Abstract
Purpose:Monitoring Crohn’s disease (CD) activity has a crucial importance, especially for evaluating treatment efficacy. Magnetic resonance enterography (MRE) and diffusion-weighted imaging (DWI) or their combination may represent potential non-invasive tools for this purpose. This study aimed to examine DWI and MRE for their potential to differentiate between different grades of ileocolonic CD activity.Materials and Methods:This retrospective study included 54 adult patients with a diagnosis of CD who underwent ileocolonoscopy and MRE including the DWI sequence. The severity of CD inflammation was categorized by Simple Endoscopic Score for Crohn’s Disease (SES-CD) as inactive, mild, moderate and severe. In addition, following conventional MRE and DWI parameters were examined: bowel wall thickness, mural T2 hyperintensity, contrast enhancement, DWI signal intensity, and apparent diffusion coefficient (ADC) values.Results:In patients with moderate to severe disease based on SES-CD, T2 hyperintensity score [1.68 ± 0.77 (1–3) vs. 2.19 ± 0.69 (1–3); p = 0.013] and mean DWI score [2.42 ± 0.58 (1–3) vs. 2.04 ± 0.69 (1–3); p = 0.037 ] were higher and mean ADC values [1.5 ± 0.4 (0.9–2.5) vs. 1.2 ± 0.3 (0.6–1.8)] were lower compared to patients with inactive to mild CD. ADC had a moderate diagnostic accuracy in predicting moderate to severe disease (AUC = 0.729, 95% CI = 0.591–0.841, p = 0.001), with a cut-off value of ≤1.47 × 10–3 mm2/sec yielded 88.5% (23/26) sensitivity, 57.1% (16/28) specificity.Conclusion:DWI, ADC and T2 signal appear to differentiate moderate to severe CD from inactive to mildly active CD, based on SES-CD evaluation and may be useful in monitoring disease activity, particularly when evaluating treatment response.
Highlights
Crohn’s disease (CD) is a chronic disorder of the gastrointestinal tract that may affect any segment, with a predilection for the terminal ileum
This study found that diffusion-weighted imaging (DWI) findings and T2 signal may be helpful in differentiating moderate to severe CD activity from less severe forms of the disease, which may be helpful for disease monitoring
This study showed significant associations between Simple Endoscopic Score for Crohn’s Disease (SES-CD) based disease activity versus apparent diffusion coefficient (ADC) and DWI signal despite using an external reference standard and DWI readings blinded to Magnetic resonance enterography (MRE), both of which may be regarded as strengths of the study
Summary
Crohn’s disease (CD) is a chronic disorder of the gastrointestinal tract that may affect any segment, with a predilection for the terminal ileum. It is characterized by the segmental enteric and transmural inflammation of the bowel wall, leading to erosions and ulcerations that result in the formation of sinuses, fistulae and abscesses as well as inflammatory strictures when untreated [1, 2]. There is no consensus regarding a single standard of reference, colonoscopy has been conventionally used for the assessment of disease activity [4] It is invasive, requiring anesthesia and absence of bowel stenosis. SES-CD has limitations such as the lack of consensus on its timing and severity grading, it appears to be more reliable and more responsive to changes in CD activity as compared to other endoscopic indices [8, 9]
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