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

Seo, Nieun; Park, Seong Ho; Kim, Kyung‐Jo; Kang, Bo-Kyeong; Lee, Yedaun; Yang, Suk‐Kyun; Ye, Byong Duk; Park, Sang Hyoung; Kim, So Yeon; Baek, Seunghee; Han, Kyunghwa; Ha, Hyun Kwon

doi:10.1148/radiol.2015150809

Cited by 126 publications

(87 citation statements)

References 35 publications

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“…Therefore, although the number of complication is low, our data suggest that gadolinium may increase the detection rate of penetrating complications, and thus increase safety in the context of immunosuppressive therapies. In that regard, our results are in keeping with those published recently by a Korean group, where sequences with and without gadolinium were discordant in 2/7 segments with penetrating complications [22].…”

Section: Discussionsupporting

confidence: 93%

Comparison of three magnetic resonance enterography indices for grading activity in Crohn’s disease

et al. 2016

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Background Magnetic resonance enterography (MRE) is an accurate examination for assessing activity in Crohn's disease (CD). Various MRE indices have been developed for that purpose, but have not been directly compared. The aim of the study was to compare the diagnostic accuracy of three MRE indices for detecting and grading disease activity in CD, using endoscopy as gold standard. Methods MRE and ileocolonoscopies performed within 1 month in 43 patients with CD were analyzed. The magnetic resonance index of activity (MaRIA), Clermont, and London indices for each colonic segment and the terminal ileum were calculated. Simplified endoscopy score for CD (SES-CD) was considered the gold standard. Results Two hundred and twenty-four intestinal segments were included in the analysis. According to the established cut-off points for detecting active disease using MaRIA, Clermont, and London indices, the sensitivity of each index was 0.88, 0.89, and 0.71, and the specificity was 0.97, 0.78, and 0.99, respectively. The sensitivity for detecting ulcerations was 0.90 and 0.83 for the MaRIA and Clermont indices, respectively, with a specificity of 0.91 and 0.89. The AUROC curve for the MaRIA, Clermont, and London indices for detecting active disease was 0.92, 0.84, and 0.85, and for detecting ulcerations was 0.90 for the MaRIA, and 0.86 for Clermont index. Conclusions The three MRE-based indices evaluated in the current study have high diagnostic accuracy for assessment of disease activity. The MaRIA index has the best operational characteristics for detecting not only disease activity but also for grading severity, which supports its use in clinical studies and clinical practice.

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Section: Discussionsupporting

confidence: 93%

Comparison of three magnetic resonance enterography indices for grading activity in Crohn’s disease

et al. 2016

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“…A recent longitudinal study by Huh et al showed that DWI-MRI could be used to diagnose complete remission and improved inflammation after medical therapy with 76% and 84% accuracy, respectively [25]. Our results are similar to that of a previous study by Seo et al, which found no significant difference in terms of correlation to CDEIS between CE-MRI (r = 0.71) and DW-MRI (r = 0.61), although a similar discrepancy for detection of penetrating complications was reported in favor of CE-MRI [11]. In two studies by Schmid-Tannwald et al, CE-MRI showed no significant differences to DW-MRI for sensitivity for the diagnosis of active inflammation (0.80 vs. 0.67) and detection of fistulas and sinus tracts (0.96 vs. 0.76) [12,26].…”

Section: Discussionsupporting

confidence: 90%

“…However, a different study by Qi et al, using capsule endoscopy as their reference standard, did find an improvement of diagnostic accuracy (79% to 92%) when DWI was added to CE-MRI [10]. A study by Seo et al included 44 patients of the same cohort used by Kim et al and focused on substitution of CE sequences with DW sequences in a conventional MRI protocol [11]. DW-MRI and CE-MRI showed 91.8% agreement for dichotomous classification of segments (inflammation or no inflammation) and comparable correlation to the Crohn's Disease Endoscopic Index of Activity (CDEIS) (r = 0.61 and 0.71, P = 0.11).…”

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confidence: 99%

Comparison of contrast-enhanced and diffusion-weighted MRI in assessment of the terminal ileum in Crohn’s disease patients

et al. 2018

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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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“…This was associated with very good levels of intra-and inter-rater reliability of the technique. Notably, DWI-MR without intravenous contrast did not prove inferior to standard contrast-enhanced MR in evaluating CD-related small-bowel inflammation in a very recent prospective non-inferiority study [18], thus confirming the data deriving from a retrospective series (Table 1) [19]. The recently reported excellent agreement between DWI-MR results and the MaRIA index further supports the usefulness of this technique in the study of CD inflammatory status [20].…”

Section: Evaluation Of Disease Activitysupporting

confidence: 74%

Evolving roles of cross-sectional imaging in Crohn's disease

Magarotto

Orlando

Coletta

et al. 2016

Digestive and Liver Disease

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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

Abstract: DWI MR enterography was noninferior to CE MR enterography for the evaluation of inflammation in Crohn disease in generally well-distended small bowel, except for the diagnosis of penetration.

Cited by 126 publications

References 35 publications

Comparison of three magnetic resonance enterography indices for grading activity in Crohn’s disease

Comparison of three magnetic resonance enterography indices for grading activity in Crohn’s disease

Comparison of contrast-enhanced and diffusion-weighted MRI in assessment of the terminal ileum in Crohn’s disease patients

Evolving roles of cross-sectional imaging in Crohn's disease

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