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Ingenerf M, Schmid-Tannwald C. Diffusion-weighted imaging in Crohn's disease. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:27-33. [PMID: 37603068 DOI: 10.1007/s00117-023-01191-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Diffusion-weighted MRI (DWI) is routinely used in abdominal imaging. In addition to neoplastic diseases, inflammatory changes can be delineated and diagnosed based on diffusion restriction in DWI. DWI is also increasingly used in the context of MRI of the small and large intestine. OBJECTIVE This article focuses on the technical aspects of DWI and its role in the diagnosis of Crohn's disease (CD) as well as in the grading of disease severity and in treatment monitoring. MATERIALS AND METHODS Guidelines, basic research papers, and review articles were analyzed. RESULTS Diffusion-weighted MRI is a specialized MRI technique that visualizes the diffusion of water molecules in biological tissues. In the context of MRI of the small and large intestine, DWI facilitates the diagnosis of inflammatory bowel disease and assessment of treatment response. DWI enables detection of not only intra- and transmural changes, but also extramural pathologies and complications. However, DWI also has its limitations and challenges. CONCLUSION This article provides a comprehensive overview of the use of DWI for diagnostic evaluation of bowel wall changes and extramural complications in the setting of CD. It also summarizes the relevant evidence available in the literature.
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Affiliation(s)
- Maria Ingenerf
- Department of Radiology, University Hospital, LMU Munich, Ziemssenstr. 5, 80336, Munich, Germany
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Pierro A, Minordi LM, Larosa L, Guerri G, Grimaldi A, Quinto F, Rotondi F, Marcellino A, Bevere T, Basilico R, Iezzi R, Cilla S. Small Bowel Imaging from Stepchild of Roentgenology to MR Enterography: Part I: Guidance in Performing and Observing Normal and Abnormal Imaging Findings. Life (Basel) 2023; 13:1691. [PMID: 37629548 PMCID: PMC10455392 DOI: 10.3390/life13081691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
MRE has become a standard imaging test for evaluating patients with small bowel pathology, but the indications, interpretation of imaging findings, methodology, and appropriate use must be standardized and widely known. Several signs of small bowel damage in inflammatory and non-inflammatory small bowel pathology include strictures, abscess, inflammatory activity, sinus tract, wall edema, fistula, mucosal lesions, and mesentery fat hypertrophy, all of which are widely and accurately explained by MRE. MRE is a non-invasive modality that accurately assesses the intra-luminal, parietal, and extra-luminal small bowel. The differential MRE appearance allows us to distinguish between different small bowel pathologies, such as neoplastic and non-neoplastic small bowel diseases. The purpose of this paper is to present the MRE technique, as well as the interpretation of imaging findings, through the approach of a rigorous stepwise methodology.
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Affiliation(s)
- Antonio Pierro
- Radiology Unit, San Timoteo Hospital, 86039 Termoli, Italy; (A.P.); (T.B.)
| | - Laura Maria Minordi
- Radiology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (L.M.M.); (L.L.); (G.G.); (A.G.); (R.I.)
| | - Luigi Larosa
- Radiology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (L.M.M.); (L.L.); (G.G.); (A.G.); (R.I.)
| | - Giulia Guerri
- Radiology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (L.M.M.); (L.L.); (G.G.); (A.G.); (R.I.)
| | - Alessandro Grimaldi
- Radiology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (L.M.M.); (L.L.); (G.G.); (A.G.); (R.I.)
| | - Fabio Quinto
- Angiography Unit, “L. Bonomo” Hospital, 70031 Andria, Italy;
| | - Fabio Rotondi
- Oncological Surgery Unit, Gemelli Molise Hospital, 86100 Campobasso, Italy;
| | | | - Teresa Bevere
- Radiology Unit, San Timoteo Hospital, 86039 Termoli, Italy; (A.P.); (T.B.)
| | - Raffaella Basilico
- Department of Neurosciences, Imaging and Clinical Studies, “Gabriele D’Annunzio” University, 66100 Chiety, Italy;
| | - Roberto Iezzi
- Radiology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (L.M.M.); (L.L.); (G.G.); (A.G.); (R.I.)
| | - Savino Cilla
- Medical Physics Unit, Responsible Research Hospital, 86100 Campobasso, Italy
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Shumba S, Musonda P, Lombe D, Chongwe G, Kayamba V. Oesophageal cancer cases recorded in the Zambia National Cancer Registry: a cross-sectional study. Pan Afr Med J 2023; 44:128. [PMID: 37275285 PMCID: PMC10237221 DOI: 10.11604/pamj.2023.44.128.32907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 10/28/2022] [Indexed: 06/07/2023] Open
Abstract
Introduction the aim of this study was to determine what proportion of patients with confirmed esophageal cancer at the largest hospital in the country were recorded in the Zambia National Cancer Registry (ZNCR). Methods we reviewed esophageal cancer records at the University Teaching Hospital (UTH) and ZNCR, between 2015 and 2017. Using Stata version 15, data were summarised and the Kruskal-Wallis was used to compute comparisons, Kaplan-Meier curves for survival estimates and Cox regression for associated factors. Results included in the final analysis were records for 222 patients with confirmed esophageal cancer and of these 51/222 (41%) were appearing in the ZNCR. The mean age of the patients was 56.2 years (SD, 13.0) and only 2/222 (1%) were confirmed alive at the time of data analysis. The median time from endoscopic diagnosis to histological confirmation was 12.5 days (IQR 7.5 - 21.5) and arrival at the Cancer Diseases Hospital (CDH) for treatment was 20 days (IQR 10 - 34). The overall median survival time in the study was 259 days (CI 95%; 151 - 501). Age, sex, time to diagnosis, histological classification and grade of tumour did not show any evidence of predicting survival in both the univariate and multivariable cox regression model (p>0.05). Conclusion a significant proportion of esophageal cancer cases seen at UTH were not included in the national registry suggesting that official figures for the prevalence of esophageal cancer in Zambia are underestimated. There is an urgent need to improve the collection of data on esophageal cancer in Zambia.
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Affiliation(s)
- Samson Shumba
- University of Zambia School of Public Health, Department of Epidemiology and Biostatistics, Lusaka, Zambia
| | - Patrick Musonda
- University of Zambia School of Public Health, Department of Epidemiology and Biostatistics, Lusaka, Zambia
| | - Dorothy Lombe
- Cancer Diseases Hospital, Nationalist Road, Lusaka, Zambia
| | - Gershom Chongwe
- University of Zambia School of Public Health, Department of Epidemiology and Biostatistics, Lusaka, Zambia
- Tropical Diseases Research Centre, Ndola, Zambia
| | - Violet Kayamba
- Tropical Gastroenterology and Nutrition Group, University of Zambia School of Medicine, PO Box 50398, Lusaka, Zambia
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Kim PH, Yoon HM, Jung AY, Lee JS, Cho YA. Diagnostic Performance of Diffusion-weighted Imaging for Evaluation of Bowel Inflammation in Paediatric Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. J Crohns Colitis 2022; 16:68-78. [PMID: 34159379 DOI: 10.1093/ecco-jcc/jjab111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS The diagnostic performance of diffusion-weighted imaging magnetic resonance enterography [DWI-MRE] has not been clearly established in a paediatric population. We systematically evaluated the diagnostic performance of DWI-MRE for the detection of bowel inflammation in paediatric patients with suspected or known inflammatory bowel disease [IBD]. METHODS MEDLINE/PubMed, EMBASE, Web of science and the Cochrane library were searched for articles investigating the diagnostic performance of DWI-MRE for the detection of bowel inflammation in paediatric patients with suspected or known IBD up to December 31, 2020. Pooled sensitivity and specificity were calculated using a bivariate random-effects model. Pooled inter-reader agreement for the interpretation of DWI-MRE was also calculated. This study was registered as PROSPERO CRD42021228754. RESULTS Nine studies covering 400 paediatric patients were included. The pooled sensitivity and specificity of DWI-MRE for the detection of bowel inflammation were 0.93 (95% confidence interval [CI], 0.88-0.96) and 0.96 [95% CI, 0.87-0.99], respectively. Substantial heterogeneity was noted in both sensitivity [I2 = 66%; p < 0.01] and specificity [I2 = 94%; p < 0.01]. Meta-regression analysis identified that the use of spasmolytics contributed to higher specificity [0.89-0.99] and that quantitative assessment with an apparent diffusion coefficient cut-off value contributed to lower sensitivity [0.93-0.85] and specificity [0.98-0.72]. The pooled coefficient of inter-reader agreement, including four studies using visual assessment, was 0.97 [95% CI, 0.78-1.00]. CONCLUSIONS DWI-MRE, especially when used with spasmolytics, is accurate for the detection of bowel inflammation in paediatric patients with suspected or known IBD. Quantitative measurement of ADC is not practical for this purpose.
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Affiliation(s)
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Republic of Korea
| | - Ah Young Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Republic of Korea
| | - Jin Seong Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Republic of Korea
| | - Young Ah Cho
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Republic of Korea
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Kitazume Y, Tsuchiya J, Takenaka K, Ohtsuka K, Kimura K, Watanabe R, Fujioka T, Fujii T, Watanabe M, Tateisi U. High b-value computed diffusion-weighted imaging for differentiating bowel inflammation in Crohn's disease. Eur J Radiol 2020; 133:109362. [PMID: 33129103 DOI: 10.1016/j.ejrad.2020.109362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/13/2020] [Accepted: 10/18/2020] [Indexed: 11/27/2022]
Abstract
Purpose This study evaluated whether high b-value computed diffusion-weighted imaging (cDWI) can improve detection and differentiation of bowel inflammation in patients with Crohn's disease (CD). Methods Fifty-four consecutive CD patients who had undergone magnetic resonance enterography (MRE) and ileocolonoscopy (ICS) or balloon-assisted enteroscopy (BAE) were retrospectively studied; cDWI with a b-value = 1500s/mm2 (cDWI1500) was generated using DWI acquired with b-values of 0 and 800 s/mm2 (aDWI800). Overall, 366 bowel segments were evaluated. The signal intensities (SIs) of the bowel lumina were visually assessed on DWI. Bowel wall-to-iliopsoas muscle SI ratios on aDWI800 and cDWI1500 images and apparent diffusion coefficient (ADC) values were measured; visual assessments for lesion detection were performed using a 5-point Likert-like scale on plain MRE with aDWI800, plain MRE with cDWI1500, and contrast-enhanced (CE)-MRE without DWI. The area under the receiver-operating characteristic curve (AUC) was calculated to compare quantitative and qualitative assessments. Results SIs of the intraluminal fluid were shown as comparable to, or lower than background SIs on 157 (44.7 %) and 345 (98.3 %) of 351 segments on aDWI800 and cDWI1500, respectively. AUCs of SI ratios on cDWI1500 images (82.0 %, [95 % confidence interval: 76.6-87.3 %]) were greater than on aDWI800 (75.2 %, [68.2-82.3 %]; p < 0.001), and were close to the ADC values (81.5 % [76.3-86.7 %]; p = 0.76). The AUCs of CE-MRE images were largest, followed by plain MRE with cDWI1500, and plain MRE with aDWI800. Conclusions As it suppresses the SIs of intraluminal fluid and improves contrast between severe and non-severe inflammation, cDWI1500 helps with CD evaluation.
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Affiliation(s)
- Yoshio Kitazume
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Junichi Tsuchiya
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Kento Takenaka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuo Ohtsuka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koichiro Kimura
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Ryosuke Watanabe
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Tomoyuki Fujioka
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Toshimitsu Fujii
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mamoru Watanabe
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan; TMDU Advanced Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ukihide Tateisi
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
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Potential MR Enterography Features to Differentiate Primary Small Intestinal Lymphoma From Crohn Disease. AJR Am J Roentgenol 2020; 215:864-873. [PMID: 32755202 DOI: 10.2214/ajr.19.22158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE. The purpose of this study was to assess the MR enterographic features of primary small intestinal lymphoma (PSIL) and compare them with active Crohn disease (CD) presenting with severe (≥ 10 mm) mural thickening of the small bowel. MATERIALS AND METHODS. This retrospective study included 15 patients with pathologically proven PSIL and 15 patients with active inflammatory CD with severe mural thickening. Various morphologic, enhancement, and diffusion parameters were compared between the two groups at MR enterography. The ratios of the upstream to involved luminal diameter and mural thickness to luminal diameter in the involved segment were calculated. An attempt was made to define a predictive model (morphologic score) for discriminating PSIL from CD with severe mural thickening. RESULTS. Patients with PSIL were more likely than those with CD to have unifocal disease (66.7% vs 20.0%, p = 0.025), circumferential involvement (86.7% vs 26.7%, p < 0.001), luminal dilatation (60.0% vs 7.0%, p = 0.005), and an attenuated fold pattern (53.3% vs none, p < 0.001). They were less likely to have serosal surface involvement (40.0% vs 100%, p = 0.001) and mesenteric fat infiltration (33.3% vs 100%, p < 0.001). Median upstream to involved luminal diameter ratio (1.5 vs 9.6, p < 0.001) and mural thickness to involved luminal diameter ratio (1.1 vs 4.3, p = 0.044) were significantly lower in patients with PSIL than in those with CD with severe mural thickening. No significant difference was observed in enhancement and diffusion measures. Morphologic score was based on the presence of luminal dilatation, unifocal involvement, mesenteric fat infiltration, and luminal stricture, yielding accuracy of 98% for differentiation between PSIL and CD with severe mural thickening. CONCLUSION. Morphologic features seen at MR enterography rather than enhancement or diffusion parameters may be valuable for differentiation of PSIL from active CD with severe mural thickening with significantly lower ratios of upstream to involved luminal diameter and mural thickness to involved luminal diameter in PSIL.
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Cansu A, Bekircavusoglu S, Oguz S, Bulut E, Fidan S. Can diffusion weighted imaging be used as an alternative to contrast-enhanced imaging on magnetic resonance enterography for the assessment of active inflammation in Crohn disease? Medicine (Baltimore) 2020; 99:e19202. [PMID: 32080107 PMCID: PMC7034637 DOI: 10.1097/md.0000000000019202] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The present study aimed to investigate the potential use of T2-weighted sequences with diffusion weighted imaging (DWI) in magnetic resonance (MR) enterography instead of conventional contrast-enhanced MR imaging (MRI) sequences for the evaluation of active inflammation in Crohn disease.Two-hundred thirteen intestinal segments of 43 patients, who underwent colonoscopy within 2 weeks before or after MR enterography were evaluated in this retrospective study. DWI sequences, T2-weighted sequences, and contrast-enhanced T1-weighted sequences were acquired in the MR enterography scan after cleaning of the bowel and using an oral contrast agent. First, the intestinal segments that had active inflammation in MR enterography were qualitatively evaluated in T2-weighted and contrast-enhanced T1-weighted sequences and then MR activity index (MRAI 1) and MRAI 2 were formed with and without contrast-enhanced sequences in 2 separate sessions.The correlation coefficient between contrast enhanced and DWI MR enterography scores (MRAI 1 and MRAI 2) of intestinal inflammation was 0.97 for all segments. In addition, separate correlation coefficients were calculated for terminal ileum, right colon, transverse colon, left colon, and rectum, and there was a strong correlation between the MRAI 1 and MRAI 2 scores of each segment (r = 0.86-0.97, P < .001). On the other hand, MR enterography had 88.7% sensitivity, 97.9% specificity, 95.5% positive predictive value, 94.6% negative predictive value, and 94.8% accuracy for detection of active inflammation in all intestinal segments in Crohn disease.DWI and T2-weighted sequences acquired with cleaning of the bowel can be used instead of contrast-enhanced MRI sequences for the evaluation of active inflammation in Crohn disease.
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Affiliation(s)
- Aysegul Cansu
- Karadeniz Technical University, Faculty of Medicine, Department of Radiology
| | | | - Sukru Oguz
- Karadeniz Technical University, Faculty of Medicine, Department of Radiology
| | - Eser Bulut
- Trabzon Kanuni Education and Research Hospital, Department of Radiology
| | - Sami Fidan
- Karadeniz Technical University, Faculty of Medicine, Department of Gastroenterology, Trabzon, Turkey
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Goyal P, Shah J, Gupta S, Gupta P, Sharma V. Imaging in discriminating intestinal tuberculosis and Crohn's disease: past, present and the future. Expert Rev Gastroenterol Hepatol 2019; 13:995-1007. [PMID: 31559871 DOI: 10.1080/17474124.2019.1673730] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Intestinal tuberculosis (ITB) and Crohn's disease (CD) have similar clinical presentation, but require different treatment approaches. Despite advances in various endoscopic, imaging, microbiological, and histological techniques, the differentiation of these two entities is often difficult. Newer radiological and image acquisition modalities have now become indispensable tools for evaluation of these two diseases.Areas covered: This review summarizes the currently available literature on various radiological investigations to differentiate ITB from CD. This review also enumerates the newer modalities in image acquisition techniques and their potential role for differentiating these two diseases. At present abdominal computed tomography (CT) scan is used as a first line investigation for differentiating ITB from CD. Magnetic resonance imaging (MRI) is preferred in pediatric patients and for follow-up studies.Expert opinion: Role of newer modalities like contrast enhanced abdominal ultrasound, perfusion CT, advanced MRI and positron emission tomography (PET) is evolving and requires further exploration. Till further robust studies are available, differentiation between ITB and CD requires use of a combination of clinical, endoscopic, serological, histological, and radiological parameters rather than relying on a single test.
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Affiliation(s)
- Pradeep Goyal
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Jimil Shah
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sonali Gupta
- Department of Medicine, St. Vincent's Medical Center, Bridgeport, CT, USA.,Department of Medicine, The Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Pankaj Gupta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Mathur P, Sharma R, Kandasamy D, Kedia S, Gamanagatti S, Ahuja V. Can ADC be used as a surrogate marker of response to therapy in intestinal tuberculosis? Abdom Radiol (NY) 2019; 44:3006-3018. [PMID: 31175381 DOI: 10.1007/s00261-019-02090-4] [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] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the utility of Diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) in assessing treatment response in patients of intestinal tuberculosis (ITB). METHOD AND MATERIALS MR Enterography (MRE) was done for patients with suspicion of ITB and 19 patients with pre- and post-treatment imaging were included in the analysis. MRE included T1W, T2W, post-contrast T1W, and DWI sequences. DWI was done using b values-0, 400 and 800 s/mm2, and ADC maps were generated. The trace DW images and ADC values were compared before and after therapy. Composite gold standard (clinical, colonoscopic criteria, and biopsy) was used to assess treatment response and to classify into no response, partial response, and complete response. RESULTS Thirty-one bowel segments were evaluated at baseline and after treatment in 19 patients. Prior to therapy, restricted diffusion was seen in 29/31 (93.5%) segments. After treatment, patients with either complete or partial response (27/31 segments, 15 patients) showed significant rise in mean ADC values from 1.1 ± 0.37 × 10-3 to 2.1 ± 0.64 × 10-3 mm2/s (p value < 0.05), whereas no significant change was found in mean ADC values of non-responders (4/29 segments in 4 patients) which increased from 1.0 ± 0.1 × 10-3 mm2/s on baseline scan to 1.32 ± 0.2 × 10-3 mm2/s on post-treatment scan (p value = 0.318). An increase in ADC value was found to be a reliable and objective marker of improvement with response to therapy. CONCLUSION ADC values show good correlation with treatment response in ITB and can be used for objectively quantifying it.
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Kedia S, Sharma R, Makharia G, Ahuja V, Desai D, Kandasamy D, Eapen A, Ganesan K, Ghoshal UC, Kalra N, Karthikeyan R, Madhusudhan KS, Philip M, Puri A, Puri S, Sinha SK, Banerjee R, Bhatia S, Bhat N, Dadhich S, Dhali GK, Goswami BD, Issar SK, Jayanthi V, Misra SP, Nijhawan S, Puri P, Sarkar A, Singh SP, Srivastava A, Abraham P, Ramakrishna BS. Indian guidelines on imaging of the small intestine in Crohn's disease: A joint Indian Society of Gastroenterology and Indian Radiology and Imaging Association consensus statement. Indian J Radiol Imaging 2019; 29:111-132. [PMID: 31367083 PMCID: PMC6639863 DOI: 10.4103/ijri.ijri_153_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The Indian Society of Gastroenterology (ISG) Task Force on Inflammatory Bowel Disease and the Indian Radiological and Imaging Association (IRIA) developed combined ISG-IRIA evidence-based best-practice guidelines for imaging of the small intestine in patients suspected to have or having Crohn's disease. The 29 consensus statements, developed through a modified Delphi process, are intended to serve as reference for teaching, clinical practice, and research.
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Affiliation(s)
- Saurabh Kedia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- Radiadiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Govind Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Devendra Desai
- Division of Gastroenterology, P D Hinduja Hospital, Mumbai, Maharashtra, India
| | | | - Anu Eapen
- Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
| | - Karthik Ganesan
- Department of Radiodiagnosis, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India
| | - Naveen Kalra
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - R Karthikeyan
- Department of Radiodiagnosis, SRM Institute of Medical Sciences and Research, Chennai, India
| | | | - Mathew Philip
- Department of Gastroenterology, PVS Memorial Hospital, Kochi, Kerala, India
| | - Amarender Puri
- Department of Gastroenterology, GB Pant Institute of Medical Education and Research, New Delhi, India
| | - Sunil Puri
- Department of Radiodiagnosis, GB Pant Institute of Medical Education and Research, New Delhi, India
| | - Saroj K Sinha
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupa Banerjee
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Shobna Bhatia
- Department of Gastroenterology, KEM Hospital, Mumbai, India
| | - Naresh Bhat
- Department of Gastroenterology, Aster CMI Hospital, Bengaluru, Karnataka, India
| | - Sunil Dadhich
- Department of Gastroenterology, SN Medical College, Jodhpur, Rajasthan, India
| | - G K Dhali
- Department of Gastroenterology, School of Digestive and Liver Diseases, Institute of Post Graduate Medical, Education and Research, Kolkata, West Bengal, India
| | - B D Goswami
- Department of Gastroenterology, Guwahati Medical College, Guwahati, Assam, India
| | - S K Issar
- Department of Gastroenterology, Jawaharlal Nehru Hospital and Research Centre, Bhilai, Chhattishgarh, India
| | - V Jayanthi
- Department of Gastroenterology, Gleneagles Global Hospitals, Chennai, India
| | - S P Misra
- Department of Gastroenterology, MLN Medical College, Allahabad, UP, India
| | - Sandeep Nijhawan
- Department of Gastroenterology, Gleneagles Global Hospitals, Chennai, India
| | - Pankaj Puri
- Department of Gastroenterology, Military Hospital, Jodhpur, Rajasthan, India
| | - Avik Sarkar
- Department of Radiodiagnosis, School of Digestive and Liver Diseases, Institute of Post Graduate Medical, Education and Research, Kolkata, West Bengal, India
| | - S P Singh
- Department of Gastroenterology, SCB Medical College, Cuttack, Odisha, India
| | - Anshu Srivastava
- Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India
| | - Philip Abraham
- Division of Gastroenterology, P D Hinduja Hospital, Mumbai, Maharashtra, India
| | - B S Ramakrishna
- Department of Gastroenterology, SRM Institute of Medical Sciences and Research, Chennai, India
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Cheng J, Wang K, Leng X, Wang Y, Xu G, Wu G. Evaluating the inflammatory activity in Crohn's disease using magnetic resonance diffusion kurtosis imaging. Abdom Radiol (NY) 2019; 44:2679-2688. [PMID: 31093729 DOI: 10.1007/s00261-019-02013-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To explore the feasibility of diffusion kurtosis imaging (DKI) for evaluating inflammatory activity in Crohn's disease (CD). MATERIALS AND METHODS In all, 51 CD patients were included, who were performed with consecutive enteroscopy, MR and DKI (b values = 0-2000 mm2/s). The lesions of bowel segments were graded as inactive (0-2), mild (3-6), and moderate-severe group (> 6) based on simplified endoscopic activity score for Crohn's disease (SES-CD), The abilities of the parameters of DKI and DWI in grading different activity lesions were compared. RESULTS One hundred and twenty-seven bowel segments including inactive (15), mild (45) and moderate-severe (67) were analyzed. ADC (r = - 0.627, p < 0.001), Dapp (r = - 0.381, p < 0.001) and Kapp (r = 0.641, p < 0.001) were correlated with SES-CD. These parameters were significantly different among the three groups (all p < 0.001). ROC analysis found ADC had the highest accuracy (AUC = 0.884, p < 0.001) to differentiate inactive from active group with the threshold at 0.865 × 10-3 mm2/s, which was slightly higher than Kapp (AUC = 0.867, p < 0.001) with the threshold at 0.645, and was obviously higher than Dapp (AUC = 0.726, p = 0.005). Similarly, ADC also had the highest accuracy (AUC = 0.846, p < 0.001) to differentiate inactive-mild from moderate-severe group with the threshold at 0.825 × 10-3 mm2/s, and minimally higher than Kapp (AUC = 0.843, p < 0.001) with the threshold at 0.695, and obviously higher than Dapp (AUC = 0.690, p < 0.001). CONCLUSION DKI is feasible and comparable to conventional DWI for the evaluation of inflammatory activity in CD.
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Affiliation(s)
- Jingyun Cheng
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China
| | - Ke Wang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China
| | - Xiaoyuan Leng
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China
| | - Yan Wang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China
| | - Guobin Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China.
| | - Guangyao Wu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China.
- Radiology Department, Shenzhen University General Hospital and Shenzhen University Clinical Medical Academy, Shenzhen, People's Republic of China.
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Apine I, Baduna M, Pitura R, Pokrotnieks J, Krumina G. The Influence of Bowel Preparation on ADC Measurements: Comparison between Conventional DWI and DWIBS Sequences. Medicina (B Aires) 2019; 55:medicina55070394. [PMID: 31330916 PMCID: PMC6681204 DOI: 10.3390/medicina55070394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/10/2019] [Accepted: 07/18/2019] [Indexed: 11/16/2022] Open
Abstract
Background and objectives: The aim of the study was to assess whether there were differences between apparent diffusion coefficient (ADC) values of diffusion-weighted imaging (DWI) and diffusion-weighted imaging with background body signal suppression (DWIBS) sequences in non-prepared and prepared bowels before and after preparation with an enteric hyperosmolar agent, to assess whether ADC measurements have the potential to avoid bowel preparation and whether ADC-DWIBS has advantages over ADC-DWI. Materials and Methods: 106 adult patients without evidence of inflammatory bowel disease (IBD) underwent magnetic resonance (MR) enterography before and after bowel preparation. ADC-DWI and ADC-DWIBS values were measured in the intestinal and colonic walls demonstrating high signal intensity (SI) at DWI tracking images of b = 800 s/mm2 before and after preparation. Results: There were significant difference (p < 0.0001) in both ADC-DWI and ADC-DWIBS results between non-prepared and prepared jejunum for DWI being 1.09 × 10−3 mm2/s and 1.76 × 10−3 mm2/s, respectively, and for DWIBS being 0.91 × 10−3 mm2/s and 1.75 × 10−3 mm2/s, respectively. Both ADC-DWI and DWIBS also showed significant difference between non-prepared and prepared colon (p < 0.0001), with DWI values 1.41 × 10−3 mm2/s and 2.13 × 10−3 mm2/s, and DWIBS—1.01 × 10−3 mm2/s and 2.04 × 10−3 mm2/s, respectively. No significant difference between ADC-DWI and ADC-DWIBS was found in prepared jejunum (p = 0.84) and prepared colon (p = 0.58), whereas a significant difference was found in non-prepared jejunum and non-prepared colon (p = 0.0001 in both samples). Conclusions: ADC between DWI and DWIBS does not differ in prepared bowel walls but demonstrates a difference in non-prepared bowel. ADC in non-prepared bowel is lower than in prepared bowel and possible overlap with the ADC range of IBD is possible in non-prepared bowel. ADC-DWIBS has no advantage over ADC-DWI in regard to IBD assessment.
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Affiliation(s)
- Ilze Apine
- Children Clinical University Hospital, LV-1004 Riga, Latvia.
- Department of Diagnostic Radiology, Riga Stradin's University, LV-1038 Riga, Latvia.
| | - Monta Baduna
- Department of Diagnostic Radiology, Riga Stradin's University, LV-1038 Riga, Latvia
| | - Reinis Pitura
- Faculty of Medicine, Riga Stradin's University, LV-1007 Riga, Latvia
| | - Juris Pokrotnieks
- Department of Internal Diseases, Riga Stradin's University, LV-1038 Riga, Latvia
| | - Gaida Krumina
- Department of Diagnostic Radiology, Riga Stradin's University, LV-1038 Riga, Latvia
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Masselli G, De Vincentiis C, Aloi M, Guida M, Cao R, Cartocci G, Miele V, Grassi R. Detection of Crohn’s disease with diffusion images versus contrast-enhanced images in pediatric using MR enterography with histopathological correlation. Radiol Med 2019; 124:1306-1314. [DOI: 10.1007/s11547-019-01067-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/07/2019] [Indexed: 02/07/2023]
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14
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Puylaert CAJ, Tielbeek JAW, Schüffler PJ, Nio CY, Horsthuis K, Mearadji B, Ponsioen CY, Vos FM, Stoker J. Comparison of contrast-enhanced and diffusion-weighted MRI in assessment of the terminal ileum in Crohn's disease patients. Abdom Radiol (NY) 2019; 44:398-405. [PMID: 30109377 DOI: 10.1007/s00261-018-1734-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of the study was to compare the performance of contrast-enhanced (CE)-MRI and diffusion-weighted imaging (DW)-MRI in grading Crohn's disease activity of the terminal ileum. METHODS Three readers evaluated CE-MRI, DW-MRI, and their combinations (CE/DW-MRI and DW/CE-MRI, depending on which protocol was used at the start of evaluation). Disease severity grading scores were correlated to the Crohn's Disease Endoscopic Index of Severity (CDEIS). Diagnostic accuracy, severity grading, and levels of confidence were compared between imaging protocols and interobserver agreement was calculated. RESULTS Sixty-one patients were included (30 female, median age 36). Diagnostic accuracy for active disease for CE-MRI, DW-MRI, CE/DW-MRI, and DW/CE-MRI ranged between 0.82 and 0.85, 0.75 and 0.83, 0.79 and 0.84, and 0.74 and 0.82, respectively. Severity grading correlation to CDEIS ranged between 0.70 and 0.74, 0.66 and 0.70, 0.69 and 0.75, and 0.67 and 0.74, respectively. For each reader, CE-MRI values were consistently higher than DW-MRI, albeit not significantly. Confidence levels for all readers were significantly higher for CE-MRI compared to DW-MRI (P < 0.001). Further increased confidence was seen when using combined imaging protocols. CONCLUSIONS There was no significant difference of CE-MRI and DW-MRI in determining disease activity, but the higher confidence levels may favor CE-MRI. DW-MRI is a good alternative in cases with relative contraindications for the use of intravenous contrast medium.
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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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Rapp JB, Anupindi SA, Maya CL, Biko DM. Assessment of normal jejunum with diffusion-weighted imaging on MRE in children. Pediatr Radiol 2018; 48:1763-1770. [PMID: 30066156 DOI: 10.1007/s00247-018-4200-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/14/2018] [Accepted: 06/25/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Diffusion restriction has been utilized as a marker for bowel inflammation on magnetic resonance enterography (MRE). However, diffusion restriction has been seen in otherwise normal appearing small bowel in patients without active inflammation, with little published data on this subject. OBJECTIVE Assess diffusion restriction in normal loops of jejunum and to determine if there is a correlation to luminal distention, age, magnet field strength, slice thickness, and bowel segment location. MATERIALS AND METHODS A retrospective analysis of subjects with a normal MRE and clinical work-up was performed. The abdomen was divided into four quadrants. If available, two loops of jejunum were randomly chosen in each quadrant. Two radiologists evaluated the loops of jejunum for distension, wall thickness, enhancement and diffusion restriction. Disagreement was resolved by consensus. Presence of diffusion restriction was correlated with luminal distension, age, magnet field strength, slice thickness and abdominal quadrant. RESULTS One hundred ninety-seven loops of jejunum were evaluated in 39 subjects. Fifteen subjects (38.5%) had jejunal loops with diffusion restriction for a total of 28 loops. There was no correlation between diffusion restriction and luminal distension, age, magnet field strength or quadrant location (P>0.05, Pearson chi-squared test or Student's t-tests). Of the 15 subjects with a loop demonstrating diffusion restriction, additional loops with diffusion restriction were found in 40%. There was a very weak trend observed for greater slice thickness in patients with jejunal diffusion restriction (Student's t-test, P=0.10). CONCLUSION Jejunal diffusion restriction is a common finding in children with no clinical evidence of bowel pathology, irrespective of patient age, luminal distension, location of bowel loop and magnetic field strength. Further studies may be valuable in assessing the impact of slice thickness on subjective diffusion restriction in the jejunum.
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Affiliation(s)
- Jordan B Rapp
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Sudha A Anupindi
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Carolina L Maya
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - David M Biko
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Diagnostic Value of Diffusion-Weighted Imaging and Apparent Diffusion Coefficient in Assessment of the Activity of Crohn Disease: 1.5 or 3 T. J Comput Assist Tomogr 2018; 42:688-696. [PMID: 29958199 PMCID: PMC6296832 DOI: 10.1097/rct.0000000000000754] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective The objective of this study is to evaluate the role of diffusion-weighted imaging (DWI) in assessment of the activity of Crohn disease (CD) and to explore differences between DWI in 3 T and 1.5 T. Methods Postcontrast magnetic resonance enterography with DWI of 72 patients with pathological proof of CD was retrospectively evaluated for restricted diffusion qualitatively and quantitavely in 3 T (n = 40) and 1.5 T (n = 32). Magnetic resonance activity score of 7 or higher was used as reference of activity. Results Fifty-five patients had active lesions. Diffusion-weighted imaging hyperintensity showed sensitivity (100%, 100%) and specificity (88.89%, 100%) in 1.5/3 T for activity assessment. Mean ± SD apparent diffusion coefficient for active lesions was 1.21 ± 0.42 and 1.28 ± 0.59 × 10−3 mm2/s in 1.5 and 3 T, respectively. The proposed cutoff values of 1.35 and 1.38 × 10−3 mm2/s in 1.5 and 3 T, respectively, had sensitivity (80%, 93%), specificity (100%, 90%), accuracy (88%, 93%), and no significant difference in accuracy between 1.5/3 T (P = 0.48). Conclusions Diffusion-weighted imaging hypersensitivity and apparent diffusion coefficient values accurately assessed the activity of CD. No significant statistical difference in diagnostic accuracy was detected between 1.5 and 3 T.
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Abstract
PURPOSE OF REVIEW Cross-sectional imaging, namely ultrasound, CT and MR enterography, complements clinical and endoscopic monitoring of activity and complications in IBD, and emerging new radiological technologies may have clinical applications in the near future. This review offers an update on the potential role of these new imaging methods in the management of IBD. RECENT FINDINGS Specific MR techniques [diffusion-weighted imaging (DWI), diffusion kurtosis imaging (DKI) and magnetization transfer] allow accurate detection of inflammation (DWI and maybe DKI) and fibrosis (magnetization transfer) in Crohn's disease, without the need of intravenous gadolinium administration. ultrasonography developments (elastography, contrast-enhanced ultrasonography, small intestine contrast ultrasonography and multispectral optoacoustic tomography) are promising techniques for evaluation of fibrosis (elastography) and inflammation (contrast ultrasonography). Dose-reduction techniques in CT allow similar quality imaging and diagnostic accuracy with lower radiation exposure. Hybrid imaging (PET/MR and PET/CT) hold promise for grading inflammation in Crohn's disease. SUMMARY The potential benefits of new cross-sectional imaging techniques in IBD include better inflammation grading, such as identification of mild degree of activity, which may be relevant whenever assessing response to treatment and, of uttermost importance, accurate preoperative detection and grading of fibrosis in stricturing Crohn's disease, facilitating surgical vs. medical therapeutic decisions.
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Pouillon L, Laurent V, Pouillon M, Bossuyt P, Bonifacio C, Danese S, Deepak P, Loftus EV, Bruining DH, Peyrin-Biroulet L. Diffusion-weighted MRI in inflammatory bowel disease. Lancet Gastroenterol Hepatol 2018; 3:433-443. [DOI: 10.1016/s2468-1253(18)30054-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 12/17/2022]
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Rozendorn N, Amitai MM, Eliakim RA, Kopylov U, Klang E. A review of magnetic resonance enterography-based indices for quantification of Crohn's disease inflammation. Therap Adv Gastroenterol 2018; 11:1756284818765956. [PMID: 29686731 PMCID: PMC5900818 DOI: 10.1177/1756284818765956] [Citation(s) in RCA: 33] [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: 11/14/2017] [Accepted: 02/28/2018] [Indexed: 02/04/2023] Open
Abstract
Magnetic resonance enterography (MRE) is a leading radiological modality in Crohn's disease (CD) and is used together with laboratory findings and endoscopic examinations for the evaluation of patients during initial diagnosis and follow up. Over the years, there has been great progress in the understanding of CD and there is a continuous strive to achieve better monitoring of patients and to develop new modalities which will predict disease course and thus help in clinical decisions making. An objective evaluation of CD using a quantification score is not a new concept and there are different clinical, endoscopies, radiological and combined indices which are used in clinical practice. Such scores are a necessity in clinical trials on CD for evaluation of disease response, however, there is no consensus of the preferred MRE score and they are not routinely used. This review presents MRE-based indices in use in the last decade: the Magnetic Resonance Index of Activity (MaRIA), the Clermont score, the Crohn's Disease Magnetic Resonance Imaging (MRI) Index (CDMI), the Magnetic Resonance Enterography Global Score (MEGS) and the Lemann index. We compare the different indices and evaluate the clinical research that utilized them. The aim of this review is to provide a reference guide for researchers and clinicians who incorporate MRE indices in their work. When devising future indices, accumulated data of the existing indices must be taken into account, as each of the current indices has its own strengths and weakness.
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Affiliation(s)
| | | | | | - Uri Kopylov
- Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
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Capsule Endoscopy Crohn's Disease Activity Index (CECDAIic or Niv Score) for the Small Bowel and Colon. J Clin Gastroenterol 2018; 52:45-49. [PMID: 27753700 DOI: 10.1097/mcg.0000000000000720] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND THE STUDY AIM Crohn's disease (CD) is a chronic inflammatory disorder defined as a transmural inflammation of the bowel wall, affecting the small and large intestine. The Capsule Endoscopy Crohn's Disease Activity Index (CECDAI or Niv score) was devised to measure mucosal disease activity. We extended the Niv score to the colon and have a comprehensive view of the whole intestine. METHODS We evaluated 3 parameters of intestinal pathology: A, Inflammation; B, Extent of disease; C, Presence of strictures. The scoring formula is as follows: CEDCAIic=(A1×B1+C1)+(A2×B2+C2)+(A3×B3+C3)+(A4×B4+C4) (1=proximal small bowel, 2=distal small bowel, 3=right colon, 4=left colon). RESULTS The median CECDAIic score was 15.5 (range, 0 to 42), and the mean±SD score was 17.2±11.5. The CECDAIic scores per patient were similar among the 5 observers. Kendall's coefficient of concordance was high and significant for almost all the parameters examined except for strictures in the proximal small bowel and distal colon. Nevertheless, the coefficients for the small bowel and for the whole intestine were high, 0.85 and 0.77, P<0.0001, respectively. CONCLUSIONS We established a new score, the CECDAIic of the small-bowel and colonic CD. We offer this easy, user-friendly score for use in randomized controlled trials and in the clinical follow-up of CD patients.
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Kedia S, Sharma R, Makharia GK, Ahuja V, Desai D, Kandasamy D, Eapen A, Ganesan K, Ghoshal UC, Kalra N, Karthikeyan D, Madhusudhan KS, Philip M, Puri AS, Puri S, Sinha SK, Banerjee R, Bhatia S, Bhat N, Dadhich S, Dhali GK, Goswami BD, Issar SK, Jayanthi V, Misra SP, Nijhawan S, Puri P, Sarkar A, Singh SP, Srivastava A, Abraham P, Ramakrishna BS. Imaging of the small intestine in Crohn's disease: Joint position statement of the Indian Society of Gastroenterology and Indian Radiological and Imaging Association. Indian J Gastroenterol 2017; 36:487-508. [PMID: 29307029 DOI: 10.1007/s12664-017-0804-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 11/26/2017] [Indexed: 02/07/2023]
Abstract
The Indian Society of Gastroenterology (ISG) Task Force on Inflammatory Bowel Disease and the Indian Radiological and Imaging Association (IRIA) developed combined ISG-IRIA evidence-based best-practice guidelines for imaging of the small intestine in patients with suspected or known Crohn's disease. These 29 position statements, developed through a modified Delphi process, are intended to serve as reference for teaching, clinical practice, and research.
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Affiliation(s)
- Saurabh Kedia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Govind K Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India.
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Devendra Desai
- Division of Gastroenterology, P D Hinduja Hospital and Medical Research Centre, Veer Sawarkar Marg, Mumbai, 400 016, India
| | - Devasenathipathy Kandasamy
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Anu Eapen
- Department of Radiodiagnosis, Christian Medical College, Vellore, 632 004, India
| | - Karthik Ganesan
- Department of Radiodiagnosis, Sir H N Reliance Foundation Hospital and Research Centre, Prarthana Samaj, Raja Rammohan Roy Road, Mumbai, 400 004, India
| | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Naveen Kalra
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - D Karthikeyan
- Department of Radiodiagnosis, SRM Institutes for Medical Science, 1, Jawaharlal Nehru Salai, Vadapalani, Chennai, 600 026, India
| | | | - Mathew Philip
- Department of Gastroenterology, PVS Memorial Hospital, Kochi, 682 017, India
| | - Amarender Singh Puri
- Department of Gastroenterology, GB Pant Institute of Medical Education and Research, 1, Jawaharlal Nehru Marg, New Delhi, 110 002, India
| | - Sunil Puri
- Department of Radiodiagnosis, GB Pant Institute of Medical Education and Research, 1, Jawaharlal Nehru Marg, New Delhi, 110 002, India
| | - Saroj K Sinha
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Rupa Banerjee
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - Shobna Bhatia
- Department of Gastroenterology, KEM Hospital, Acharya Donde Marg, Parel, Mumbai, 400 012, India
| | - Naresh Bhat
- Department of Gastroenterology, Aster CMI Hospital, 43/2, New Airport Road, NH.7, Sahakara Nagar, Bengaluru, 560 092, India
| | - Sunil Dadhich
- Department of Gastroenterology, SN Medical College, Residency Road, Shastri Nagar, Jodhpur, 342 003, India
| | - G K Dhali
- Department of Gastroenterology, School of Digestive and Liver Diseases, Institute of Post Graduate Medical, Education and Research, Kolkata, 700 020, India
| | - B D Goswami
- Department of Gastroenterology, Guwahati Medical College, GMC Hospital Road, Bhangagarh, Guwahati, 781 032, India
| | - S K Issar
- Department of Gastroenterology, Jawaharlal Nehru Hospital and Research Centre, Hospital Sector, Bhilai, 490 009, India
| | - V Jayanthi
- Department of Gastroenterology, Gleneagles Global Hospitals, 439, Cheran Nagar, Perumbakkam, Chennai, 600 100, India
| | - S P Misra
- Department of Gastroenterology, MLN Medical College, Allahabad, 211 002, India
| | - Sandeep Nijhawan
- Department of Gastroenterology, SMS Medical College, J L N. Marg, Jaipur, 302 004, India
| | - Pankaj Puri
- Department of Gastroenterology, Military Hospital, Cantt Area, Jodhpur, 342 006, India
| | - Avik Sarkar
- Department of Radiodiagnosis, School of Digestive and Liver Diseases, Institute of Post Graduate Medical, Education and Research, Kolkata, 700 020, India
| | - S P Singh
- Department of Gastroenterology, SCB Medical College, Dock Road, Manglabag, Cuttack, 753 007, India
| | - Anshu Srivastava
- Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Philip Abraham
- Division of Gastroenterology, P D Hinduja Hospital and Medical Research Centre, Veer Sawarkar Marg, Mumbai, 400 016, India
| | - B S Ramakrishna
- Institute of Gastroenterology, SRM Institutes for Medical Science, 1, Jawaharlal Nehru Salai, Vadapalani, Chennai, 600 026, India
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Small-bowel mucosal healing assessment by capsule endoscopy as a predictor of long-term clinical remission in patients with Crohn's disease: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2017; 29:844-848. [PMID: 28410352 DOI: 10.1097/meg.0000000000000881] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Capsule endoscopy (CE) may be used for the evaluation and follow-up of patients with Crohn's disease. CE scores correspond to the degree of mucosal inflammation, a major therapeutic target. The aim of this meta-analysis and systematic review was to determine whether mucosal healing assessment by CE may serve as a predictor of clinical remission in patients with Crohn's disease. To identify observational or controlled English-language full-text studies assessing mucosal healing by CE in patients with Crohn's disease up to 30 September 2016, we searched PubMed, Embase, Central, Medline, and Scopus using the key words 'mucosal healing' and 'capsule endoscopy'. A meta-analysis was carried out using 'Comprehensive meta-analysis' software. Pooled odds ratios and 95% confidence intervals were calculated. Five observational studies including 142 patients from five countries fulfilled the inclusion criteria. No publication bias was found by funnel plot. The mucosal healing CE score was found to be significantly associated with improved outcome after a follow-up of 12 weeks to 24 months, with an odds ratio of 11.06 (95% confidence interval: 3.74-32.73, P<0.001). The degree of heterogeneity among the studies was small (Q=2.014, d.f.[Q]=3, P=0.569 and I=0). Endoscopy scores may play a role in the long-term prognostic evaluation of patients with Crohn's disease. Our results may be accepted as proof of concept, but larger studies are needed to corroborate these findings.
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Klang E, Kopylov U, Eliakim R, Rozendorn N, Yablecovitch D, Lahat A, Ben-Horin S, Amitai MM. Diffusion-weighted imaging in quiescent Crohn's disease: correlation with inflammatory biomarkers and video capsule endoscopy. Clin Radiol 2017; 72:798.e7-798.e13. [PMID: 28506799 DOI: 10.1016/j.crad.2017.04.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 03/05/2017] [Accepted: 04/04/2017] [Indexed: 02/08/2023]
Abstract
AIM To investigate the role of restricted diffusion in quiescent Crohn's disease (CD) patients and its association with inflammatory biomarkers and endoscopic disease. MATERIAL AND METHODS Fifty-two quiescent CD patients prospectively underwent magnetic resonance enterography (MRE) and video capsule endoscopy (VCE) and were tested for the inflammatory biomarkers, faecal calprotectin (FCP) and C-reactive protein (CRP). Restricted diffusion in the distal ileum was qualitatively (absence/presence) and quantitatively (apparent diffusion coefficient [ADC]) assessed by two readers. The VCE-based Lewis score was calculated for the distal ileum. Restricted diffusion sensitivity and specificity for VCE ulcerations were assessed for patients with elevated (>100 μg/g) or normal (<100 μg/g) FCP. Receiver operating characteristic (ROC) curve was used to assess the ability of ADC to identify patients with concurrent VCE ulceration and elevated FCP. RESULTS The sensitivity and specificity of restricted diffusion for patients with VCE ulceration were higher in patients with elevated FCP (reader 1: 71.4%, 80%, reader 2: 76.2%, 100%, respectively) compared to patients with normal FCP (reader 1: 46.2%, 61.5%; reader 2: 15.4%, 76.9%, respectively). The ADC had a high diagnostic accuracy for identifying patients that had concurrent VCE ulceration and elevated FCP (reader 1: AUC=0.819, reader 2: AUC=0.832). CONCLUSION In quiescent CD patients, the presence of restricted diffusion is suggestive of an active inflammation, associated with elevated FCP. Thus, DWI may serve as a clinical tool in the follow-up of these patients, implying subclinical inflammatory flares.
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Affiliation(s)
- E Klang
- Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Ramat Gan, Israel; Department of Gastroenterology, The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - U Kopylov
- Department of Gastroenterology, The Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - R Eliakim
- Department of Gastroenterology, The Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - N Rozendorn
- Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Ramat Gan, Israel; Department of Gastroenterology, The Chaim Sheba Medical Center, Ramat Gan, Israel.
| | - D Yablecovitch
- Department of Gastroenterology, The Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - A Lahat
- Department of Gastroenterology, The Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - S Ben-Horin
- Department of Gastroenterology, The Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - M M Amitai
- Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Ramat Gan, Israel; Department of Gastroenterology, The Chaim Sheba Medical Center, Ramat Gan, Israel
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MR Enterography Assessment of Bowel Inflammation Severity in Crohn Disease Using the MR Index of Activity Score: Modifying Roles of DWI and Effects of Contrast Phases. AJR Am J Roentgenol 2017; 208:1022-1029. [PMID: 28225669 DOI: 10.2214/ajr.16.17324] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this article is to appraise the use of the MR index of activity (MaRIA) score in evaluating Crohn disease (CD) on present-day MR enterography images, with an emphasis on determining the modifying roles of DWI and the effects of different contrast enhancement phases. SUBJECTS AND METHODS Fifty patients prospectively underwent MR enterography, including DWI and enteric and portal phase scans, and ileocolonoscopy with segmental CD endoscopic index of severity (CDEIS) scoring within a week. Thirty-nine terminal ilea and 40 right-sided colons (mean [± SD] segmental CDEIS score, 14.3 ± 12.1) from 42 patients with CD (mean age, 27 ± 6.2 years) were finally analyzed by three independent readers. Original and modified (ulcer replaced with DWI grade) MaRIA scores were compared regarding their correlation with segmental CDEIS score, accuracy in diagnosing active (segmental CDEIS score ≥ 3) and severe (segmental CDEIS score ≥ 12) inflammation, and interobserver reproducibility. The primary analysis used portal phase data, and the agreement between portal and enteric phase scores was analyzed. RESULTS MaRIA and modified MaRIA scores correlated similarly with CDEIS scores (r = 0.737 and 0.742; p = 0.387) and did not significantly differ in terms of AUC values for the diagnosis of active (0.909 and 0.903; p = 0.571) or severe (0.907 and 0.892; p = 0.443) inflammation. The intraclass correlation coefficient was significantly higher for modified MaRIA than for MaRIA (0.845 and 0.701; p < 0.001). The mean difference between portal and enteric phase scores (i.e., portal minus enteric) was 0.33-0.36 score points for individual readers, and the Bland-Altman repeatability coefficient was 0.9-1.42 score points. CONCLUSION Interobserver reproducibility in evaluating the severity of bowel inflammation in CD using the MaRIA score can be improved by modification with DWI. MaRIA scoring provides steady results across enteric and portal phases.
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Hahnemann M, Dechene A, Kathemann S, Sirin S, Gerken G, Lauenstein T, Kinner S. Diagnostic value of diffusion-weighted imaging (DWI) for the assessment of the small bowel in patients with inflammatory bowel disease. Clin Radiol 2017; 72:95.e1-95.e8. [DOI: 10.1016/j.crad.2016.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 07/28/2016] [Accepted: 08/18/2016] [Indexed: 12/22/2022]
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Bhatnagar G, Von Stempel C, Halligan S, Taylor SA. Utility of MR enterography and ultrasound for the investigation of small bowel Crohn's disease. J Magn Reson Imaging 2016; 45:1573-1588. [PMID: 27943484 DOI: 10.1002/jmri.25569] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/11/2016] [Indexed: 12/18/2022] Open
Abstract
Cross sectional Imaging plays an increasingly important role the diagnosis and management of Crohn's disease. Particular emphasis is placed on MRI and Ultrasound as they do not impart ionising radiation. Both modalities have reported high sensitivity for disease detection, activity assessment and evaluation of extra-luminal complications, and have positive effects on clinical decision making. International Guidelines now recommend MRI and Ultrasound in the routine management of Crohn's disease patients. This article reviews the current evidence base supporting both modalities with an emphasis on the key clinical questions. We describe current protocols, basic imaging findings and highlight areas in need of further research. LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 4 J. MAGN. RESON. IMAGING 2017;45:1573-1588.
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Affiliation(s)
- Gauraang Bhatnagar
- Frimley Park Hospital NHS Foundation Trust, London, UK.,Centre for Medical Imaging, University College London, London, UK
| | | | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
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Abstract
The majority of patients with Crohn's disease require abdominal surgery during their lifetime, some of whom will require multiple operations. Postoperative complications are seen more frequently in patients requiring abdominal surgery for Crohn's disease than in patients requiring abdominal surgery for other conditions. In this article, we review the evidence supporting preoperative optimization, discussing strategies that potentially improve surgical outcomes and reduce perioperative morbidity and mortality. We discuss the roles of adequate cross-sectional imaging, nutritional optimization, appropriate adjustments of medical therapy, management of preoperative abscesses and phlegmons, smoking cessation and thromboembolic prophylaxis. We also review operation-related factors, and discuss their potential implications with respect to postoperative complications. Overall, the literature suggests that preoperative management has a major effect on postoperative outcomes.
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Baliyan V, Das CJ, Sharma R, Gupta AK. Diffusion weighted imaging: Technique and applications. World J Radiol 2016; 8:785-798. [PMID: 27721941 PMCID: PMC5039674 DOI: 10.4329/wjr.v8.i9.785] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 06/11/2016] [Accepted: 08/15/2016] [Indexed: 02/06/2023] Open
Abstract
Diffusion weighted imaging (DWI) is a method of signal contrast generation based on the differences in Brownian motion. DWI is a method to evaluate the molecular function and micro-architecture of the human body. DWI signal contrast can be quantified by apparent diffusion coefficient maps and it acts as a tool for treatment response evaluation and assessment of disease progression. Ability to detect and quantify the anisotropy of diffusion leads to a new paradigm called diffusion tensor imaging (DTI). DTI is a tool for assessment of the organs with highly organised fibre structure. DWI forms an integral part of modern state-of-art magnetic resonance imaging and is indispensable in neuroimaging and oncology. DWI is a field that has been undergoing rapid technical evolution and its applications are increasing every day. This review article provides insights in to the evolution of DWI as a new imaging paradigm and provides a summary of current role of DWI in various disease processes.
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DWI in Pediatric Small-Bowel Crohn Disease: Are Apparent Diffusion Coefficients Surrogates for Disease Activity in Patients Receiving Infliximab Therapy? AJR Am J Roentgenol 2016; 207:1002-1008. [PMID: 27505635 DOI: 10.2214/ajr.16.16477] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this study was to determine prospectively whether bowel wall apparent diffusion coefficient (ADC) measurements can be used to monitor treatment response to infliximab therapy in the setting of pediatric small-bowel Crohn disease. SUBJECTS AND METHODS Twenty-eight pediatric subjects with newly diagnosed biopsy-proven Crohn disease of the distal or terminal ileum treated with infliximab were enrolled. Subjects underwent MR enterography at baseline, 1 month after therapy, and 6 months after therapy. Imaging features were documented, including bowel wall ADC and arterial or enteric phase contrast-enhanced signal intensity normalized to that of unenhanced imaging. A linear mixed model assessed the relationship between ADC and time; patient age and sex and azathioprine combination therapy were covariates. The diagnostic performance (with 95% CIs) of an increase in bowel wall ADC of 20% or more for identifying response to infliximab was calculated using a decrease in normalized contrast-enhanced bowel wall signal intensity of 20% or more as the reference standard. RESULTS Bowel wall ADC increased over time (mean [± SD], 1180 ± 200 × 10-6 mm2/s at baseline, 1420 ± 420 × 10-6 mm2/s at 1 month, and 1450 ± 450 × 10-6 mm2/s at 6 months; p = 0.0003); azathioprine therapy modulated this rate of change (p = 0.003). There was a statistically significant negative correlation between change in ADC and change in normalized contrast-enhanced signal intensity over time (ρ = -0.36; p < 0.001). The diagnostic performance of change in ADC for identifying response to infliximab therapy was sensitivity of 0.58 (95% CI, 0.34-0.80), specificity of 0.52 (95% CI, 0.31-0.72), positive predictive value of 0.48 (95% CI, 0.27-0.69), and negative predictive value of 0.62 (95% CI, 0.38-0.82). CONCLUSION Bowel wall ADC increases over time in pediatric subjects receiving infliximab, but the diagnostic performance of ADC is likely insufficient for reliable treatment monitoring.
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Dohan A, Taylor S, Hoeffel C, Barret M, Allez M, Dautry R, Zappa M, Savoye-Collet C, Dray X, Boudiaf M, Reinhold C, Soyer P. Diffusion-weighted MRI in Crohn's disease: Current status and recommendations. J Magn Reson Imaging 2016; 44:1381-1396. [PMID: 27249184 DOI: 10.1002/jmri.25325] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/12/2016] [Indexed: 12/19/2022] Open
Abstract
Over the past years, technological improvements and refinements in magnetic resonance imaging (MRI) hardware have made high-quality diffusion-weighted imaging (DWI) routinely possible for the bowel. DWI is promising for the detection and characterization of lesions in Crohn's disease (CD) and has been advocated as an alternative to intravenous gadolinium-based contrast agents. Furthermore, quantification using the apparent diffusion coefficient may have value as a biomarker of CD activity and has shown promise. In this article we critically review the literature pertaining to the value of DWI in CD for detection, characterization, and quantification of disease activity and complications. Although the body of supportive evidence is growing, it is clear that well-designed, multicenter studies are required before the role of DWI in clinical practice can be fully established. J. Magn. Reson. Imaging 2016;44:1381-1396.
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Affiliation(s)
- Anthony Dohan
- McGill University Health Center, Department of Radiology, McGill University Health Center, Montreal, QC, Canada
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
- INSERM UMR 965, Paris, France
| | - Stuart Taylor
- Centre for Medical Imaging, University College London, Podium Level 2, University College Hospital, London, UK
| | | | - Maximilien Barret
- Department of Gastroenterology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Matthieu Allez
- Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
- Department of Gastroenterology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Raphael Dautry
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Magaly Zappa
- Department of Radiology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | | | - Xavier Dray
- Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
- Department of Gastroenterology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mourad Boudiaf
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Caroline Reinhold
- McGill University Health Center, Department of Radiology, McGill University Health Center, Montreal, QC, Canada
| | - Philippe Soyer
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
- INSERM UMR 965, Paris, France
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Abstract
OBJECTIVE The purpose of this article is to provide a comprehensive review regarding DWI enterography used for evaluating Crohn disease and to summarize the relevant evidence. CONCLUSION Active bowel inflammation in Crohn disease causes restricted diffusion on MR enterography with DWI. Enterographic DWI to evaluate Crohn disease is increasingly drawing attention for both academic research and clinical practice and has shown potential as a quantitative tool for assessing bowel inflammation. DWI enterography also has multiple unresolved issues and limitations.
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Diffusion-weighted Magnetic Resonance Enterography for Evaluating Bowel Inflammation in Crohn's Disease: A Systematic Review and Meta-analysis. Inflamm Bowel Dis 2016; 22:669-79. [PMID: 26457380 DOI: 10.1097/mib.0000000000000607] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND To systematically determine the performance of diffusion-weighted imaging magnetic resonance enterography (DWI-MRE) for evaluating bowel inflammation in Crohn's disease and sources of heterogeneity between reported results. METHODS We identified research studies that investigated DWI-MRE to diagnose bowel inflammation (present versus absent) or to assess bowel inflammatory severity in Crohn's disease by performing a systematic search of PubMed MEDLINE and EMBASE (until March 31, 2015). Study quality was assessed using QUADAS-2. For studies reporting dichotomous diagnosis of bowel inflammation, study heterogeneity and threshold effect were analyzed, summary sensitivity and specificity were estimated, and meta-regression analysis was performed to further explore study heterogeneity. For studies reporting assessment of inflammatory severity, a qualitative summary was performed. RESULTS Of 159 articles screened, we found 12 studies (1515 bowel segments) reporting a diagnosis of bowel inflammation and 6 studies (1066 bowel segments) reporting assessment of inflammatory severity. The summary sensitivity and specificity were 92.9% (95% CI, 85.8%-96.6%; I = 87.9%) and 91% (95% CI, 79.7%-96.3%; I = 95.1%), respectively. Sensitivity and false-positive rate were inversely correlated (r = -0.650; P = 0.022). Lack of blinding to contrast-enhanced MRE when interpreting DWI-MRE (P = 0.01) and use of contrast-enhanced MRE as a reference standard (P < 0.01) in some studies were significant factors for study heterogeneity and likely caused overestimation of DWI-MRE accuracy. There was rather clear correlation between diffusion-related parameters and bowel inflammation severity, although the strengths were heterogeneous (correlation coefficient, 0.39-0.98). CONCLUSIONS DWI-MRE accuracy was very heterogeneous between studies and was likely overestimated in some studies. Despite rather clear correlation between diffusion-related parameters and bowel inflammatory severity, its strength was variable.
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Li Y, Hauenstein K. New Imaging Techniques in the Diagnosis of Inflammatory Bowel Diseases. VISZERALMEDIZIN 2015; 31:227-34. [PMID: 26557830 PMCID: PMC4608604 DOI: 10.1159/000435864] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Cross-sectional imaging modalities are fundamental in the management of patients with inflammatory bowel disease (IBD) from the first diagnosis and throughout the entire course of the disease. Over the past few years, the use of magnetic resonance (MR) imaging (MRI) has considerably increased, and no other imaging modality has experienced as advanced a development as MRI. Methods A comprehensive literature search (PubMed/Medline) using keywords such as ‘MR enterography’, ‘imaging modalities’, ‘IBD’, and ‘Crohn's disease’ was performed. 48 articles published between 1999 and 2015 were systematically reviewed. In this article, besides the current standard MRI techniques, we review novel and implementable for routine use MR techniques. The use of positron emission tomography/computed tomography (PET/CT) and hybrid imaging such as PET/MRI with enormous potential will also be briefly discussed. Results New imaging techniques such as diffusion-weighted imaging, dynamic contrast-enhanced MR perfusion, and MR motility imaging yield advanced findings about changes in the microenvironment and alterations in motility of the affected bowel segment, and are proven to improve the diagnostic accuracy in assessing the scale, activity level, and severity of the IBD. Novel magnetization transfer imaging allows direct visualization of fibrosis in the bowel wall. Conclusion Diffusion-weighted imaging can be easily implemented in standard MRI for routine use to further enhance the diagnostic accuracy in disease assessment. For validation of magnetization transfer imaging, larger studies are warranted.
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Affiliation(s)
- Yan Li
- Institute of Diagnostic and Interventional Radiology, University Medicine Rostock, Rostock, Germany
| | - Karlheinz Hauenstein
- Institute of Diagnostic and Interventional Radiology, University Medicine Rostock, Rostock, Germany
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