Year 2019 / Volume 111 / Number 1
Original
Apparent diffusion coefficient and enhancement patterns in MR imaging as markers of severe or moderate ileum inflammation in Crohn’s disease

28-33

DOI: 10.17235/reed.2018.5691/2018

Riccardo Faletti, Davide Giuseppe Ribaldone, Marco Gatti, Chiara Perazzini, Mattia Robella, Francesca Angelino, Giorgio Maria Saracco, Marco Astegiano, Rinaldo Pellicano, Paolo Fonio,

Abstract
Background and purpose: magnetic resonance enterography has been increasingly used for the diagnosis and follow-up of Crohn’s disease (CD). The purpose of the study was to compare the apparent diffusion coefficient (ADC) with wall enhancement for the differentiation of severe, moderate or no inflammation activity in the ileum. Methods: a prospective, blinded study was conducted of 46 CD patients with a clinical Crohn’s disease activity index (CDAI) ≥ 220 and a simple endoscopic score for Crohn’s disease (ES-CD) ≥ 7, which yielded 58 inflamed segments with CD. Twenty controls were also included. All segments were characterized by four ADC readings. The two different enhancement patterns observed in inflamed segments, transmural or mucosal, were associated with severely (23) or moderately (35) active CD. Results: the ADC value decreased from 2.79 ± 0.35 x 10-3 mm2/s for normal segments to 1.81 ± 0.39 x 10-3 mm2/s for the moderately inflamed segments and 1.15 ± 0.20 x 10-3 mm2/s for severely inflamed segments (p ≤ 0.0001). ROC curve analysis on the basis of the three ADC distributions showed a very good discrimination capability with an area under the curve of 0.95. Three groups were defined as follows: normal ileum ADC > 2.4 x 10-3 mm2/s, moderate stages of inflammation 1.5 x 10-3 mm2/s < ADC ≤ 2.4 x 10-3 mm2/s and severe stages of ADC ≤ 1.5 x 10-3 mm2/s. Conclusions: the ADC value reliably discriminates between normal and inflamed ileum and also distinguishes between severe and moderate inflammation.
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References
1. Kiryu S, Dodanuki K, Takao H, et al. Free-Breathing Diffusion-Weighted Imaging for the Assessment of Inflammatory Activity in Crohn’s Disease. J Magnetic Reson Imaging 2009; 29: 880-6.
2. Griffin N, Grant LA, Anderson S, et al. Small bowel MR enterography: problem solving in Crohn's disease. Insight imaging 2012; 3: 251-63.
3. Del Vescovo R, Sansoni I, Caviglia R, et al. Dynamic contrast enhanced magnetic resonance imaging of the terminal ileum: differentiation of activity of Crohn's disease. Abdom Imaging 2008; 33: 417-24.
4. Makanyanga J, Punwani S, Taylor SA. Assessment of wall inflammation and fibrosis in Crohn’s disease: value of T1-weighted gadolinium-enhanced MR imaging. Abdom Imaging 2012; 37: 933-43.
5. Sinha R, Verma R, Verma S, et al. MR Enterography of Crohn Disease: Part 2, Imaging and Pathologic Findings. AJR 2011; 197: 80-85.
6. Tielbeek JA, Ziech ML, Li Z, et al. Evaluation of conventional, dynamic contrast enhanced and diffusion weighted MRI for quantitative Crohn's disease assessment with histopathology of surgical specimens. Eur Radiol 2014; 24:619629.
7. Oto A, Zhu F, Kulkarni K, et al. Evaluation of Diffusion-weighted MR Imaging for Detection of Bowel Inflammation in Patients with Crohn’s Disease. Acad Radiology 2009; 16: 597-603.
11. Caruso A, DʼIncà R, Scarpa M, et al. Diffusion-weighted magnetic resonance for assessing ileal Crohn's disease activity. Inflamm Bowel Dis 2014; 20: 1575-83.
8. Foti PV, Farina R, Coronella M, et al. Crohn's disease of the small bowel: evaluation of ileal inflammation by diffusion-weighted MR imaging and correlation with the Harvey-Bradshaw index. Radiol Med 2015; 120: 585-94.
9. Hordonneau C, Buisson A, Scanzi J, et al. Diffusion-weighted magnetic resonance imaging in ileocolonic Crohn's disease: validation of quantitative index of activity. Am J Gastroenterol 2014; 109:89-98.
10. Oto A, Kayhan A, Williams JT, et al. Active Crohn’s Disease in the Small Bowel: Evaluation by Diffusion Weighted Imaging and Quantitative Dynamic Contrast Enhanced MR Imaging. J Magn Reson Imaging 2011; 33: 615-24.
12. Gomollón F, Dignass A, Annese V, et al. 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 1: Diagnosis and Medical Management. J Crohns Colitis 2017; 11: 3-25.
13. Seo N, Park SH, Kim K-J, Kang B-K, Lee Y, Yang S-K, et al. MR Enterography for the Evaluation of Small-Bowel Inflammation in Crohn Disease by Using Diffusion-weighted Imaging without Intravenous Contrast Material: A Prospective Noninferiority Study. Radiology 2016;278(3):762–72.
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Faletti R, Ribaldone D, Gatti M, Perazzini C, Robella M, Angelino F, et all. Apparent diffusion coefficient and enhancement patterns in MR imaging as markers of severe or moderate ileum inflammation in Crohn’s disease. 5691/2018


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Publication history

Received: 02/05/2018

Accepted: 13/07/2018

Online First: 04/10/2018

Published: 17/01/2019

Article revision time: 69 days

Article Online First time: 155 days

Article editing time: 260 days


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