Diffusion-weighted MRI in Crohn's disease: Current status and recommendations

Dohan, Anthony; Taylor, Stuart A.; Hoeffel, Christine; Barret, Maximilien; Allez, Matthieu; Dautry, Raphaël; Zappa, Magaly; Savoye‐Collet, Céline; Dray, Xavier; Boudiaf, Mourad; Reinhold, Caroline; Soyer, Philippe

doi:10.1002/jmri.25325

Cited by 87 publications

(79 citation statements)

References 127 publications

(284 reference statements)

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“…Analysis of contrast enhancement has now clearly proven its interest in follow-up and characterization between inflammatory or fibrotic ileocolonic lesions[31,38]. Recent MRI sequences like diffusion or magnetization transfer could be used in the future for evaluation of patients under treatment[20,39,40]. Compared to our previous study, we found a higher (one third) rate of deep remission at 40 mo than at 12 mo (one quarter)[18].…”

Section: Discussionmentioning

confidence: 53%

Magnetic resonance imaging may predict deep remission in patients with perianal fistulizing Crohn's disease

Thomassin¹,

Armengol-Debeir²,

Charpentier³

et al. 2017

WJG

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AIMTo evaluate the imaging course of Crohn’s disease (CD) patients with perianal fistulas on long-term maintenance anti-tumor necrosis factor (TNF)-α therapy and identify predictors of deep remission.METHODSAll patients with perianal CD treated with anti-TNF-α therapy at our tertiary care center were evaluated by magnetic resonance imaging (MRI) and clinical assessment. Two MR examinations were performed: at initiation of anti-TNF-α treatment and then at least 2 years after. Clinical assessment (remission, response and non-response) was based on Present’s criteria. Rectoscopic patterns, MRI Van Assche score, and MRI fistula activity signs (T2 signal and contrast enhancement) were collected for the two MR examinations. Fistula healing was defined as the absence of T2 hyperintensity and contrast enhancement on MRI. Deep remission was defined as the association of both clinical remission, absence of anal canal ulcers and healing on MRI. Characteristics and imaging patterns of patients with and without deep remission were compared by univariate and multivariate analyses.RESULTSForty-nine consecutive patients (31 females and 18 males) were included. They ranged in age from 14-70 years (mean, 33 years). MRI and clinical assessment were performed after a mean period of exposure to anti-TNF-α therapy of 40 ± 3.7 mo. Clinical remission, response and non-response were observed in 53.1%, 20.4%, and 26.5% of patients, respectively. Deep remission was observed in 32.7% of patients. Among the 26 patients in clinical remission, 10 had persisting inflammation of fistulas on MRI (T2 hyperintensity, n = 7; contrast enhancement, n = 10). Univariate analysis showed that deep remission was associated with the absence of rectal involvement and the absence of switch of anti-TNF-α treatment or surgery requirement. Multivariate analysis demonstrated that only the absence of rectal involvement (OR = 4.6; 95%CI: 1.03-20.5) was associated with deep remission.CONCLUSIONDeep remission is achieved in approximately one third of patients on maintenance anti-TNF-α therapy. Absence of rectal involvement is predictive of deep remission.

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Section: Discussionmentioning

confidence: 53%

Magnetic resonance imaging may predict deep remission in patients with perianal fistulizing Crohn's disease

Thomassin¹,

Armengol-Debeir²,

Charpentier³

et al. 2017

WJG

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“…Furthermore review of the literature reveals successful results of the examination of the diffuse bowel pathologies with DWI imaging [18][19][20].…”

Section: Resultsmentioning

confidence: 99%

The utility of diffusion-weighted magnetic resonance imaging in differentiation of benign and malignant diffuse colon wall thickening

Koç¹,

Serhatlioğlu²

2017

Med-Science

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To examine the effectiveness of apparent diffusion coefficient (ADC) values in differentiation of benign bowel wall thickening and malignant diffuse scirrhous type's bowel wall thickening. Subject and Methods A total of 81 patients who underwent abdomen diffusion-weighted magnetic resonance imaging (DW MRI) in our clinic between April 2015 and September 2016 was analyzed. Of these patients, 42 had benign bowel wall thickening and 39 had malignant bowel wall thickening. The values of ADC were measured with two different b-values (400, 1000 s/mm2). Benign and malignant ADC values were compared using areas under the receiver-operating characteristic (ROC) curve. Results: According to the ADC values, the mean ADC values (x10-3 mm2/s) of benign lesions were 1.42±0.17 for b 400, 1.39±0.12 for b 1000. The mean ADC values (x10-3 mm2/s) of malignant lesions were 1.08±0.15 for b 400, 1.02±0.13 for b 1000. There were significantly lower ADC values in malignant lesions in all b values (P=.001 for b 400, P=.001 for b 1000). ROC analysis showed that a cut-off value of 1.24 x 10-3 mm2/s between the malignant and benign values with a sensitivity of 91 %, specificity of 85 %, and an accuracy of 84 %. The positive predictive value, negative predictive value, and diagnostic accuracy of ADC values were determined to be 97 %, 86 %, and 88 % respectively. Conclusion: Measurement of ADC values by DWI was effective in differentiation of malignant diffuse scirrhous types of bowel wall thickening from benign bowel wall thickening.

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“…At present, cross-sectional imaging, including computed tomography (CT) enterography and magnetic resonance enterography (MRE), serve important roles in the detection of bowel lesions (5)(6)(7). Recent guidelines regarding patient preparation and acquisition for cross-sectional small bowel and colonic imaging have been established (8).…”

Section: Introductionmentioning

confidence: 99%

Potential of diffusion‑weighted imaging in magnetic resonance enterography to identify neoplasms in the ileocecal region: Use of ultra‑high b‑value diffusion‑weighted imaging

Feng

Wang

et al. 2019

Oncol Lett

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Patients with chronic inflammatory bowel disease have an increased risk of colorectal cancer, and the differentiation between neoplastic and inflammatory lesions often poses a clinical dilemma. The aim of the present study was to investigate whether diffusion-weighted (DW) magnetic resonance (MR) enterography with ultra-high b-value facilitates the identification of neoplastic lesions in the ileocecal region. A total of 76 patients (22 patients with neoplasms, 26 inflammatory lesions and 28 normal subjects) from 292 cases of suspected bowel disorders were included in the present study. All patients were examined with conventional MR enterography and DW imaging (DWI) with seven different b-values (400, 600, 800, 1,000, 1,200, 1,500 and 3,000 sec/mm 2 ) in a 3T MR scanner. DWI scans with different b-values were analyzed independently by two radiologists for the presence of ileocecal lesions. The signal intensity of the majority of inflammatory lesions and normal bowel segments gradually decreased to the background intensity with increasing b-values; however, neoplastic lesions demonstrated relative hyperintensity compared with the background. In addition, ~76% of the positive findings from b=3,000 sec/mm 2 DWI were neoplasms. In conclusion, a lesion with consistently high signal intensity from DWI images with b-values increasing to 3,000 sec/mm 2 indicated the presence of neoplasms. The results suggested that ultra-high b-value (3,000 sec/mm 2 ) imaging may aid the clinical differentiation of neoplasms from benign conditions.

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Diffusion-weighted MRI in Crohn's disease: Current status and recommendations

Cited by 87 publications

References 127 publications

Magnetic resonance imaging may predict deep remission in patients with perianal fistulizing Crohn's disease

Magnetic resonance imaging may predict deep remission in patients with perianal fistulizing Crohn's disease

The utility of diffusion-weighted magnetic resonance imaging in differentiation of benign and malignant diffuse colon wall thickening

Potential of diffusion‑weighted imaging in magnetic resonance enterography to identify neoplasms in the ileocecal region: Use of ultra‑high b‑value diffusion‑weighted imaging

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