Evaluation of Diffusion-weighted MR Imaging for Detection of Bowel Inflammation in Patients with Crohn's Disease

Oto, Aytekin; Zhu, Fang; Kulkarni, Kirti; Karczmar, Gregory S.; Turner, Jerrold R.; Rubin, David T.

doi:10.1016/j.acra.2008.11.009

Cited by 216 publications

(149 citation statements)

References 11 publications

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“…When ADC values are considered, our results are similar to those of ‹nci et al (2). These results suggest that DW-MRI may be more effective in the diagnosis of appendicitis compared to its ability to display inflammatory areas in Crohn's disease.…”

Section: Discussionsupporting

confidence: 80%

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The value of diffusion weighted MR imaging and apparent diffusion coefficient quantification in the diagnosis of perforated and non-perforated appendicitis

Avcu

Çetin²,

Arslan³

et al. 2012

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to evaluate the effectiveness of diffusion-weighted magnetic resonance imaging (DW-MRI) and apparent diffusion coefficient (ADC) values in the diagnosis of acute appendicitis and differentiation of perforated and nonperforated appendicitis cases, with histopathologic correlation. MATERIALS AND METHODSSixty consecutive patients (34 males, 26 females; mean age, 35.6±15.5 years; range, 17-83 years) with a presumptive diagnosis of acute appendicitis were included in this prospective study. With a 1.5 Tesla MRI unit, DW-MRI examinations were performed with b values of 50, 400, and 800 s/mm 2 . The mean ADC values of case and control groups, as well as in perforated and nonperforated groups were compared. RESULTSOf the 60 cases, 44 had a radiological diagnosis of acute appendicitis, and 16 were regarded as normal. Of the 40 patients who underwent surgical operation, 12 had a histopathological diagnosis of perforated appendicitis, and 28 had nonperforated appendicitis. Mean ADC value in patients with acute appendicitis (1.01±0.26×10 -3 mm 2 /s) was lower than the control group (1.85±0.13×10 -3 mm 2 /s) (P < 0.001). Mean ADC value of the perforated group (0.79±0.19×10 -3 mm 2 /s) was lower than the nonperforated group (1.11±0.22×10 -3 mm 2 /s) (P < 0.001). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate of DW-MRI in the diagnosis of acute appendicitis were 97.5%, 100%, 97.5%, 100%, and 98.1%, respectively. CONCLUSION DW-MRI and ADC quantification are effective in the diagnosis of acute appendicitis, both in perforated and nonperforated cases. Magnetic resonance imaging (MRI) is the radiological imaging technique offering the highest soft tissue contrast resolution. Currently, in addition to conventional MRI, other MRI techniques are commonly and routinely used, including diffusion-weighted MRI (DW-MRI). DW-MRI is a functional imaging technique that relies on the measurement of the accelerated or slowed microscopic diffusion movements of protons of water molecules. The images are obtained in short interval times and without the requirement for any contrast medium (1).Recently, studies have reported the use of DW-MRI to show active inflammatory lesions in the bowel. In these reports, the mean apparent diffusion coefficient (ADC) of the inflamed bowel segments were compared with the ADC of normal segments, and statistically significant difference was demonstrated (1, 2). Only one study has been investigated the use of DW-MRI for the diagnosis of patients with acute appendicitis (3). However, this study did not focus on the differential diagnosis of perforated and nonperforated appendicitis cases.The aim of this study was to evaluate the effectiveness of DW-MRI and quantitative measurement of ADC values in the diagnosis of acute appendicitis, and in the differentiation between perforated and nonperforated appendicitis cases, with histopathologic correlation. Materials and methods Patient selectionThis prospective study was performed betw...

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Section: Discussionsupporting

confidence: 80%

“…In these reports, the mean apparent diffusion coefficient (ADC) of the inflamed bowel segments were compared with the ADC of normal segments, and statistically significant difference was demonstrated (1,2). Only one study has been investigated the use of DW-MRI for the diagnosis of patients with acute appendicitis (3).…”

mentioning

confidence: 99%

The value of diffusion weighted MR imaging and apparent diffusion coefficient quantification in the diagnosis of perforated and non-perforated appendicitis

Avcu

Çetin²,

Arslan³

et al. 2012

Diagn Interv Radiol

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“…well-known imaging features are evaluated using a combination of unenhanced and post-contrast T1-weighted images, usually with fat suppression, T2-weighted images with and without fat suppression, and more recently diffusion-weighted images [16][17][18][19]. However, there are times when these sequences are not completely diagnostic for inflammatory bowel disease, and having additional imaging criteria would be useful.…”

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confidence: 99%

Erratum to: Identifying decreased peristalsis of abnormal small bowel segments in Crohn’s disease using cine MR enterography: the frozen bowel sign

et al. 2014

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Purpose: The purpose of this study was to evaluate whether affected bowel in Crohn's disease patients can be identified by observing decreased peristalsis (frozen bowel sign) using cine balanced steady-state free precession (cine BSSFP) images. Materials and methods: 5 radiologists independently reviewed cine BSSFP sequences from randomized MR Enterography (MRE) exams for 30 normal and 30 Crohn's disease patients, graded overall small bowel peristalsis from slowest to fastest, and graded peristalsis for the most abnormal small bowel segment. Sensitivity and specificity of the frozen bowel sign for diagnosing Crohn's disease were calculated. T tests of the peristalsis difference between abnormal segments and overall small bowel were conducted. Results: For 5 readers, the sensitivity and specificity of cine BSSFP of the frozen bowel sign for diagnosing Crohn's disease ranged from 70% to 100% and 87% to 100%, respectively. There were significant differences in peristalsis between abnormal small bowel segments and the overall small bowel for Crohn's patients, but not in the overall small bowel between normal-MRE patients and Crohn's disease patients. Conclusion: Abnormal Crohn's small bowel segments have significantly decreased peristalsis compared to normal small bowel, which can be identified using cine BSSFP sequences as the frozen bowel sign.Key words: MR enterography-Small bowelPeristalsis-Motility-Cine MRI-Crohn's disease Erratum to: Abdom Imaging DOI 10.1007/s00261-014-0258-yThe original publication did not include the images pertaining to the supplementary video files. This has been corrected in this article.Using MR enterography (MRE) to diagnose inflamed small bowel segments in patients with Crohn's disease requires a multiparametric approach, evaluating imaging features from several different pulse sequences. The most commonly used imaging features are well established in the literature for both CT scan [1][2][3][4] and MRI [5][6][7][8][9][10][11][12][13][14][15]. These include bowel wall thickening, bowel wall edema, perienteric edema and fluid, and mucosal, transmural, and possibly serosal hyperenhancement after intravenous contrast or gadolinium administration. With MRE, these Electronic supplementary material: The online version of this article

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“…The apparent diffusion coefficient (ADCs) is quantitative expressions of the diffusion characteristics of tissue. Its values decrease with increased tissue cellularity or cell density and may help in the quantitative analysis of disease activity [74,75] . In inflammatory disease of the bowel [75,76] the increased cellularity lead to rescrict diffusion (low ADC values) and high signal of DVI showed high sensitivity (86%-94%) and specificity (81.4%-84.8%) in inflammatory disease of the bowel with 94% of sensitivity and 88% of specificity by using an ADC threshold of 2.4 × 10 3 mm 2 /s [75,7781] .…”

Section: Indicationsmentioning

confidence: 99%

Current tecniques and new perpectives research of magnetic resonance enterography in pediatric Crohn’s disease

Masselli

Mastroiacovo

Marco

et al. 2016

WJR

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Crohn's disease affects more than 500000 individuals in the United States, and about 25% of cases are diagnosed during the pediatric period. Imaging of the bowel has undergone dramatic changes in the past two decades. The endoscopy with biopsy is generally considered the diagnostic reference standard, this combination can evaluates only the mucosa, not inflammation or fibrosis in the mucosa. Actually, the only modalities that can visualize submucosal tissues throughout the small bowel are the computed tomography (CT) enterography (CTE) with the magnetic resonance enterography (MRE). CT generally is highly utilized, but there is growing concern over ionizing radiation and cancer risk; it is a very important aspect to keep in consideration in pediatric patients. In contrast to CTE, MRE does not subject patients to ionizing radiation and can be used to detect detailed morphologic information and functional data of bowel disease, to monitor the effects of medical therapy more accurately, to detect residual active disease even in patients showing apparent clinical resolution and to guide treatment more accurately.

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Evaluation of Diffusion-weighted MR Imaging for Detection of Bowel Inflammation in Patients with Crohn's Disease

Cited by 216 publications

References 11 publications

The value of diffusion weighted MR imaging and apparent diffusion coefficient quantification in the diagnosis of perforated and non-perforated appendicitis

The value of diffusion weighted MR imaging and apparent diffusion coefficient quantification in the diagnosis of perforated and non-perforated appendicitis

Erratum to: Identifying decreased peristalsis of abnormal small bowel segments in Crohn’s disease using cine MR enterography: the frozen bowel sign

Current tecniques and new perpectives research of magnetic resonance enterography in pediatric Crohn’s disease

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