cleansing and oral contrast agent worse than males (p = 0.05 and 0.047). No significant difference between different age groups was found. CONCLUSIONS Ileocolonoscopy was rated as better tolerable than PET/MR and the overall rate for future preference was very similar. Optimization of both modalities might enhance patients' acceptance.
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Affiliation(s)
- Yan Li
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany.
| | - Jost Langhorst
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, University of Duisburg-Essen, Am Deimelsberg 34a, 45276 Essen, Germany
| | - Anna K Koch
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, University of Duisburg-Essen, Am Deimelsberg 34a, 45276 Essen, Germany
| | - Aydin Demircioglu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Benedikt Schaarschmidt
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Jens M Theysohn
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Ole Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Onofrio Catalano
- Abdominal Imaging and Martinos Center for Biomedical Imaging Research, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
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Guglielmo FF, Anupindi SA, Fletcher JG, Al-Hawary MM, Dillman JR, Grand DJ, Bruining DH, Chatterji M, Darge K, Fidler JL, Gandhi NS, Gee MS, Grajo JR, Huang C, Jaffe TA, Park SH, Rimola J, Soto JA, Taouli B, Taylor SA, Baker ME. Small Bowel Crohn Disease at CT and MR Enterography: Imaging Atlas and Glossary of Terms. Radiographics 2020; 40:354-375. [DOI: 10.1148/rg.2020190091] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Heverhagen JT. Invited Commentary on “Small Bowel Crohn Disease at CT and MR Enterography,” with Response from Dr Guglielmo et al. Radiographics 2020; 40:375-377. [DOI: 10.1148/rg.2020190213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Johannes T. Heverhagen
- University Institute for Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital, Bern Bern, Switzerland
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64
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Bane O, Mendichovszky IA, Milani B, Dekkers IA, Deux JF, Eckerbom P, Grenier N, Hall ME, Inoue T, Laustsen C, Lerman LO, Liu C, Morrell G, Pedersen M, Pruijm M, Sadowski EA, Seeliger E, Sharma K, Thoeny H, Vermathen P, Wang ZJ, Serafin Z, Zhang JL, Francis ST, Sourbron S, Pohlmann A, Fain SB, Prasad PV. Consensus-based technical recommendations for clinical translation of renal BOLD MRI. MAGMA (NEW YORK, N.Y.) 2020; 33:199-215. [PMID: 31768797 PMCID: PMC7021747 DOI: 10.1007/s10334-019-00802-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/18/2019] [Accepted: 10/22/2019] [Indexed: 01/08/2023]
Abstract
Harmonization of acquisition and analysis protocols is an important step in the validation of BOLD MRI as a renal biomarker. This harmonization initiative provides technical recommendations based on a consensus report with the aim to move towards standardized protocols that facilitate clinical translation and comparison of data across sites. We used a recently published systematic review paper, which included a detailed summary of renal BOLD MRI technical parameters and areas of investigation in its supplementary material, as the starting point in developing the survey questionnaires for seeking consensus. Survey data were collected via the Delphi consensus process from 24 researchers on renal BOLD MRI exam preparation, data acquisition, data analysis, and interpretation. Consensus was defined as ≥ 75% unanimity in response. Among 31 survey questions, 14 achieved consensus resolution, 12 showed clear respondent preference (65-74% agreement), and 5 showed equal (50/50%) split in opinion among respondents. Recommendations for subject preparation, data acquisition, processing and reporting are given based on the survey results and review of the literature. These technical recommendations are aimed towards increased inter-site harmonization, a first step towards standardization of renal BOLD MRI protocols across sites. We expect this to be an iterative process updated dynamically based on progress in the field.
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Affiliation(s)
- Octavia Bane
- BioMedical Engineering and Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Iosif A Mendichovszky
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Bastien Milani
- Center for BioMedical Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean-Francois Deux
- Department of Radiology, Groupe Hospitalier Henri Mondor, Créteil, France
| | - Per Eckerbom
- Department of Radiology, Institution for Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Nicolas Grenier
- Department of Radiology, Université de Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - Michael E Hall
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Tsutomu Inoue
- Department of Nephrology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Christoffer Laustsen
- The MR Research Center Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Chunlei Liu
- Electrical Engineering and Computer Science, and Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA, USA
| | - Glen Morrell
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Michael Pedersen
- Department of Clinical Medicine-Comparative Medicine Lab, Aarhus University Hospital, Aarhus, Denmark
| | - Menno Pruijm
- Nephrology and Hypertension Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Elizabeth A Sadowski
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Erdmann Seeliger
- Institute of Physiology, Charité-University Medicine Berlin, Berlin, Germany
| | - Kanishka Sharma
- Imaging Biomarkers Group, Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Harriet Thoeny
- Department of Radiology, Hôpital Cantonal Fribourgois, University of Fribourg, Fribourg, Switzerland
| | - Peter Vermathen
- Departments for BioMedical Research and Radiology, Inselspital, Universitaetspital Bern, Bern, Switzerland
| | - Zhen J Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Zbigniew Serafin
- Department of Radiology, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Jeff L Zhang
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Susan T Francis
- Sir Peter Mansfield Centre, University of Notthingham, Notthingham, UK
| | - Steven Sourbron
- Imaging Biomarkers Group, Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Andreas Pohlmann
- Berlin Ultrahigh Field Facility, Max Delbrueck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Sean B Fain
- Departments of Biomedical Engineering, Radiology, and Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Pottumarthi V Prasad
- Department of Radiology, Center for Advanced Imaging, NorthShore University Health System, Evanston, IL, USA.
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Abstract
BACKGROUND Crohn's disease (CD) is a chronic and destructive bowel disease; continued disease activity can lead to penetrating complications. With the recent advent of effective medications, the importance of using a treat-to-target approach to guide therapy is becoming important. METHODS In this review, we reviewed the previous evidence for evaluating CD lesions. RESULTS We describe ileocolonoscopy's role in assessing disease activity, as well as recent progress in modalities, such as balloon-assisted endoscopy, capsule endoscopy, magnetic resonance enterography, computed tomography enterography, and ultrasonography. Advances in modalities have changed CD assessment, with small-bowel involvement becoming more important. CONCLUSIONS Proper optimization is necessary in clinical practice.
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van Wassenaer EA, de Voogd FAE, van Rijn RR, van der Lee JH, Tabbers MM, van Etten-Jamaludin FS, Kindermann A, de Meij TGJ, Gecse KB, D’Haens GR, Benninga MA, Koot BGP. Bowel ultrasound measurements in healthy children - systematic review and meta-analysis. Pediatr Radiol 2020; 50:501-508. [PMID: 31838567 PMCID: PMC7067709 DOI: 10.1007/s00247-019-04567-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/13/2019] [Accepted: 10/30/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Ultrasound (US) is a noninvasive method of assessing the bowel that can be used to screen for bowel pathology, such as Inflammatory Bowel Disease, in children. Knowledge about US findings of the bowel in healthy children is important for interpreting US results in cases where disease is suspected. OBJECTIVE To assess the bowel wall thickness in different bowel segments in healthy children and to assess differences in bowel wall thickness among pediatric age categories. MATERIALS AND METHODS We conducted a systematic search in the PubMed, Embase, Cochrane, and CINAHL databases for studies describing bowel wall thickness measured by transabdominal US in healthy children. We excluded studies using contrast agent. We calculated the pooled mean and standard deviation scores and assessed differences among age categories (0-4 years, 5-9 years, 10-14 years, 15-18 years), first with analysis of variance (ANOVA) and further with subsequent Student's t-tests for independent samples, corrected for multiple testing. RESULTS We identified 191 studies and included 7 of these studies in the systematic review. Reported bowel wall thickness values ranged from 0.8 mm to 1.9 mm in the small bowel and from 1.0 mm to 1.9 mm in the colon. The mean colonic bowel wall thickness is larger in children ages 15-19 years compared to 0-4 years (range in difference: 0.3-0.5 mm [corrected P<0.02]). CONCLUSION The reported upper limit of bowel wall thickness in healthy children is 1.9 mm in the small bowel and the colon, and mean thickness increases slightly with age in jejunum and colon. These values can be used as guidance when screening for bowel-related pathology in children.
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Affiliation(s)
- Elsa A. van Wassenaer
- grid.7177.60000000084992262Pediatric Gastroenterology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Floris A. E. de Voogd
- grid.7177.60000000084992262Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rick R. van Rijn
- grid.7177.60000000084992262Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Johanna H. van der Lee
- grid.7177.60000000084992262Pediatric Clinical Research Office, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands ,Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, the Netherlands
| | - Merit M. Tabbers
- grid.7177.60000000084992262Pediatric Gastroenterology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | | | - Angelika Kindermann
- grid.7177.60000000084992262Pediatric Gastroenterology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Tim G. J. de Meij
- grid.12380.380000 0004 1754 9227Pediatric Gastroenterology Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - K. B. Gecse
- grid.7177.60000000084992262Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Geert R. D’Haens
- grid.7177.60000000084992262Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc A. Benninga
- grid.7177.60000000084992262Pediatric Gastroenterology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Bart G. P. Koot
- grid.7177.60000000084992262Pediatric Gastroenterology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Nery F, Buchanan CE, Harteveld AA, Odudu A, Bane O, Cox EF, Derlin K, Gach HM, Golay X, Gutberlet M, Laustsen C, Ljimani A, Madhuranthakam AJ, Pedrosa I, Prasad PV, Robson PM, Sharma K, Sourbron S, Taso M, Thomas DL, Wang DJJ, Zhang JL, Alsop DC, Fain SB, Francis ST, Fernández-Seara MA. Consensus-based technical recommendations for clinical translation of renal ASL MRI. MAGMA (NEW YORK, N.Y.) 2019. [PMID: 31833014 DOI: 10.1007/s10334‐019‐00800‐z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This study aimed at developing technical recommendations for the acquisition, processing and analysis of renal ASL data in the human kidney at 1.5 T and 3 T field strengths that can promote standardization of renal perfusion measurements and facilitate the comparability of results across scanners and in multi-centre clinical studies. METHODS An international panel of 23 renal ASL experts followed a modified Delphi process, including on-line surveys and two in-person meetings, to formulate a series of consensus statements regarding patient preparation, hardware, acquisition protocol, analysis steps and data reporting. RESULTS Fifty-nine statements achieved consensus, while agreement could not be reached on two statements related to patient preparation. As a default protocol, the panel recommends pseudo-continuous (PCASL) or flow-sensitive alternating inversion recovery (FAIR) labelling with a single-slice spin-echo EPI readout with background suppression and a simple but robust quantification model. DISCUSSION This approach is considered robust and reproducible and can provide renal perfusion images of adequate quality and SNR for most applications. If extended kidney coverage is desirable, a 2D multislice readout is recommended. These recommendations are based on current available evidence and expert opinion. Nonetheless they are expected to be updated as more data become available, since the renal ASL literature is rapidly expanding.
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Affiliation(s)
- Fabio Nery
- Developmental Imaging and Biophysics Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Charlotte E Buchanan
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Anita A Harteveld
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Aghogho Odudu
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Octavia Bane
- Translational and Molecular Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eleanor F Cox
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Katja Derlin
- Department of Radiology, Hannover Medical School, Hannover, Germany
| | - H Michael Gach
- Departments of Radiation Oncology, Radiology, and Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Xavier Golay
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Marcel Gutberlet
- Department of Radiology, Hannover Medical School, Hannover, Germany
| | - Christoffer Laustsen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Alexandra Ljimani
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ananth J Madhuranthakam
- Department of Radiology and Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ivan Pedrosa
- Department of Radiology and Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Pottumarthi V Prasad
- Department of Radiology, Center for Advanced Imaging, NorthShore University Health System, Evanston, IL, USA
| | - Philip M Robson
- Translational and Molecular Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kanishka Sharma
- Imaging Biomarkers Group, Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Steven Sourbron
- Imaging Biomarkers Group, Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Manuel Taso
- Division of MRI Research, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - David L Thomas
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Danny J J Wang
- Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - Jeff L Zhang
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - David C Alsop
- Division of MRI Research, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Sean B Fain
- Departments of Medical Physics, Radiology, and Biomedical Engineering, University of Wisconsin, Madison, Madison, USA
| | - Susan T Francis
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
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Nery F, Buchanan CE, Harteveld AA, Odudu A, Bane O, Cox EF, Derlin K, Gach HM, Golay X, Gutberlet M, Laustsen C, Ljimani A, Madhuranthakam AJ, Pedrosa I, Prasad PV, Robson PM, Sharma K, Sourbron S, Taso M, Thomas DL, Wang DJJ, Zhang JL, Alsop DC, Fain SB, Francis ST, Fernández-Seara MA. Consensus-based technical recommendations for clinical translation of renal ASL MRI. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2019; 33:141-161. [PMID: 31833014 PMCID: PMC7021752 DOI: 10.1007/s10334-019-00800-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 12/14/2022]
Abstract
Objectives This study aimed at developing technical recommendations for the acquisition, processing and analysis of renal ASL data in the human kidney at 1.5 T and 3 T field strengths that can promote standardization of renal perfusion measurements and facilitate the comparability of results across scanners and in multi-centre clinical studies. Methods An international panel of 23 renal ASL experts followed a modified Delphi process, including on-line surveys and two in-person meetings, to formulate a series of consensus statements regarding patient preparation, hardware, acquisition protocol, analysis steps and data reporting. Results Fifty-nine statements achieved consensus, while agreement could not be reached on two statements related to patient preparation. As a default protocol, the panel recommends pseudo-continuous (PCASL) or flow-sensitive alternating inversion recovery (FAIR) labelling with a single-slice spin-echo EPI readout with background suppression and a simple but robust quantification model. Discussion This approach is considered robust and reproducible and can provide renal perfusion images of adequate quality and SNR for most applications. If extended kidney coverage is desirable, a 2D multislice readout is recommended. These recommendations are based on current available evidence and expert opinion. Nonetheless they are expected to be updated as more data become available, since the renal ASL literature is rapidly expanding. Electronic supplementary material The online version of this article (10.1007/s10334-019-00800-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fabio Nery
- Developmental Imaging and Biophysics Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Charlotte E Buchanan
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Anita A Harteveld
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Aghogho Odudu
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Octavia Bane
- Translational and Molecular Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eleanor F Cox
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Katja Derlin
- Department of Radiology, Hannover Medical School, Hannover, Germany
| | - H Michael Gach
- Departments of Radiation Oncology, Radiology, and Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Xavier Golay
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Marcel Gutberlet
- Department of Radiology, Hannover Medical School, Hannover, Germany
| | - Christoffer Laustsen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Alexandra Ljimani
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ananth J Madhuranthakam
- Department of Radiology and Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ivan Pedrosa
- Department of Radiology and Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Pottumarthi V Prasad
- Department of Radiology, Center for Advanced Imaging, NorthShore University Health System, Evanston, IL, USA
| | - Philip M Robson
- Translational and Molecular Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kanishka Sharma
- Imaging Biomarkers Group, Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Steven Sourbron
- Imaging Biomarkers Group, Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Manuel Taso
- Division of MRI Research, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - David L Thomas
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Danny J J Wang
- Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - Jeff L Zhang
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - David C Alsop
- Division of MRI Research, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Sean B Fain
- Departments of Medical Physics, Radiology, and Biomedical Engineering, University of Wisconsin, Madison, Madison, USA
| | - Susan T Francis
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
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Lamb CA, Kennedy NA, Raine T, Hendy PA, Smith PJ, Limdi JK, Hayee B, Lomer MCE, Parkes GC, Selinger C, Barrett KJ, Davies RJ, Bennett C, Gittens S, Dunlop MG, Faiz O, Fraser A, Garrick V, Johnston PD, Parkes M, Sanderson J, Terry H, Gaya DR, Iqbal TH, Taylor SA, Smith M, Brookes M, Hansen R, Hawthorne AB. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut 2019; 68:s1-s106. [PMID: 31562236 PMCID: PMC6872448 DOI: 10.1136/gutjnl-2019-318484] [Citation(s) in RCA: 1251] [Impact Index Per Article: 250.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 06/10/2019] [Accepted: 06/10/2019] [Indexed: 02/06/2023]
Abstract
Ulcerative colitis and Crohn's disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn's and Colitis UK). A systematic review of 88 247 publications and a Delphi consensus process involving 81 multidisciplinary clinicians and patients was undertaken to develop 168 evidence- and expert opinion-based recommendations for pharmacological, non-pharmacological and surgical interventions, as well as optimal service delivery in the management of both ulcerative colitis and Crohn's disease. Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care. Twenty research priorities to inform future clinical management are presented, alongside objective measurement of priority importance, determined by 2379 electronic survey responses from individuals living with ulcerative colitis and Crohn's disease, including patients, their families and friends.
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Affiliation(s)
- Christopher Andrew Lamb
- Newcastle University, Newcastle upon Tyne, UK
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Nicholas A Kennedy
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- University of Exeter, Exeter, UK
| | - Tim Raine
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
| | - Philip Anthony Hendy
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Imperial College London, London, UK
| | - Philip J Smith
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Jimmy K Limdi
- The Pennine Acute Hospitals NHS Trust, Manchester, UK
- University of Manchester, Manchester, UK
| | - Bu'Hussain Hayee
- King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Miranda C E Lomer
- King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gareth C Parkes
- Barts Health NHS Trust, London, UK
- Barts and the London School of Medicine and Dentistry, London, UK
| | - Christian Selinger
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
| | | | - R Justin Davies
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
- University of Cambridge, Cambridge, UK
| | - Cathy Bennett
- Systematic Research Ltd, Quorn, UK
- Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | | | - Malcolm G Dunlop
- University of Edinburgh, Edinburgh, UK
- Western General Hospital, Edinburgh, UK
| | - Omar Faiz
- Imperial College London, London, UK
- St Mark's Hospital, Harrow, UK
| | - Aileen Fraser
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | | | - Miles Parkes
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
| | - Jeremy Sanderson
- King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Daniel R Gaya
- Glasgow Royal Infirmary, Glasgow, UK
- University of Glasgow, Glasgow, UK
| | - Tariq H Iqbal
- Queen Elizabeth Hospital Birmingham NHSFoundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
| | - Stuart A Taylor
- University College London, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Melissa Smith
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - Matthew Brookes
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
- University of Wolverhampton, Wolverhampton, UK
| | - Richard Hansen
- Royal Hospital for Children Glasgow, Glasgow, UK
- University of Glasgow, Glasgow, UK
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Abstract
Ulcerative colitis and Crohn's disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn's and Colitis UK). A systematic review of 88 247 publications and a Delphi consensus process involving 81 multidisciplinary clinicians and patients was undertaken to develop 168 evidence- and expert opinion-based recommendations for pharmacological, non-pharmacological and surgical interventions, as well as optimal service delivery in the management of both ulcerative colitis and Crohn's disease. Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care. Twenty research priorities to inform future clinical management are presented, alongside objective measurement of priority importance, determined by 2379 electronic survey responses from individuals living with ulcerative colitis and Crohn's disease, including patients, their families and friends.
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73
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Bane O, Mendichovszky IA, Milani B, Dekkers IA, Deux JF, Eckerbom P, Grenier N, Hall ME, Inoue T, Laustsen C, Lerman LO, Liu C, Morrell G, Pedersen M, Pruijm M, Sadowski EA, Seeliger E, Sharma K, Thoeny H, Vermathen P, Wang ZJ, Serafin Z, Zhang JL, Francis ST, Sourbron S, Pohlmann A, Fain SB, Prasad PV. Consensus-based technical recommendations for clinical translation of renal BOLD MRI. MAGMA (NEW YORK, N.Y.) 2019. [PMID: 31768797 DOI: 10.1007/s10334‐019‐00802‐x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Harmonization of acquisition and analysis protocols is an important step in the validation of BOLD MRI as a renal biomarker. This harmonization initiative provides technical recommendations based on a consensus report with the aim to move towards standardized protocols that facilitate clinical translation and comparison of data across sites. We used a recently published systematic review paper, which included a detailed summary of renal BOLD MRI technical parameters and areas of investigation in its supplementary material, as the starting point in developing the survey questionnaires for seeking consensus. Survey data were collected via the Delphi consensus process from 24 researchers on renal BOLD MRI exam preparation, data acquisition, data analysis, and interpretation. Consensus was defined as ≥ 75% unanimity in response. Among 31 survey questions, 14 achieved consensus resolution, 12 showed clear respondent preference (65-74% agreement), and 5 showed equal (50/50%) split in opinion among respondents. Recommendations for subject preparation, data acquisition, processing and reporting are given based on the survey results and review of the literature. These technical recommendations are aimed towards increased inter-site harmonization, a first step towards standardization of renal BOLD MRI protocols across sites. We expect this to be an iterative process updated dynamically based on progress in the field.
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Affiliation(s)
- Octavia Bane
- BioMedical Engineering and Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Iosif A Mendichovszky
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Bastien Milani
- Center for BioMedical Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean-Francois Deux
- Department of Radiology, Groupe Hospitalier Henri Mondor, Créteil, France
| | - Per Eckerbom
- Department of Radiology, Institution for Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Nicolas Grenier
- Department of Radiology, Université de Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - Michael E Hall
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Tsutomu Inoue
- Department of Nephrology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Christoffer Laustsen
- The MR Research Center Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Chunlei Liu
- Electrical Engineering and Computer Science, and Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA, USA
| | - Glen Morrell
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Michael Pedersen
- Department of Clinical Medicine-Comparative Medicine Lab, Aarhus University Hospital, Aarhus, Denmark
| | - Menno Pruijm
- Nephrology and Hypertension Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Elizabeth A Sadowski
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Erdmann Seeliger
- Institute of Physiology, Charité-University Medicine Berlin, Berlin, Germany
| | - Kanishka Sharma
- Imaging Biomarkers Group, Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Harriet Thoeny
- Department of Radiology, Hôpital Cantonal Fribourgois, University of Fribourg, Fribourg, Switzerland
| | - Peter Vermathen
- Departments for BioMedical Research and Radiology, Inselspital, Universitaetspital Bern, Bern, Switzerland
| | - Zhen J Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Zbigniew Serafin
- Department of Radiology, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Jeff L Zhang
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Susan T Francis
- Sir Peter Mansfield Centre, University of Notthingham, Notthingham, UK
| | - Steven Sourbron
- Imaging Biomarkers Group, Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Andreas Pohlmann
- Berlin Ultrahigh Field Facility, Max Delbrueck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Sean B Fain
- Departments of Biomedical Engineering, Radiology, and Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Pottumarthi V Prasad
- Department of Radiology, Center for Advanced Imaging, NorthShore University Health System, Evanston, IL, USA.
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74
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Gatti M, Allois L, Carisio A, Dianzani C, Garcia Martinez M, Ruggirello I, Varello S, Darvizeh F, Faletti R. Magnetic resonance enterography. MINERVA GASTROENTERO 2019; 65:319-334. [PMID: 31760740 DOI: 10.23736/s1121-421x.19.02639-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Crohn's disease is a condition of chronic inflammation that may involve any part of the gastrointestinal tract, although it more frequently affects the terminal ileum. Longstanding inflammation may lead to several bowel complications including obstruction, stricture, fistula and abscesses which often necessitate surgery. Cross-sectional imaging methods such as computed tomography and magnetic resonance imaging are being utilized more frequently to assess mural and extramural inflammatory bowel disease manifestations. Magnetic resonance enterography (MRE) for assessment of small bowel is optimal because of absence of ionizing radiation, better soft tissue contrast, development of motion-free sequences and high resolution images. A typical protocol includes pre and postcontrast sequences utilizing an enteric contrast agent for adequate bowel distention and an antiperistaltic agent. Overall, MRE allows the evaluation of disease activity, extraenteric complication and response to therapy with a great impact on patient management. In this review we discuss the features of MRE from patient's preparation and exam protocol to pathological findings.
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Affiliation(s)
- Marco Gatti
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy -
| | - Luca Allois
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Andrea Carisio
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Chiara Dianzani
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Maria Garcia Martinez
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Irene Ruggirello
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Sara Varello
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Fatemeh Darvizeh
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Riccardo Faletti
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
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75
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Ljimani A, Caroli A, Laustsen C, Francis S, Mendichovszky IA, Bane O, Nery F, Sharma K, Pohlmann A, Dekkers IA, Vallee JP, Derlin K, Notohamiprodjo M, Lim RP, Palmucci S, Serai SD, Periquito J, Wang ZJ, Froeling M, Thoeny HC, Prasad P, Schneider M, Niendorf T, Pullens P, Sourbron S, Sigmund EE. Consensus-based technical recommendations for clinical translation of renal diffusion-weighted MRI. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2019; 33:177-195. [PMID: 31676990 PMCID: PMC7021760 DOI: 10.1007/s10334-019-00790-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/17/2019] [Accepted: 10/19/2019] [Indexed: 12/13/2022]
Abstract
Objectives Standardization is an important milestone in the validation of DWI-based parameters as imaging biomarkers for renal disease. Here, we propose technical recommendations on three variants of renal DWI, monoexponential DWI, IVIM and DTI, as well as associated MRI biomarkers (ADC, D, D*, f, FA and MD) to aid ongoing international efforts on methodological harmonization. Materials and methods Reported DWI biomarkers from 194 prior renal DWI studies were extracted and Pearson correlations between diffusion biomarkers and protocol parameters were computed. Based on the literature review, surveys were designed for the consensus building. Survey data were collected via Delphi consensus process on renal DWI preparation, acquisition, analysis, and reporting. Consensus was defined as ≥ 75% agreement. Results Correlations were observed between reported diffusion biomarkers and protocol parameters. Out of 87 survey questions, 57 achieved consensus resolution, while many of the remaining questions were resolved by preference (65–74% agreement). Summary of the literature and survey data as well as recommendations for the preparation, acquisition, processing and reporting of renal DWI were provided. Discussion The consensus-based technical recommendations for renal DWI aim to facilitate inter-site harmonization and increase clinical impact of the technique on a larger scale by setting a framework for acquisition protocols for future renal DWI studies. We anticipate an iterative process with continuous updating of the recommendations according to progress in the field. Electronic supplementary material The online version of this article (10.1007/s10334-019-00790-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexandra Ljimani
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Anna Caroli
- Department of Biomedical Engineering, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Christoffer Laustsen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Susan Francis
- Sir Peter Mansfield Imaging Centre, University Park, University of Nottingham, Nottingham, NG7 2RD, UK
| | | | - Octavia Bane
- Translational and Molecular Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fabio Nery
- Developmental Imaging and Biophysics Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Kanishka Sharma
- Imaging Biomarkers Group, Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Andreas Pohlmann
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrueck Center for Molecular Medicine in the Helmholtz Association, 13125, Berlin, Germany
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean-Paul Vallee
- Department of Diagnostic, Geneva University Hospital and University of Geneva, 1211, Geneva-14, Switzerland
| | - Katja Derlin
- Department of Radiology, Hannover Medical School, Hannover, Germany
| | - Mike Notohamiprodjo
- Die Radiologie, Munich, Germany.,Department of Radiology, University Hospital Tuebingen, Tübingen, Germany
| | - Ruth P Lim
- Department of Radiology, Austin Health, The University of Melbourne, Melbourne, Australia
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Suraj D Serai
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Joao Periquito
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrueck Center for Molecular Medicine in the Helmholtz Association, 13125, Berlin, Germany
| | - Zhen Jane Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Martijn Froeling
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Harriet C Thoeny
- Department of Radiology, Hôpital Cantonal Fribourgois (HFR), University of Fribourg, 1708, Fribourg, Switzerland
| | - Pottumarthi Prasad
- Department of Radiology, Center for Advanced Imaging, NorthShore University Health System, Evanston, IL, USA
| | - Moritz Schneider
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Pneumology Center, German Center for Lung Research, Munich, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrueck Center for Molecular Medicine in the Helmholtz Association, 13125, Berlin, Germany
| | - Pim Pullens
- Ghent Institute for Functional and Metabolic Imaging, Ghent University, Ghent, Belgium.,Department of Radiology, University Hospital Ghent, Ghent, Belgium
| | - Steven Sourbron
- Imaging Biomarkers Group, Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Eric E Sigmund
- Department of Radiology, Center for Biomedical Imaging (CBI), Center for Advanced Imaging Innovation and Research (CAI2R), NYU Langone Health, New York, NY, USA
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76
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Technical recommendations for clinical translation of renal MRI: a consensus project of the Cooperation in Science and Technology Action PARENCHIMA. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2019; 33:131-140. [PMID: 31628564 PMCID: PMC7021737 DOI: 10.1007/s10334-019-00784-w] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 09/23/2019] [Accepted: 10/01/2019] [Indexed: 12/14/2022]
Abstract
Purpose The potential of renal MRI biomarkers has been increasingly recognised, but clinical translation requires more standardisation. The PARENCHIMA consensus project aims to develop and apply a process for generating technical recommendations on renal MRI. Methods A task force was formed in July 2018 focused on five methods. A draft process for attaining consensus was distributed publicly for consultation and finalised at an open meeting (Prague, October 2018). Four expert panels completed surveys between October 2018 and March 2019, discussed results and refined the surveys at a face-to-face meeting (Aarhus, March 2019) and completed a second round (May 2019). Results A seven-stage process was defined: (1) formation of expert panels; (2) definition of the context of use; (3) literature review; (4) collection and comparison of MRI protocols; (5) consensus generation by an approximate Delphi method; (6) reporting of results in vendor-neutral and vendor-specific terms; (7) ongoing review and updating. Application of the process resulted in 166 consensus statements. Conclusion The process generated meaningful technical recommendations across very different MRI methods, while allowing for improvement and refinement as open issues are resolved. The results are likely to be widely supported by the renal MRI community and thereby promote more harmonisation.
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77
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Lu J, Zhou Z, Morelli JN, Yu H, Luo Y, Hu X, Li Z, Hu D, Shen Y. A Systematic Review of Technical Parameters for MR of the Small Bowel in non-IBD Conditions over the Last Ten Years. Sci Rep 2019; 9:14100. [PMID: 31575890 PMCID: PMC6773732 DOI: 10.1038/s41598-019-50501-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 09/13/2019] [Indexed: 12/27/2022] Open
Abstract
Technical guidelines for magnetic resonance imaging (MRI) of the small bowel (SB) in the setting of inflammatory bowel diseases (IBDs) were detailed in a 2017 consensus issued by European Society of Gastrointestinal and Abdominal Radiology (ESGAR) and European Society of Pediatric Radiology (ESPR); however, MRI for non-IBD conditions was not addressed. Hence, we performed a systematic review collecting researches on SB MRI for non-IBDs. The literatures were then divided into morphologic group and functional group. Information about the MRI techniques, gastrointestinal preparation, and details of cine-MRI protocols was extracted. We found that a 1.5 T MRI system, prone positioning, and MR enterography were frequently utilized in clinical practice. Gadolinium contrast sequences were routinely implemented, while diffusion-weighted imaging (DWI) was much less performed. The gastrointestinal preparation varied throughout the studies. No uniform protocols for cine imaging could be established. SB MRI examinations for non-IBDs are far from standardized, especially for functional studies. Recommendations for standard parameters in cine-MRI sequences are difficult to make due to lack of evidentiary support. MRI investigations in non-IBD conditions are needed and the standardization of non-IBD imaging in clinical practice is required.
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Affiliation(s)
- Jingyu Lu
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ziling Zhou
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | | | - Hao Yu
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yan Luo
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuemei Hu
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhen Li
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Daoyu Hu
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yaqi Shen
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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78
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Kim J, Kim SH, Kim TO. Evaluation of CT enterography findings for endoscopic complete remission after anti-TNF-α therapy in patients with Crohn's disease. Acta Radiol 2019; 60:1200-1208. [PMID: 30628841 DOI: 10.1177/0284185118820062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jieun Kim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Seung Ho Kim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Tae Oh Kim
- Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
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79
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Society of abdominal radiology gastrointestinal bleeding disease-focused panel consensus recommendations for CTA technical parameters in the evaluation of acute overt gastrointestinal bleeding. Abdom Radiol (NY) 2019; 44:2957-2962. [PMID: 31346741 DOI: 10.1007/s00261-019-02131-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To formulate consensus recommendations for CT angiography technical parameters used to evaluate overt gastrointestinal (GI) bleeding. METHODS An electronic questionnaire consisting of 17 questions was sent to a panel of 16 radiologists with expertise on the imaging of GI bleeding from the Society of Abdominal Radiology GI Bleeding disease-focused panel to obtain consensus agreement on issues related to CTA technical parameters for imaging overt GI bleeding. A multi-round Delphi method of voting was performed to obtain consensus which was defined as ≥ 80% agreement. RESULTS Consensus agreement was reached in 15/17 (89%) of the questions including the technique for the administration of IV contrast, the number of phases, scan timing, and image reconstruction. CONCLUSIONS A panel of experts on the imaging of GI bleeding from the Society of Abdominal Radiology was able to reach consensus on the majority of technical parameters used for CTA of overt GI bleeding. These recommendations should improve the quality of patient care by adopting these minimal technical requirements for optimal exam performance and lead to less variation in the performance of these exams which will facilitate collecting and comparing published data from different centers. These recommendations will need revisions as additional scientific data become available.
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80
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Yu H, Feng C, Wang Z, Li J, Wang Y, Hu X, Li Z, Shen Y, Hu D. Potential of diffusion-weighted imaging in magnetic resonance enterography to identify neoplasms in the ileocecal region: Use of ultra-high b-value diffusion-weighted imaging. Oncol Lett 2019; 18:1451-1457. [PMID: 31423210 DOI: 10.3892/ol.2019.10441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 05/13/2019] [Indexed: 12/13/2022] Open
Abstract
Patients with chronic inflammatory bowel disease have an increased risk of colorectal cancer, and the differentiation between neoplastic and inflammatory lesions often poses a clinical dilemma. The aim of the present study was to investigate whether diffusion-weighted (DW) magnetic resonance (MR) enterography with ultra-high b-value facilitates the identification of neoplastic lesions in the ileocecal region. A total of 76 patients (22 patients with neoplasms, 26 inflammatory lesions and 28 normal subjects) from 292 cases of suspected bowel disorders were included in the present study. All patients were examined with conventional MR enterography and DW imaging (DWI) with seven different b-values (400, 600, 800, 1,000, 1,200, 1,500 and 3,000 sec/mm2) in a 3T MR scanner. DWI scans with different b-values were analyzed independently by two radiologists for the presence of ileocecal lesions. The signal intensity of the majority of inflammatory lesions and normal bowel segments gradually decreased to the background intensity with increasing b-values; however, neoplastic lesions demonstrated relative hyperintensity compared with the background. In addition, ~76% of the positive findings from b=3,000 sec/mm2 DWI were neoplasms. In conclusion, a lesion with consistently high signal intensity from DWI images with b-values increasing to 3,000 sec/mm2 indicated the presence of neoplasms. The results suggested that ultra-high b-value (3,000 sec/mm2) imaging may aid the clinical differentiation of neoplasms from benign conditions.
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Affiliation(s)
- Hao Yu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Cui Feng
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Zi Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Jianjun Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Yanchun Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Xuemei Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Yaqi Shen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
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Ordás I, Rimola J, Alfaro I, Rodríguez S, Castro-Poceiro J, Ramírez-Morros A, Gallego M, Giner À, Barastegui R, Fernández-Clotet A, Masamunt M, Ricart E, Panés J. Development and Validation of a Simplified Magnetic Resonance Index of Activity for Crohn's Disease. Gastroenterology 2019; 157:432-439.e1. [PMID: 30953614 DOI: 10.1053/j.gastro.2019.03.051] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS The magnetic resonance index of activity (MARIA) for Crohn's disease (CD) is used to assess the activity of luminal CD. However, it has a number of practical limitations. We aimed to develop and validate a simplified MARIA to more easily and quickly assess CD activity and response to therapy. PATIENTS AND METHODS We performed a retrospective analysis of magnetic resonance imaging data from 98 participants in 2 studies. We used logistic regression analysis to identify magnetic resonance imaging parameters independently associated with CD endoscopic index of severity (CDEIS) scores (the reference standard). We validated the responsiveness and reliability of the simplified MARIA in an independent cohort of 37 patients who underwent magnetic resonance imaging and endoscopy before and after a therapeutic intervention. RESULTS Logistic regression analysis showed that dichotomous qualitative assessment of wall thickening (>3 mm), presence of mural edema, perienteric fat stranding, and ulcers were independently associated with CDEIS scores; we used these factors to create a simplified MARIA. Simplified MARIA scores greater than 1 identified segments with active CD with 90% sensitivity and 81% specificity (area under the curve 0.91; 95% confidence interval 0.88-0.94). Simplified MARIA scores of 2 or more detected severe lesions (ulcers) with 85% sensitivity and 92% specificity (area under the curve 0.94; 95% confidence interval 0.91-0.96). For each patient, there was a high level of correlation between simplified MARIA scores and CDEIS scores (r = 0.83) and simplified MARIA scores and original MARIA scores (and r = 0.93) (P < .001). The simplified MARIA score accurately detected changes in lesion severity in response to therapy and was as reliable as endoscopy for the assessment of mucosal healing. CONCLUSION We developed and validated a simplified MARIA for easier and faster assessment of CD activity and severity. This index identifies patients with a response to therapy with a high level of accuracy. These findings require confirmation in independent, multireader studies.
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Affiliation(s)
- Ingrid Ordás
- IBD Unit, Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBER-EHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain.
| | - Jordi Rimola
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBER-EHD), Barcelona, Spain; IBD Unit, Radiology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Ignacio Alfaro
- IBD Unit, Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sonia Rodríguez
- IBD Unit, Radiology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Jesús Castro-Poceiro
- IBD Unit, Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Anna Ramírez-Morros
- IBD Unit, Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marta Gallego
- IBD Unit, Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Àngel Giner
- IBD Unit, Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBER-EHD), Barcelona, Spain
| | - Rebeca Barastegui
- IBD Unit, Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Agnès Fernández-Clotet
- IBD Unit, Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maica Masamunt
- IBD Unit, Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Elena Ricart
- IBD Unit, Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBER-EHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Julián Panés
- IBD Unit, Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBER-EHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
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82
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Rao N, Kumar S, Taylor S, Plumb A. Diagnostic pathways in Crohn's disease. Clin Radiol 2019; 74:578-591. [PMID: 31005268 DOI: 10.1016/j.crad.2019.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/14/2019] [Indexed: 12/17/2022]
Abstract
The management of Crohn's disease (CD) is shifting from a stepwise, incremental approach based on symptom control to more aggressive early combined immunosuppression in an attempt to induce remission more rapidly and avoid long-term bowel damage. Accurately defining disease activity is a major challenge, as there is often a disconnect between symptomatology and underlying disease status. The role of imaging in CD has evolved such that it now plays a central role establishing the initial diagnosis, characterising disease phenotype, activity assessment, disease surveillance, and assessing response to therapy. Furthermore, the "treat-to-target" approach is being investigated in CD, with resolution of transmural inflammation on cross-sectional imaging being the treatment goal. In this review, we summarise the principal imaging techniques available to the radiologist, the key findings, and provide some guidance on the preferred imaging option in the diagnostic pathway. We consider the relative merits and drawbacks of each imaging technique before offering a brief discussion of some current developments and research avenues in CD imaging. We discuss how imaging may be useful in a "treat-to-target" approach. Finally, we highlight some practical considerations around service configuration and delivery to optimise imaging in CD in an accurate, cost-effective manner.
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Affiliation(s)
- N Rao
- Department of Radiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - S Kumar
- Centre for Medical Imaging, University College London, London, UK
| | - S Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - A Plumb
- Centre for Medical Imaging, University College London, London, UK.
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83
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Yu H, Shen YQ, Tan FQ, Zhou ZL, Li Z, Hu DY, Morelli JN. Quantitative diffusion-weighted magnetic resonance enterography in ileal Crohn's disease: A systematic analysis of intra and interobserver reproducibility. World J Gastroenterol 2019; 25:3619-3633. [PMID: 31367161 PMCID: PMC6658399 DOI: 10.3748/wjg.v25.i27.3619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/20/2019] [Accepted: 06/08/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Magnetic resonance enterography (MRE) is increasingly attractive as a noninvasive and radiation-free tool for assessing Crohn's disease (CD). Diffusion-weighted imaging (DWI) is recommended as an optional MRE sequence for CD by the European Society of Gastrointestinal and Abdominal Radiology, and has shown a superb potential as a quantitative modality for bowel inflammation evaluation. However, the measurement reproducibility of quantitative DWI analysis in MRE has not been ascertained so far. To facilitate the application of quantitative diffusion-weighted MRE in the clinical routine, systematic investigations of the intra and interobserver reproducibility of DWI quantitative parameters should be performed. AIM To evaluate the intra and interobserver reproducibility of quantitative analysis for diffusion-weighted MRE (DW-MRE) in ileal CD. METHODS Forty-four subjects (21 with CD and 23 control subjects) who underwent ileocolonoscopy and DW-MRE (b = 800 s/mm2) within one week were included. Two radiologists independently measured apparent diffusion coefficients (ADC) of the terminal ileum and signal intensity ratio (SR) of the terminal ileum to ipsilateral psoas muscle on DWI images (b = 800 s/mm2). Between- and within-reader agreements were assessed using intraclass correlation coefficients (ICC), coefficients of variation (CoV), and 95% limits of agreement of Bland-Altman plots (BA-LA LoA). Diagnostic performances of ADC and SR for identifying inflamed terminal ileum from the normal were evaluated by receiver operating characteristic (ROC) curve analysis. RESULTS There were no significant differences in ADC or SR values between the two sessions or between the two radiologists either in the CD or control group (paired t-test, P > 0.05). The intra and interobserver reproducibility of ADC (ICC: 0.952-0.984; CoV: 3.73-6.28%; BA-LA LoA: ±11.27% to ±15.88%) and SR (ICC: 0.969-0.989; CoV: 3.51%-4.64%; BA-LA LoA: ±10.62% to ±15.45%) was excellent for CD. Agreement of ADC measurements was slightly less in control subjects (ICC: 0.641-0.736; CoV: 10.47%-11.43%; BA-LA LoA: ± 26.59% to ± 30.83%). SR of normal terminal ileum demonstrated high intra and interobserver reproducibility (ICC: 0.944-0.974; CoV: 3.73%-6.28%; BA-LA LoA: ± 18.58% to ± 24.43%). ADC and SR of two readers had outstanding diagnostic efficiencies (area under the ROC curve: 0.923-0.988). CONCLUSION Quantitative parameters derived from DW-MRE have good to excellent intra and interobserver agreements with high diagnostic accuracy, and can serve as robust and efficient quantitative biomarkers for CD evaluation.
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Affiliation(s)
- Hao Yu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Ya-Qi Shen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Fang-Qin Tan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Zi-Ling Zhou
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Dao-Yu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - John N Morelli
- St. John’s Medical Center, Tulsa, OK 74133, United States
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84
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Mang T, Scharitzer M. [Imaging of gastrointestinal inflammation : Characteristic patterns and signs]. Radiologe 2019; 58:281-291. [PMID: 29572712 DOI: 10.1007/s00117-018-0376-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
CLINICAL PROBLEM Pathological conditions of the gastrointestinal tract can result from various disorders, including inflammatory, infectious, neoplastic, and ischemic diseases. RADIOLOGICAL STANDARD PROCEDURES Cross-sectional imaging techniques have largely replaced many of the conventional fluoroscopic examinations, such as small bowel follow-through and double-contrast barium enema. The former allow for time-efficient, accurate, and minimally invasive diagnostics. Therefore, they have become important diagnostic tools for the evaluation of inflammatory diseases of the gastrointestinal tract. The distension of the intestinal lumen with orally administered neutral contrast media improves not only the evaluation of the intraluminal aspect, but also of the cross-sectional appearance. Furthermore, with cross-sectional imaging techniques, the additional assessment of the extraintestinal structures and organs is also possible. METHODICAL INNOVATIONS AND ASSESSMENT With the ongoing development of scanner and software technology, pathologic conditions of the gastrointestinal wall can be characterized in more detail by both computed tomography and magnetic resonance imaging. A structured approach, based on the analysis of typical radiological signs and patterns, combined with the evaluation of extraintestinal findings may help to assign the observed imaging findings to specific disease groups. RECOMMENDATIONS This article summarizes common signs and typical patterns frequently seen in inflammatory conditions of the gastrointestinal tract. A systematic approach for structured analysis of specific and nonspecific imaging features and common pitfalls may aid in the interpretation and help to narrow the spectrum of potential differential diagnoses.
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Affiliation(s)
- T Mang
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - M Scharitzer
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
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85
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Watson TA, Petit P, Augdal TA, Avni EF, Bruno C, Damasio MB, Darge K, Kjucevsek D, Franchi-Abella S, Ibe D, Littooij A, Lobo L, Mentzel HJ, Napolitano M, Ntoulia A, Riccabona M, Stafrace S, Wozniak M, Ording Müller LS. European Society of Paediatric Radiology abdominal imaging task force: statement on imaging in very early onset inflammatory bowel disease. Pediatr Radiol 2019; 49:841-848. [PMID: 30915515 DOI: 10.1007/s00247-019-04375-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Very early onset inflammatory bowel disease (VEO-IBD) is defined as disease presenting before the age of 6. These children require a tailored imaging approach because conventional imaging studies can be difficult to perform at such a young age. Unlike inflammatory bowel disease in older children and adults, colonic disease predominates in VEO-IBD, and small-bowel disease is rare. Distinguishing Crohn disease from ulcerative colitis is challenging both clinically and on histology. Radiology offers the greatest utility for detecting small-bowel disease because it helps to distinguish the two main disease entities and guide clinical management. Small-bowel ultrasound is recommended as the first-line investigation because it requires relatively little preparation, is readily available and is generally well tolerated in young children. We present these recommendations, based on the current evidence for radiologic management in this group, and propose an imaging algorithm for investigating VEO-IBD.
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Affiliation(s)
- Tom A Watson
- Department of Radiology,, Great Ormond Street Hospital for Children NHS Foundation Trust,, Great Ormond Street, London, WC1N 3JH, UK.
| | - Philippe Petit
- Service d'Imagerie Pédiatrique et Prénatale, Hôpital Timone Enfants, Marseille, France
| | - Thomas A Augdal
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - E Fred Avni
- Department of Pediatric Radiology, Jeanne de Flandre Hospital, CHRU de Lille, Lille, France
| | - Costanza Bruno
- Department of Radiology, Radiology Institute,, Verona, Italy
| | | | - Kassa Darge
- Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania,, Philadelphia, PA, USA
| | - Damjana Kjucevsek
- Department of Diagnostic Imaging, University Children's Hospital, Ljubljana, Slovenia
| | - Stéphanie Franchi-Abella
- Department of Paediatric Radiology, Hôpital Bicêtre - Hôpitaux Universitaires Paris-Sud, Université Paris-Sud,, Orsay, France
| | - Donald Ibe
- Department of Radiology,, Ahmadu Bello University Teaching Hospital Shika,, Zaria, Kaduna, Nigeria
| | - Annemieke Littooij
- Princess Maxima Center for Pediatric Oncology, Wilhelmina Children's Hospital Utrecht/UMCU,, Utrecht, the Netherlands
| | - Luisa Lobo
- Department of Radiology, Hospital de Santa Maria-CHLN, University Hospital,, Lisbon, Portugal
| | - Hans J Mentzel
- Section of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, University Hospital Jena,, Jena, Germany
| | - Marcelo Napolitano
- Department of Paediatric Radiology and Neuroradiology,, V. Buzzi Children's Hospital,, Milan, Italy
| | | | - Michael Riccabona
- Department of Radiology, Division of Pediatric Radiology, University Hospital Graz,, Graz, Austria
| | | | - Magdalena Wozniak
- Department of Pediatric Radiology, Medical University of Lublin, Lublin, Poland
| | - Lil-Sofie Ording Müller
- Department of Radiology and Nuclear Medicine, Unit for Paediatric Radiology, Oslo University Hospital, Oslo, Norway
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86
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Manetta R, Capretti I, Belleggia N, Marsecano C, Viscido A, Bruno F, Arrigoni F, Ma L, Guglielmi G, Splendiani A, Di Cesare E, Masciocchi C, Barile A. Magnetic resonance enterography (MRE) and ultrasonography (US) in the study of the small bowel in Crohn's disease: state of the art and review of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:38-50. [PMID: 31085972 PMCID: PMC6625566 DOI: 10.23750/abm.v90i5-s.8337] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Indexed: 02/06/2023]
Abstract
Crohn’s disease (CD) is a chronic idiopathic disease and its diagnosis is based on a combination of clinical symptoms, laboratory tests and imaging data. There isn’t a diagnostic gold standard: the ileocolonoscopy with mucosal biopsies represents the standard for luminal disease, while cross-sectional imaging such as Ultrasound (US), Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) can show transmural alterations and extraintestinal manifestations. CD is usually diagnosed in the young age and after baseline diagnosis, the patients have to undergo to variable follow-up depending on remission or active disease. The aim of our review is to compare Magnetic Resonance Enterography (MRE) to Ultrasonography (US) in the follow-up of CD. (www.actabiomedica.it)
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Affiliation(s)
- Rosa Manetta
- Division of Radiology, S. Salvatore Hospital, L'Aquila, Italy.
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87
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Bowel wall healing assessed using magnetic resonance imaging predicts sustained clinical remission and decreased risk of surgery in Crohn's disease. J Gastroenterol 2019; 54:312-320. [PMID: 30167884 DOI: 10.1007/s00535-018-1505-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 08/26/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Endoscopic mucosal healing is considered as the best therapeutic target in Crohn's disease (CD) as it is associated with better long-term outcomes. We investigated whether bowel wall healing (BWH) assessed using magnetic resonance imaging (MRI) could predict favorable outcomes and could be a potential therapeutic target. METHODS We performed a post hoc analysis from two prospective studies (n = 174 patients). All the patients with previous objective signs of bowel inflammation and assessed by MRI for therapeutic efficacy had a standardized and blinded evaluation, and underwent MRI. Complete BWH was defined as no segmental MaRIA > 7 or no segmental Clermont score > 8.4 and BWH as no segmental MaRIA > 11 or no segmental Clermont score > 12.5. Clinical corticosteroid-free remission (CFREM) was defined as no reappearance or worsening of clinical manifestation leading to therapeutic modification, hospitalization or CD-related surgery. Multivariate analyses were performed including all the relevant parameters. RESULTS Overall, 63 patients with CD were included (mean follow-up = 4.8 ± 3.1 semesters). In multivariate analysis (n = 303 semesters), complete BWH or BWH was associated with sustained CFREM according to MaRIA [OR = 4.42 (2.29-26.54); p = 0.042 and OR = 3.43 (1.02-27.02); p = 0.047, respectively] or Clermont score [OR = 3.09 (1.01-12.91); p = 0.049 and OR = 3.88 (1.40-13.80); p = 0.036, respectively]. In multivariate analysis (n = 63 patients), complete BWH or BWH was associated with decreased risk of surgery using MaRIA [HR = 0.16 (0.043-0.63); p = 0.008 and HR = 0.24 (0.07-0.77); p = 0.017, respectively] or Clermont score [HR = 0.24 (0.07-0.78); p = 0.016 and HR = 0.23 (0.07-0.76); p = 0.016, respectively]. CONCLUSIONS MRI endpoints are predictive of favorable outcomes after medical therapy and could be used as therapeutic target in daily practice and clinical trials.
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88
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Sturm A, Maaser C, Calabrese E, Annese V, Fiorino G, Kucharzik T, Vavricka SR, Verstockt B, van Rheenen P, Tolan D, Taylor SA, Rimola J, Rieder F, Limdi JK, Laghi A, Krustiņš E, Kotze PG, Kopylov U, Katsanos K, Halligan S, Gordon H, González Lama Y, Ellul P, Eliakim R, Castiglione F, Burisch J, Borralho Nunes P, Bettenworth D, Baumgart DC, Stoker J. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 2: IBD scores and general principles and technical aspects. J Crohns Colitis 2019; 13:273-284. [PMID: 30137278 DOI: 10.1093/ecco-jcc/jjy114] [Citation(s) in RCA: 215] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Andreas Sturm
- Department of Gastroenterology, DRK Kliniken Berlin I Westend, Berlin, Germany
| | - Christian Maaser
- Outpatients Department of Gastroenterology, Hospital Lüneburg, Lüneburg, Germany
| | - Emma Calabrese
- Department of Systems Medicine, University of Rome, Tor Vergata, Italy
| | - Vito Annese
- Department of Gastroenterology, Valiant Clinic & American Hospital, Dubai, UAE
| | - Gionata Fiorino
- Department of Gastroenterology, Humanitas Clinical and Research Institute, Milan, Italy
| | - Torsten Kucharzik
- Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Lüneburg, Germany
| | | | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven and CHROMETA - Translational Research in Gastrointestinal Disorders, KU Leuven, Belgium
| | - Patrick van Rheenen
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, University Medical Center Groningen, Groningen, The Netherlands
| | - Damian Tolan
- Clinical Radiology, St James's University Hospital, Leeds, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Jordi Rimola
- Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Florian Rieder
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jimmy K Limdi
- Department of Gastroenterology, Pennine Acute Hospitals NHS Trust, Manchester; Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Andrea Laghi
- Department of Clinical and Surgical Translational Medicine, Sapienza - University of Rome, Rome, Italy
| | - Eduards Krustiņš
- Department of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Paulo G Kotze
- Colorectal Surgery Unit, Catholic University of Paraná PUCPR, Curitiba, Brazil
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Konstantinos Katsanos
- Department of Gastroenterology and Hepatology, University and Medical School of Ioannina, Ioannina, Greece
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - Hannah Gordon
- Section of Gastroenterology & Hepatology, Royal London Hospital, London, UK
| | - Yago González Lama
- Department of Gastroenterology, University Hospital Puerta De Hierro, Majadahonda Madrid, Spain
| | - Pierre Ellul
- Department of Medicine, Mater Dei Hospital, Msida, Malta
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Paula Borralho Nunes
- Department of Anatomic Pathology, Hospital Cuf Descobertas; Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Dominik Bettenworth
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
| | - Daniel C Baumgart
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Academic Medical Center AMC, University of Amsterdam, Amsterdam, The Netherlands
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89
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Smith J, Godfrey E, Bowden D, Hickman K, Sharkey L, Butler A, Upponi S. Imaging of adult intestinal failure. Clin Radiol 2019; 74:603-612. [PMID: 30654907 DOI: 10.1016/j.crad.2018.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/11/2018] [Indexed: 01/30/2023]
Abstract
Intestinal failure is the inability to maintain adequate nutrition or hydration through the gut. It is caused by a diverse range of benign and malignant aetiologies. Imaging takes a central role in the multidisciplinary assessment of patients with intestinal failure.
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Affiliation(s)
- J Smith
- Department of Radiology, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 2QQ, UK
| | - E Godfrey
- Department of Radiology, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 2QQ, UK
| | - D Bowden
- Department of Radiology, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 2QQ, UK
| | - K Hickman
- Department of Radiology, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 2QQ, UK
| | - L Sharkey
- Department of Gastroenterology, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 2QQ, UK
| | - A Butler
- Department of Surgery, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 2QQ, UK
| | - S Upponi
- Department of Radiology, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 2QQ, UK.
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90
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IVIM with fractional perfusion as a novel biomarker for detecting and grading intestinal fibrosis in Crohn’s disease. Eur Radiol 2018; 29:3069-3078. [DOI: 10.1007/s00330-018-5848-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/03/2018] [Accepted: 10/22/2018] [Indexed: 01/18/2023]
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91
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Smereczyński A, Kołaczyk K. Pitfalls in ultrasound imaging of the stomach and the intestines. J Ultrason 2018; 18:207-211. [PMID: 30451403 PMCID: PMC6442211 DOI: 10.15557/jou.2018.0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 11/22/2022] Open
Abstract
The gastrointestinal tract is an extraordinary human organ in terms of its morphology and function. Its complex structure and enormous length as well as frequent presence of gas discourage many doctors performing ultrasound examination from its exploration. Moreover, there are anatomical structures in multiple locations which can mimic certain abnormalities. It is difficult to present an exhaustive account of the problem of gastrointestinal tract ultrasound imaging errors in a single work; therefore, this study focuses mainly on false positive errors which usually result from a lack of knowledge of anatomical variants of the gastrointestinal tract structure. In the case of the stomach, rugae and muscle layer thickening towards the pylorus have been mentioned, which constitute variants of the structure of this organ examined when empty. Diagnostic pitfalls in the small intestine may include the dudenojejunal flexure (ligament of Treitz), the horizontal part of the duodenum and the ileocaecal valve. The status of the apparent lesions in all of the cases mentioned will be resolved following fluid intake by the patient. In the colon, the varied structure of semilunar folds should be taken note of. Their large thickness can warrant suspicion of wall invasion or a polyp. In addition, the study emphasises the importance of appropriate preparation of a patient for gastrointestinal tract examination since it determines the accuracy of the diagnosis. The authors also take note of common ‘sins’ of physicians such as hasty examination and failure to comply with the stomach and appendix examination protocol.
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Affiliation(s)
- Andrzej Smereczyński
- Ultrasound Self-Study Club, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Kołaczyk
- Ultrasound Self-Study Club, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
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92
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Serban ED. Treat-to-target in Crohn's disease: Will transmural healing become a therapeutic endpoint? World J Clin Cases 2018; 6:501-513. [PMID: 30397606 PMCID: PMC6212605 DOI: 10.12998/wjcc.v6.i12.501] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/17/2018] [Accepted: 10/08/2018] [Indexed: 02/05/2023] Open
Abstract
Crohn's disease (CD) represents a chronic transmural inflammatory condition of the gastrointestinal tract, which usually leads to structural damage and significant disability. Deep remission - defined by both clinical and endoscopic remission, signifying mucosal healing - represents the current endpoint in the treat-to-target strategy, significantly improving patients' long-term outcomes. Transmural healing (TH) could be a more effective target, but this possibility remains unclear. This narrative review aims to critically review and summarize the available literature relating TH to long-term outcomes, being the first of its kind and to the best of the author's knowledge. A systematic literature search (from inception to March 31 2018) was performed, using multiple databases, and identifying seven full-text manuscripts. In those studies, long-term favorable outcomes (≥ 52 wk) included sustained clinical remission, as well as fewer therapeutic changes, CD-related hospitalizations, and surgeries. Despite heterogeneous design and methodological limitations, six of the studies demonstrated that TH or intestinal healing (TH plus mucosal healing) were predictive for the aforementioned favorable outcomes. Therefore, TH may become a reasonable therapeutic target and be included in the concept of deep remission. Further prospective, well-designed, multicenter trials aiming to better define the role of TH in personalized therapy for CD and to determine the long-term influence of TH on bowel damage and disability are warranted.
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Affiliation(s)
- Elena Daniela Serban
- 2nd Department of Pediatrics, “Iuliu Hatieganu” University of Medicine and Pharmacy, Emergency Hospital for Children, Cluj-Napoca 400177, Romania
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93
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Preoperative evaluation of small bowel complications in Crohn’s disease: comparison of diffusion-weighted and contrast-enhanced MR imaging. Eur Radiol 2018; 29:2034-2044. [DOI: 10.1007/s00330-018-5734-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/12/2018] [Accepted: 08/28/2018] [Indexed: 02/08/2023]
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94
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Barber J, Shah N, Watson T. Early onset inflammatory bowel disease – What the radiologist needs to know. Eur J Radiol 2018; 106:173-182. [DOI: 10.1016/j.ejrad.2018.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/15/2018] [Accepted: 07/02/2018] [Indexed: 02/07/2023]
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95
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Khachab F, Loundou A, Roman C, Colavolpe N, Aschero A, Bourlière-Najean B, Daidj N, Desvignes C, Pico H, Gorincour G, Auquier P, Petit P. Can diffusion weighting replace gadolinium enhancement in magnetic resonance enterography for inflammatory bowel disease in children? Pediatr Radiol 2018; 48:1432-1440. [PMID: 29982955 DOI: 10.1007/s00247-018-4169-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 04/13/2018] [Accepted: 05/25/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Contrast-enhanced MRI is often used for diagnosis and follow-up of children with inflammatory bowel disease. OBJECTIVE To compare the accuracy of diffusion-weighted MRI (DWI) to contrast-enhanced MRI in children with known or suspected inflammatory bowel disease. MATERIALS AND METHODS This retrospective, consecutive study included 55 children. We used ileo-colonoscopy and histology as the reference standard from the terminal ileum to the rectum, and contrast-enhanced MRI as the reference standard proximal to the terminal ileum. DWI and contrast-enhanced MRI sequences were independently reviewed and compared per patient and per segment to these reference standards and to the follow-up for each child. RESULTS We obtained endoscopic data for 340/385 colonic and ileal segments (88%). The rate of agreement per segment between DWI and endoscopy was 64%, and the rate of agreement between contrast-enhanced MRI and endoscopy was 59%. Per patient, sensitivity and specificity of bowel wall abnormalities as compared to the endoscopy were 87% and 100% for DWI, and 70% and 100% for contrast-enhanced MRI, respectively. Positive and negative predictive values were, respectively, 100% and 57% for DWI, and 96% and 41% for contrast-enhanced MRI. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of DWI compare to contrast-enhanced MRI in the segments proximal to the terminal ileum were 90%, 98%, 90%, 98% and 96%, respectively. CONCLUSION The diagnostic performance of DWI is competitive to that of contrast-enhanced MRI in children with known or suspected inflammatory bowel disease.
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Affiliation(s)
- Farah Khachab
- Pediatric Radiology Department, Hopital de la Timone, Assistance Publique des Hopitaux de Marseille, 264 Rue Saint-Pierre, 13385, Marseille Cedex 5, Marseille, France
| | - Anderson Loundou
- Public Health Department, Hopital de la Timone, Assistance Publique des Hopitaux de Marseille, Marseille, France
| | - Céline Roman
- Pediatric Gastroenterology Department, Hopital de la Timone, Assistance Publique des Hopitaux de Marseille, Marseille, France
| | - Nathalie Colavolpe
- Pediatric Radiology Department, Hopital de la Timone, Assistance Publique des Hopitaux de Marseille, 264 Rue Saint-Pierre, 13385, Marseille Cedex 5, Marseille, France
| | - Audrey Aschero
- Pediatric Radiology Department, Hopital de la Timone, Assistance Publique des Hopitaux de Marseille, 264 Rue Saint-Pierre, 13385, Marseille Cedex 5, Marseille, France
| | - Brigitte Bourlière-Najean
- Pediatric Radiology Department, Hopital de la Timone, Assistance Publique des Hopitaux de Marseille, 264 Rue Saint-Pierre, 13385, Marseille Cedex 5, Marseille, France
| | - Nassima Daidj
- Pediatric Radiology Department, Hopital de la Timone, Assistance Publique des Hopitaux de Marseille, 264 Rue Saint-Pierre, 13385, Marseille Cedex 5, Marseille, France
| | - Catherine Desvignes
- Pediatric Radiology Department, Hopital de la Timone, Assistance Publique des Hopitaux de Marseille, 264 Rue Saint-Pierre, 13385, Marseille Cedex 5, Marseille, France
| | - Harmony Pico
- Pediatric Radiology Department, Hopital de la Timone, Assistance Publique des Hopitaux de Marseille, 264 Rue Saint-Pierre, 13385, Marseille Cedex 5, Marseille, France
| | - Guillaume Gorincour
- Pediatric Radiology Department, Hopital de la Timone, Assistance Publique des Hopitaux de Marseille, 264 Rue Saint-Pierre, 13385, Marseille Cedex 5, Marseille, France
| | - Pascal Auquier
- Public Health Department, Hopital de la Timone, Assistance Publique des Hopitaux de Marseille, Marseille, France
| | - Philippe Petit
- Pediatric Radiology Department, Hopital de la Timone, Assistance Publique des Hopitaux de Marseille, 264 Rue Saint-Pierre, 13385, Marseille Cedex 5, Marseille, France.
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96
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Taylor SA, Mallett S, Bhatnagar G, Baldwin-Cleland R, Bloom S, Gupta A, Hamlin PJ, Hart AL, Higginson A, Jacobs I, McCartney S, Miles A, Murray CD, Plumb AA, Pollok RC, Punwani S, Quinn L, Rodriguez-Justo M, Shabir Z, Slater A, Tolan D, Travis S, Windsor A, Wylie P, Zealley I, Halligan S. Diagnostic accuracy of magnetic resonance enterography and small bowel ultrasound for the extent and activity of newly diagnosed and relapsed Crohn's disease (METRIC): a multicentre trial. Lancet Gastroenterol Hepatol 2018; 3:548-558. [PMID: 29914843 PMCID: PMC6278907 DOI: 10.1016/s2468-1253(18)30161-4] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Magnetic resonance enterography (MRE) and ultrasound are used to image Crohn's disease, but their comparative accuracy for assessing disease extent and activity is not known with certainty. Therefore, we did a multicentre trial to address this issue. METHODS We recruited patients from eight UK hospitals. Eligible patients were 16 years or older, with newly diagnosed Crohn's disease or with established disease and suspected relapse. Consecutive patients had MRE and ultrasound in addition to standard investigations. Discrepancy between MRE and ultrasound for the presence of small bowel disease triggered an additional investigation, if not already available. The primary outcome was difference in per-patient sensitivity for small bowel disease extent (correct identification and segmental localisation) against a construct reference standard (panel diagnosis). This trial is registered with the International Standard Randomised Controlled Trial, number ISRCTN03982913, and has been completed. FINDINGS 284 patients completed the trial (133 in the newly diagnosed group, 151 in the relapse group). Based on the reference standard, 233 (82%) patients had small bowel Crohn's disease. The sensitivity of MRE for small bowel disease extent (80% [95% CI 72-86]) and presence (97% [91-99]) were significantly greater than that of ultrasound (70% [62-78] for disease extent, 92% [84-96] for disease presence); a 10% (95% CI 1-18; p=0·027) difference for extent, and 5% (1-9; p=0·025) difference for presence. The specificity of MRE for small bowel disease extent (95% [85-98]) was significantly greater than that of ultrasound (81% [64-91]); a difference of 14% (1-27; p=0·039). The specificity for small bowel disease presence was 96% (95% CI 86-99) with MRE and 84% (65-94) with ultrasound (difference 12% [0-25]; p=0·054). There were no serious adverse events. INTERPRETATION Both MRE and ultrasound have high sensitivity for detecting small bowel disease presence and both are valid first-line investigations, and viable alternatives to ileocolonoscopy. However, in a national health service setting, MRE is generally the preferred radiological investigation when available because its sensitivity and specificity exceed ultrasound significantly. FUNDING National Institute of Health and Research Health Technology Assessment.
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Affiliation(s)
- Stuart A Taylor
- Centre for Medical Imaging, University College London (UCL), London, UK.
| | - Susan Mallett
- Institute of Applied Health Research, National Institute of Health and Research Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Rachel Baldwin-Cleland
- Intestinal Imaging Centre, St Mark's Hospital, London North West University Healthcare (LNWUH) National Health Service (NHS) Trust, Harrow, UK
| | - Stuart Bloom
- Department of Gastroenterology, University College Hospital, London, UK
| | - Arun Gupta
- Intestinal Imaging Centre, St Mark's Hospital, London North West University Healthcare (LNWUH) National Health Service (NHS) Trust, Harrow, UK
| | - Peter J Hamlin
- Department of Gastroenterology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ailsa L Hart
- Inflammatory Bowel Disease Unit, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK
| | - Antony Higginson
- Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | | | - Sara McCartney
- Department of Gastroenterology, University College Hospital, London, UK
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck University of London, London, UK
| | - Charles D Murray
- Department of Gastroenterology and Endoscopy, Royal Free London NHS Foundation Trust, London, UK
| | - Andrew A Plumb
- Centre for Medical Imaging, University College London (UCL), London, UK
| | - Richard C Pollok
- Department of Gastroenterology, St George's Hospital, London, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London (UCL), London, UK
| | - Laura Quinn
- Institute of Applied Health Research, National Institute of Health and Research Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Zainib Shabir
- Comprehensive Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, Holborn, London, UK
| | - Andrew Slater
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Damian Tolan
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Simon Travis
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
| | | | - Peter Wylie
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Ian Zealley
- Department of Radiology, Ninewells Hospital, Dundee, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London (UCL), London, UK
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97
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Son JH, Kim SH, Cho EY, Ryu KH. Comparison of diagnostic performance between 1 millisievert CT enterography and half-standard dose CT enterography for evaluating active inflammation in patients with Crohn's disease. Abdom Radiol (NY) 2018; 43:1558-1566. [PMID: 29038856 DOI: 10.1007/s00261-017-1359-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare the diagnostic performance of CT enterography (CTE) images obtained at 1 millisievert (mSv) and reconstructed with filtered back projection (FBP) and adaptive statistical iterative reconstruction (ASIR) with those of half-dose CTE images for the evaluation of active inflammation in patients with Crohn's disease. METHODS Forty-six consecutive patients (mean age 29 years; range 15-59 years) with Crohn's disease underwent CTE which comprised a standard-dose scan at the enteric phase (45 s), a half-dose scan with ASIR at the portal venous phase (70 s), and 1 mSv scans with FBP and ASIR at the delayed phase (90 s) under a fixed 120 kVp and variable mAs. Two blinded readers independently recorded confidence scores for active inflammation in the ileum and terminal ileum, respectively. The diagnostic performance of each image set was compared by pairwise comparison of receiver operating characteristic curves. The established image findings on standard-dose scan and ileocolonoscopy served as the reference standard. RESULTS A total of 92 bowel segments were analyzed. For reader 1, the diagnostic performance was increased from 1 mSv CT with FBP and 1 mSv CT with ASIR to half-dose scan with ASIR (AUC, 0.759, 0.794, and 0.845; P = 0.1429, P = 0.0107, respectively). For reader 2, there was no significant difference among the three image sets (AUC, 0.848, 0.865, and 0.845; P > 0.05, respectively). CONCLUSIONS The diagnostic performance of 1 mSv CTE may be comparable to that of half-dose CTE.
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Affiliation(s)
- Jung Hee Son
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Haeundae-ro 875, Haeundae-gu, Busan, 48108, Republic of Korea
| | - Seung Ho Kim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Haeundae-ro 875, Haeundae-gu, Busan, 48108, Republic of Korea.
| | - Een Young Cho
- Health Promotion Center, Inje University College of Medicine, Haeundae Paik Hospital, Haeundae-ro 875, Haeundae-gu, Busan, 48108, Republic of Korea
| | - Kyeong Hwa Ryu
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Samjeongja-ro 11, Seongsan-gu, Changwon, 51472, Republic of Korea
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98
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Schöllnast H. Radiologische Charakterisierung chronisch-entzündlicher Darmerkrankungen. Radiologe 2018; 58:312-319. [DOI: 10.1007/s00117-018-0372-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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99
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100
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de Jonge CS, Gollifer RM, Nederveen AJ, Atkinson D, Taylor SA, Stoker J, Menys A. Dynamic MRI for bowel motility imaging-how fast and how long? Br J Radiol 2018; 91:20170845. [PMID: 29474115 PMCID: PMC6209475 DOI: 10.1259/bjr.20170845] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective: Dynamic imaging of small intestinal motility is an increasingly common research method to examine bowel physiology in health and disease. However, limited data exist to guide imaging protocols with respect to quantitative analysis. The purpose of this study is to define the required temporal resolution and scan duration in dynamic MRI for small bowel motility assessment. Methods: Six healthy volunteers underwent motility imaging with MR enterography using breath-hold protocol. A coronal two-dimensional balanced fast field echo sequence was used to acquire dynamic data at a high temporal resolution of 10 frames per second (fps). Motility was quantified by generating a registration-derived motility index for local and global regions of bowel. To evaluate temporal resolution and scan duration, the data were undersampled and the scan length was varied to determine the impact on motility index. Results: The mean motility index stabilizes at a temporal resolution of 1 fps (median absolute percentage change 1.4% for global and 1.9% for local regions of interest). The mean motility index appears to stabilize for scan durations of 15 s or more in breath-hold (median absolute % change 2.8% for global and 1.7% for local regions of interest). Conclusion: A temporal resolution of at least 1 fps and a scan duration of at least 15 s is necessary in breath-hold scans for consistent motility observations. The majority of small bowel motility studies to date are in line with these requirements. Advances in knowledge: This study suggests the minimum temporal resolution and scan duration required in breath-hold scans to obtain robust measurements of small bowel motility from MRI.
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Affiliation(s)
- Catharina S de Jonge
- 1 Department of Radiology and Nuclear Medicine, Academic Medical Center , Amsterdam , Netherlands
| | | | - Aart J Nederveen
- 1 Department of Radiology and Nuclear Medicine, Academic Medical Center , Amsterdam , Netherlands
| | - David Atkinson
- 2 Centre for Medical Imaging, University College London , London , UK
| | - Stuart A Taylor
- 2 Centre for Medical Imaging, University College London , London , UK
| | - Jaap Stoker
- 1 Department of Radiology and Nuclear Medicine, Academic Medical Center , Amsterdam , Netherlands
| | - Alex Menys
- 2 Centre for Medical Imaging, University College London , London , UK
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