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?

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.

MR Enterography in Crohnʼs Disease: Comparison of Contrast Imaging with Diffusion-weighted Imaging and a special Form of Color Coding

“…The specificity was somewhat higher than in our study (97.9 %). However, the examination was performed at 3 Tesla and only involved the colon and terminal ileum 7 .…”

“…2 zu sehen. Statistik Alle erfassten Parameter und Ergebnisse wurden mithilfe der Statistik-Software SPSS, IBM Statistics, Version 20.0.0 ausgewertet.Die Werte der beiden Seo-Scores wurden in einem Scatterplot gegeneinander aufgetragen und in Subtraktionshistogrammen dargestellt (▶ Abb [3][4][5][6][7][8][9]…”

Diagnostic Accuracy of Non-Invasive Imaging for Detection of Colonic Inflammation in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

“…Multiple disease scoring systems were used. The modified Baron score was used in three studies [13][14][15], the Simple Clinical Colitis Activity Index (SCCAI) in two studies [13,16], the CD Endoscopic Index of Severity (CDEIS) in two studies [17,18], Crohn's Disease Activity Index (CDAI) in three studies [19][20][21], Pediatric Crohn's Disease Activity Index (PCDAI) in one study [22], Mayo Endoscopic Subscore (MES) in two studies [16,23], Truelove and Witts score in two studies [21,24], and the Simple Endoscopic Score for CD (SES-CD) was used in four studies [13,[25][26][27] The performance of MRI and US was assessed in 24 and 17 studies, respectively, while CT was assessed only in two studies hence excluding this imaging modality from the meta-analyses. The diagnostic test values (TP, FP, TN, and FN) of the colonic segments and the sensitivity and specificity values were not presented in all the included studies.…”

Editorial for “Bowel Wall Visualization Using MR Enterography in Relationship to Bowel Lumen Contents and Patient Demographics”

“…In addition, some studies have used bowel preparation protocols, which can affect the quality of bowel visualization. 3,4 However, this practice is currently not a clinical standard as evident from a recent survey of academic institutions. 5 Moreover, a recent study by Sinha et al has suggested that bowel cleansing is not necessary since MRE primarily focuses on the small bowel, which is unaffected by a loaded colon.…”

“…For high‐quality MRE, adequate luminal distension and visualization of bowel wall enhancement is vital, which is achieved by the patient ingesting a regimen of liquids, including a hyperosmolar liquid and a biphasic oral contrast agent, and also administration of intravenous gadolinium. In addition, some studies have used bowel preparation protocols, which can affect the quality of bowel visualization 3,4 . However, this practice is currently not a clinical standard as evident from a recent survey of academic institutions 5 .…”