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

Abstract

Purpose We compared contrast-enhanced MR enterography with diffusion-weighted sequences to evaluate the validity of diffusion-weighted sequences for activity assessment in Crohnʼs disease compared to endoscopy. In addition, we investigated a new color-coded image post-processing technique in comparison with standard sequences and endoscopy. Materials and Methods Included were 197 MR enterographies (2015–2017) performed by using standardized examination protocols. The intestine was divided into 7 segments, which were compared separately. The accuracy of the MR examinations with regard to disease activity was validated using the Seo and MaRIA score and endoscopy findings. In addition, the image data were post-processed using a color-coded evaluation method (DCE tool on OsiriX). Results The comparison between contrast-enhanced and diffusion-weighted sequences showed a highly significant correlation for all bowel sections with a mean Spearman correlation coefficient of 0.876 (0.809–0.928). The color-coded image post-processing showed a sensitivity of 83.2 % and a specificity of 70.5 % in comparison with the MaRIA score. In comparison to endoscopy, a sensitivity of 81.3 % and a specificity of 70.5 %. In comparison with endoscopy, the MaRIA score showed a sensitivity of 80.2 % and a specificity of 84.0 % at a cut-off of 7. The visual score according to Seo showed a sensitivity of 85.7 % with a specificity of 77.0 % in the contrast-weighted examination and a sensitivity of 87.9 % and a specificity of 71.8 % for diffusion weighted images. Conclusion Diffusion-weighted sequences are as good as contrast-weighted sequences for assessing inflammatory activity in Crohnʼs disease. Contrast is often helpful for assessing complications, but this was not the purpose of this study. Visual imaging using color-coded data sets was similarly good at detecting inflammation. Key points: Citation Format

Role of abbreviated non-contrast-enhanced MR-enterography in the evaluation of Crohn's disease activity and complications as an alternative for full protocol contrast-enhanced study: A systematic review and meta-analysis

“… T2-sMARIA shows a diagnostic accuracy similar to CE-sMARIA in all of these fields. Jakob, 2022 [43] DWI sequences with color coding ileocolonoscopy small bowel and colon active inflammation adult DWI-based color-coded image: 81.3% Sens, 70.5% Spec DWI Seo score: 87.9% Sens, 71.8% Spec DWI was as good as CE sequences in diagnosing active disease. Color-coding did not add diagnostic value Cococcioni, 2021 [58] CINE quantitative motility histopathology terminal ileum active inflammation pediatric MI was lower in inflamed bowel (median:0.12) compared to normal bowel (median:0.21) ( p = 0.02).…”

“…With regard to potential novel technologies utilizing DWI, recent research has indicated that diffusion Kurtosis imaging (DKI) and intravoxel incoherent motion (IVIM) are alternative techniques that may offer higher levels of accuracy than conventional DWI and hold promise for future use [ 41 , 42 ]. Additionally, Jakob et al have employed an innovative color-coding program for DWI images, demonstrating favorable results [43] . Moreover, DWI and ADC mapping have been utilized for detecting fibrostenotic complications, which will be discussed in more detail later.…”

Small Bowel Imaging from Stepchild of Roentgenology to MR Enterography: Part I: Guidance in Performing and Observing Normal and Abnormal Imaging Findings

“…Diffusion-weighted imaging was also suggested [ 27 ], but it is not mandatory. Nonetheless, we strongly recommend its use because DWI improves the diagnostic accuracy of MRE [ 28 , 29 , 30 ]. DWI should be acquired in the axial plane during free breathing and must include b values ranging from 0 to 900 [ 26 ].…”