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Bouhnik Y, Le Berre C, Zappa M, Lewin M, Boudiaf M, Zagdanski AM, Frampas E, Oudjit A, Scotto B, Tissier M, Annet L, Aufort S, Yzet T, Cuilleron M, Baudin G, Abitbol V, Cosnes J, Bourreille A, Mary J, Dupas JL, Marteau P, Picon L, Pelletier AL, Altwegg R, Dewit O, Filippi J, Roblin X, Stéfanescu C. Development of a New Index to Assess Small Bowel Inflammation Severity in Crohn's Disease Using Magnetic Resonance Enterography. CROHN'S & COLITIS 360 2022; 4:otac004. [PMID: 36777552 PMCID: PMC9802414 DOI: 10.1093/crocol/otac004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Indexed: 11/14/2022] Open
Abstract
Background The severity of small bowel (SB) inflammation in Crohn's disease (CD) patients is a key component of the therapeutic choice. We aimed to develop a SB-CD Magnetic Resonance Enterography (MRE) index of Inflammation Severity (CDMRIS). Methods Each gastroenterologist/radiologist pair in 13 centers selected MREs from 6 patients with SB-CD stratified on their perceived MRE inflammation severity. The 78 blinded MREs were allocated through balanced incomplete block design per severity stratum to these 13 pairs for rating the presence/severity of 13 preselected items for each SB 20-cm diseased segment. Global inflammation severity was evaluated using a 100-cm visual analog scale. Reproducibility of recorded items was evaluated. The CDMRIS was determined through linear mixed modeling as a combination of the numbers of segments with lesions highly correlated to global inflammation severity. Results Four hundred and forty-two readings were available. Global inflammation severity mean ± SD was 21.0 ± 16.2. The independent predictors explaining 54% of the global inflammation severity variance were the numbers of segments with T1 mild-moderate and severe intensity of enhancement, deep ulceration without fistula, comb sign, fistula, and abscess. Unbiased correlation between CDMRIS and global inflammation severity was 0.76. Conclusions The CDMRIS is now available to evaluate the severity of SB-CD inflammation. External validation and sensitivity-to-change are mandatory next steps.
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Affiliation(s)
- Yoram Bouhnik
- Service de gastro-entérologie-MICI, AP-HP, Hôpital Beaujon, Clichy, France
| | - Catherine Le Berre
- Institut des Maladies de l’Appareil Digestif, Nantes University Hospital, Nantes, France,Address correspondence to: Catherine Le Berre, MD, Institut des Maladies de l’Appareil Digestif, Nantes University Hospital, 1 place Alexis Ricordeau, 44093 Nantes Cedex 1, France ()
| | - Magaly Zappa
- Service de radiologie, AP-HP, Hôpital Beaujon, Clichy, France
| | - Maïté Lewin
- Service de radiologie, AP-HP, Hôpital Paul Brousse, Villejuif, France
| | - Mourad Boudiaf
- Service de radiologie, AP-HP, Hôpital Cochin, Paris, France
| | | | - Eric Frampas
- Service central de radiologie et imagerie médicale, Nantes University Hospital, Nantes, France
| | - Ammar Oudjit
- Service de radiologie, AP-HP, Hôpital Cochin, Paris, France
| | - Béatrice Scotto
- Service de radiologie, University Hospital of Tours, Tours, France
| | - Muriel Tissier
- Service de radiologie, AP-HP, Hôpital Bichat, Paris, France
| | - Laurence Annet
- Medical Imaging Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - Sophie Aufort
- Service de radiologie, Clinique du Parc, Castelnau Le Lez, France
| | - Thierry Yzet
- Service de radiologie digestive, University Hospital of Amiens-Picardie, Hôpital Sud, Amiens, France
| | - Muriel Cuilleron
- Service de radiologie, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Guillaume Baudin
- Service d’imagerie diagnostique et interventionnelle, Hôpital de L’Archet, Nice, France
| | - Vered Abitbol
- Service d’hépato-gastro-entérologie, AP-HP, Hôpital Cochin, Paris, France
| | - Jacques Cosnes
- Service de gastroentérologie, AP-HP, Hôpital Saint-Antoine, Paris, France
| | - Arnaud Bourreille
- Institut des Maladies de l’Appareil Digestif, Nantes University Hospital, Nantes, France
| | - Jean Yves Mary
- UMR-S-1153 Inserm, Denis Diderot-Paris 7 University, Hôpital Saint-Louis, Paris, France
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Foti PV, Travali M, Farina R, Palmucci S, Coronella M, Spatola C, Puzzo L, Garro R, Inserra G, Riguccio G, Zanoli L, Basile A. Can Conventional and Diffusion-Weighted MR Enterography Biomarkers Differentiate Inflammatory from Fibrotic Strictures in Crohn's Disease? ACTA ACUST UNITED AC 2021; 57:medicina57030265. [PMID: 33803953 PMCID: PMC8000737 DOI: 10.3390/medicina57030265] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/07/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022]
Abstract
Background and Objectives: To retrospectively assess the value of magnetic resonance enterography (MRE) parameters derived from conventional and diffusion weighted imaging (DWI) sequences to differentiate fibrotic strictures from inflammatory ones in adult patients with Crohn’s disease (CD), using surgical specimens as the histopathological reference standard. Material and Methods: Twenty-three patients with CD who had undergone surgical resection of ileal strictures with full-thickness histopathologic analysis within 3 months from preoperative MRE were included. Two radiologists blinded to histopathology in consensus evaluated the following biomarkers on MRE images matched to resected pathological specimens: T1 ratio, T2 ratio, enhancement pattern, mural thickness, pre-stenotic luminal diameter, and apparent diffusion coefficient (ADC). A blinded pathologist graded stricture histological specimens with acute inflammation score (AIS) and fibrosis score (FS). MRE measurements were correlated with the reference standard. Results: Inflammation and fibrosis coexisted in 78.3% of patients. T2 ratio was reduced in patients with severe fibrosis (p = 0.01). Pre-stenotic bowel dilatation positively correlated with FS (p = 0.002). The ADC value negatively correlated with FS (p < 0.001) and was different between FS grades (p < 0.05). The area under the receiver operating characteristic curve for discriminating between none and mild/moderate–severe bowel wall fibrosis was 0.75 for pre-stenotic bowel dilatation (sensitivity 100%, specificity 44.4%) and 0.97 for ADC (sensitivity 80%, specificity 100%). Conclusions: Inflammation and fibrosis often coexist in CD bowel strictures needing surgery. The combination of parameters derived from conventional MR sequences (T2 ratio, pre-stenotic dilatation) and from DWI (ADC) may provide a contribution to detect and grade bowel fibrosis in adult CD patients.
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Affiliation(s)
- Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia, 78-95123 Catania, Italy; (M.T.); (R.F.); (S.P.); (M.C.); (C.S.); (A.B.)
- Correspondence: ; Tel.: +39-095-378-2360; Fax: +39-095-378-2368
| | - Mario Travali
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia, 78-95123 Catania, Italy; (M.T.); (R.F.); (S.P.); (M.C.); (C.S.); (A.B.)
| | - Renato Farina
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia, 78-95123 Catania, Italy; (M.T.); (R.F.); (S.P.); (M.C.); (C.S.); (A.B.)
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia, 78-95123 Catania, Italy; (M.T.); (R.F.); (S.P.); (M.C.); (C.S.); (A.B.)
| | - Maria Coronella
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia, 78-95123 Catania, Italy; (M.T.); (R.F.); (S.P.); (M.C.); (C.S.); (A.B.)
| | - Corrado Spatola
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia, 78-95123 Catania, Italy; (M.T.); (R.F.); (S.P.); (M.C.); (C.S.); (A.B.)
| | - Lidia Puzzo
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Anatomic Pathology Section, University of Catania, Via Santa Sofia, 78-95123 Catania, Italy; (L.P.); (R.G.)
| | - Rossella Garro
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Anatomic Pathology Section, University of Catania, Via Santa Sofia, 78-95123 Catania, Italy; (L.P.); (R.G.)
| | - Gaetano Inserra
- Department of Clinical and Experimental Medicine, U.O. Medicina Interna, University of Catania, Via Santa Sofia, 78-95123 Catania, Italy; (G.I.); (G.R.)
| | - Gaia Riguccio
- Department of Clinical and Experimental Medicine, U.O. Medicina Interna, University of Catania, Via Santa Sofia, 78-95123 Catania, Italy; (G.I.); (G.R.)
| | - Luca Zanoli
- Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia, 78-95123 Catania, Italy;
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia, 78-95123 Catania, Italy; (M.T.); (R.F.); (S.P.); (M.C.); (C.S.); (A.B.)
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Cicero G, Mazziotti S. Crohn's disease at radiological imaging: focus on techniques and intestinal tract. Intest Res 2020; 19:365-378. [PMID: 33232590 PMCID: PMC8566824 DOI: 10.5217/ir.2020.00097] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/02/2020] [Indexed: 11/05/2022] Open
Abstract
Over recent years, inflammatory bowel diseases have become an issue of increased attention in daily clinical practice, due to both a rising incidence and improved imaging capability in detection. In particular, the diagnosis of Crohn's disease is based on clinical picture, laboratory tests and colonoscopy with biopsy. However, colonoscopic evaluation is limited to the mucosal layer. Thus, imaging modalities play a pivotal role in enriching the clinical picture, delivering information on intestinal and extraintestinal involvement. All the imaging modalities can be employed in evaluation of Crohn's disease patients, each of them with specific strengths as well as limitations. In this wide selection, the choice of a proper diagnostic framework can be challenging for the clinician. Therefore, the aim of this work is to offer an overview of the different imaging techniques, with brief technical details and diagnostic potential related to each intestinal tract.
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Affiliation(s)
- Giuseppe Cicero
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Silvio Mazziotti
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
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da Silva Moraes AC, de Freitas Moraes G, de Araújo ALE, Luiz RR, Elia C, Carneiro AJ, de Souza HSP. Abdominal ultrasonography with color Doppler analysis in the assessment of ileal Crohn's disease: comparison with magnetic resonance enterography. Intest Res 2019; 17:227-236. [PMID: 30962408 PMCID: PMC6505095 DOI: 10.5217/ir.2018.00124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/13/2019] [Indexed: 02/07/2023] Open
Abstract
Background/Aims Consistently defining disease activity remains a critical challenge in the follow-up of patients with Crohn’s disease (CD). We investigated the potential applicability of abdominal ultrasonography with color Doppler (USCD) analysis for the detection of morphological alterations and inflammatory activity in CD. Methods Forty-three patients with CD ileitis/ileocolitis were evaluated using USCD analysis with measurements obtained on the terminal ileum and right colon. Sonographic parameters included wall thickening, stricture, hyperemia, presence of intra-abdominal mass, and fistulas. Patients were evaluated for the clinical activity (Harvey-Bradshaw Index [HBI]), fecal calprotectin (FC) and C-reactive protein (CRP). The USCD performance was assessed using magnetic resonance enterography (MRE) as a criterion standard. Results Most measurements obtained with USCD matched the data generated with MRE; however, the agreement improved in clinically active patients where sensitivity, positive predictive value, and accuracy were >80%, considering wall thickening and hyperemia. Complications such as intestinal wall thickening, stricture formation, and hyperemia, were detected in the USCD analysis with moderate agreement with MRE. The best agreement with the USCD analysis was obtained in regard to FC, where the sensitivity, positive predictive value, and accuracy were >70%. The overall performance of USCD was superior to that of HBI, FC and CRP levels, particularly when considering thickening, stricture, and hyperemia parameters. Conclusions USCD represents a practical noninvasive and low-cost tool for evaluating patients with ileal or ileocolonic disease, particularly in clinically active CD. Therefore, USCD might become a useful asset in the follow-up of patients with CD.
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Affiliation(s)
- Antonio Carlos da Silva Moraes
- Serviço de Gastroenterologia, Departamento de Clínica Médica, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Antonio Luis Eiras de Araújo
- Serviço de Radiologia, Departamento de Radiologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ronir Raggio Luiz
- Instituto de Estudos de Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Celeste Elia
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Antonio Jose Carneiro
- Serviço de Gastroenterologia, Departamento de Clínica Médica, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Heitor Siffert Pereira de Souza
- Serviço de Gastroenterologia, Departamento de Clínica Médica, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,D'Or Institute for Research and Education, Rio de Janeiro, Brazil
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Can MR Enterography and Diffusion-Weighted Imaging Predict Disease Activity Assessed by Simple Endoscopic Score for Crohn's Disease? J Belg Soc Radiol 2019; 103:10. [PMID: 30671568 PMCID: PMC6337050 DOI: 10.5334/jbsr.1521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose: Monitoring Crohn’s disease (CD) activity has a crucial importance, especially for evaluating treatment efficacy. Magnetic resonance enterography (MRE) and diffusion-weighted imaging (DWI) or their combination may represent potential non-invasive tools for this purpose. This study aimed to examine DWI and MRE for their potential to differentiate between different grades of ileocolonic CD activity. Materials and Methods: This retrospective study included 54 adult patients with a diagnosis of CD who underwent ileocolonoscopy and MRE including the DWI sequence. The severity of CD inflammation was categorized by Simple Endoscopic Score for Crohn’s Disease (SES-CD) as inactive, mild, moderate and severe. In addition, following conventional MRE and DWI parameters were examined: bowel wall thickness, mural T2 hyperintensity, contrast enhancement, DWI signal intensity, and apparent diffusion coefficient (ADC) values. Results: In patients with moderate to severe disease based on SES-CD, T2 hyperintensity score [1.68 ± 0.77 (1–3) vs. 2.19 ± 0.69 (1–3); p = 0.013] and mean DWI score [2.42 ± 0.58 (1–3) vs. 2.04 ± 0.69 (1–3); p = 0.037 ] were higher and mean ADC values [1.5 ± 0.4 (0.9–2.5) vs. 1.2 ± 0.3 (0.6–1.8)] were lower compared to patients with inactive to mild CD. ADC had a moderate diagnostic accuracy in predicting moderate to severe disease (AUC = 0.729, 95% CI = 0.591–0.841, p = 0.001), with a cut-off value of ≤1.47 × 10–3 mm2/sec yielded 88.5% (23/26) sensitivity, 57.1% (16/28) specificity. Conclusion: DWI, ADC and T2 signal appear to differentiate moderate to severe CD from inactive to mildly active CD, based on SES-CD evaluation and may be useful in monitoring disease activity, particularly when evaluating treatment response.
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Crohn Disease: A 5-Point MR Enterocolonography Classification Using Enteroscopic Findings. AJR Am J Roentgenol 2019; 212:67-76. [DOI: 10.2214/ajr.17.18897] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Koc G, Doganay S, Sevinc E, Deniz K, Chavhan G, Gorkem SB, Karacabey N, Dogan MS, Coskun A, Aslan D. Magnetic resonance enterography in pediatric celiac disease. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2017. [DOI: 10.1016/j.jpedp.2017.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Magnetic resonance enterography in pediatric celiac disease. J Pediatr (Rio J) 2017; 93:413-419. [PMID: 28153484 DOI: 10.1016/j.jped.2016.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/18/2016] [Accepted: 11/03/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To assess if magnetic resonance enterography is capable of showing evidence/extent of disease in pediatric patients with biopsy-proven celiac disease by comparing with a control group, and to correlate the magnetic resonance enterography findings with anti-endomysial antibody level, which is an indicator of gluten-free dietary compliance. METHODS Thirty-one pediatric patients (mean age 11.7±3.1 years) with biopsy-proven celiac disease and 40 pediatric patients as a control group were recruited in the study. The magnetic resonance enterography images of both patients with celiac disease and those of the control group were evaluated by two pediatric radiologists in a blinded manner for the mucosal pattern, presence of wall thickening, luminal distention of the small bowel, and extra-intestinal findings. Patient charts were reviewed to note clinical features and laboratory findings. The histopathologic review of the duodenal biopsies was re-conducted. RESULTS The mean duration of the disease was 5.6±1.8 years (range: 3-7.2 years). In 24 (77%) of the patients, anti-endomysial antibody levels were elevated (mean 119.2±66.6RU/mL). Magnetic resonance enterography revealed normal fold pattern in all the patients. Ten (32%) patients had enlarged mesenteric lymph nodes. CONCLUSION Although a majority of the patients had elevated anti-endomysial antibody levels indicating poor dietary compliance, magnetic resonance enterography did not show any mucosal abnormality associated with the inability of magnetic resonance enterography to detect mild/early changes of celiac disease in children. Therefore, it may not be useful for the follow-up of pediatric celiac disease.
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Ultrasound Shear Wave Elastography and Contrast Enhancement: Effective Biomarkers in Crohn's Disease Strictures. Inflamm Bowel Dis 2017; 23:421-430. [PMID: 28129289 DOI: 10.1097/mib.0000000000001020] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Inflammation, fibrosis, and muscular hypertrophy lead to thickened bowel in Crohn's disease forming strictures. Ultrasound shear wave elastography (SWE) measures bowel wall stiffness. Contrast-enhanced ultrasound (CEUS) uniquely detects bowel wall inflammation. We aim to correlate SWE of ileal Crohn's disease in vivo to CEUS peak enhancement and pathology grades of inflammation, fibrosis, and muscular hypertrophy. METHODS In a prospective institutional review board-approved study, 105 consecutive ileal patients with Crohn's disease received ultrasound. At maximal bowel wall thickness (>4 mm), SWE and CEUS were performed. Fifteen patients had ileal resection within a mean time interval of 71.0 ± 66.9 days. Pathology scores for inflammation, fibrosis, and muscular hypertrophy were compared with SWE and CEUS measurements. RESULTS Mean in vivo SWE velocity for patients with and without surgery was 2.8 ± 0.7 and 2.2 ± 0.8 m/s (P < 0.01), respectively. In all ileal specimens, chronic exceeded active inflammatory change (P < 0.001). There was an inverse relationship between CEUS peak enhancement and both fibrosis, r = -0.59, P = 0.02, and SWE velocity measurements, r = -0.61, P = 0.03. Strictured bowel specimens had more smooth muscle hypertrophy than fibrosis, P < 0.001. There was moderate correlation between SWE and muscular hypertrophy, r = 0.59, P = 0.02 and no significant relationship between SWE and fibrosis scores (P > 0.05). CONCLUSIONS Stiffer bowel from smooth muscle hypertrophy increases SWE measurements. We report a novel relation of high SWE with muscle hypertrophy, and inverse relationship with CEUS peak enhancement; providing differentiation between active and chronic bowel wall inflammation to improve selection between medical therapy and surgery.
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Diffusion-weighted MRI Enables to Accurately Grade Inflammatory Activity in Patients of Ileocolonic Crohn's Disease: Results from an Observational Study. Inflamm Bowel Dis 2017; 23:244-253. [PMID: 28079618 DOI: 10.1097/mib.0000000000001001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) is a novel technique to evaluate bowel inflammation in Crohn's disease (CD). It remains unclear whether DWI could differentiate grades of inflammation activity and add to the accuracy of conventional magnetic resonance enterography (MRE) in defining disease activity. We aimed to assess the accuracy of DWI for evaluating ileocolonic CD inflammation compared with conventional MRE, using ileocolonoscopy as reference standard. METHODS This was an observational study of CD patients who underwent both ileocolonoscopy and MRE with DWI. The conventional MRE and DWI findings of the ileocolon were scored from 0 to 3. The respective segment endoscopic disease activity was scored by simplified endoscopic score for Crohn's disease (SES-CD) and was graded as inactive (0-2), mild (3-6) or moderate-severe (≥7). RESULTS One hundred eighty-five bowel segments from 43 consecutive CD patients were evaluated and included inactive (n = 86), mild (n = 72), and moderate-severe (n = 27) ileo-colonic segments. The area under the receiver operating characteristics curve (AUC) of 0.973 for apparent diffusion coefficient (ADC) to differentiate active from inactive CD was significantly higher than those of conventional MRE parameters (AUC between 0.840 and 0.940). Higher accuracy of ADC (AUC = 0.919) for differentiating inactive-mild from moderate-severe CD was also shown compared with that of conventional MRE parameters (AUC between 0.868 and 0.915). ADC values demonstrated strongest correlation with SES-CD (r = -0.880) comparing to DWI SI and conventional MRE parameters (r between 0.787 and 0.867). CONCLUSIONS DWI enables to accurately grade inflammatory activity in patients of ileocolonic CD and may be better suited than conventional MRE for monitoring the activity of CD.
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Li XH, Sun CH, Mao R, Zhang ZW, Jiang XS, Pui MH, Chen MH, Li ZP. Assessment of Activity of Crohn Disease by Diffusion-Weighted Magnetic Resonance Imaging. Medicine (Baltimore) 2015; 94:e1819. [PMID: 26512584 PMCID: PMC4985398 DOI: 10.1097/md.0000000000001819] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
To assess the diagnostic efficacy of diffusion-weighted MR imaging (DWI) for evaluating inflammatory activity in patients with Crohn's disease (CD). A total of 47 CD patients underwent MR enterography (MRE) and DWI using 3 b values of 50, 400, and 800 s/mm. Apparent diffusion coefficients (ADCs) of inflamed and normal bowel wall were calculated. The conventional MRE findings and DWI signal intensities were qualitatively scored from 0 to 3. The correlation between Crohn disease activity index (CDAI) and both ADCs and magnetic resonance imaging scores was analyzed. Receiver-operating characteristic curve analysis was used to determine the diagnostic accuracy of CD activity. Of the 47 patients, 25 were active CD (CDAI≥150) and 22 were inactive (CDAI<150). Diffusion-weighted MR imaging and MRE + DWI scores of active CD were significantly higher than that of inactive CD (both P < 0.001). Apparent diffusion coefficients in inflamed segments of active CD were lower than that of inactive CD (P < 0.001). The DWI scores (r = 0.74, P < 0.001), ADCs (r = -0.71, P < 0.001), MRE scores (r = 0.54, P < 0.001), and MRE + DWI scores (r = 0.66, P < 0.001) were all correlated with CDAI. The areas under the receiver-operating characteristics curves for ADCs, DWI scores, MRE scores, and MRE + DWI scores ranged from 0.83 to 0.98. The threshold ADC value of 1.17 × 10 mm/s allowed differentiation of active from inactive CD with 100% sensitivity and 88% specificity. Diffusion-weighted MR imaging and ADC correlated with CD activity, and had excellent diagnostic accuracy for differentiating active from inactive CD.
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Affiliation(s)
- Xue-Hua Li
- From the Department of Radiology, (X-HL, C-HS, X-SJ, Z-PL); Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (RM, M-HC); Department of Radiology, UT Southwestern Medical Center, Dallas, TX (Z-WZ); and Department of Radiology, Conde de S. Januario Central Hospital, Macau, China (MHP)
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