Comparison between Diffusion-Weighted Sequences with Selective and Non-Selective Fat Suppression in the Evaluation of Crohn's Disease Activity: Are They Equally Useful?

Ilze Apine,Ilze Apine,Juris Pokrotnieks,Gaida Krumina,Ivanda Franckevica,Reinis Pitura

doi:10.3390/diagnostics10060347

Abstract

Background: We compared the efficiency of two MRI diffusion weighted imaging (DWI) techniques: DWI with SPIR (DWISPIR) and DWI with STIR (DWISTIR), to estimate their eligibility for quantitative assessment of Crohn’s disease activity in children and adults. Methods: In inflamed terminal ileum segments (n = 32 in adults, n = 46 in children), Magnetic Resonance Index of Activity (MaRIA) was calculated, ADC values of both DWI techniques were measured, and the corresponding Clermont scores calculated. ADC values of both DWI techniques were compared between both and within each patient group, assessing their mutual correlation. Correlations between MaRIA and the corresponding ADC values, and Clermont scores based on both DWI techniques were estimated. Results: No correlation between ADC of DWISPIR and DWISTIR was observed (rho = 0.27, p = 0.13 in adults, rho = 0.20, p = 0.17 in children). The correlation between MaRIA and Clermont scores was strong in both techniques—in SPIR, rho = 0.93; p < 0.0005 in adults, rho = 0.98, p < 0.0005 in children, and, in STIR, rho = 0.89; p < 0.0005 in adults, rho = 0.95, p < 0.0005 in children. The correlation between ADC and MaRIA was moderate negative for DWISTIR (rho = 0.93, p < 0.0005 in adults, rho = 0.95, p < 0.0005 in children), but, in DWISTIR, no correlation between ADC and MaRIA score was observed in adults (rho = −0.001, p = 0.99), whereas children presented low negative correlation (rho = −0.374, p = 0.01). Conclusions: DWISTIR is not suitable for quantitative assessment of Crohn’s disease activity both in children and adult patients.

Highlights

Crohn’s disease (CD) is an idiopathic chronic relapsing inflammatory bowel condition, which manifests itself in fistulae, abscesses and strictures [1]
SPIR and STIR presenting with high SI in diffusion weighted imaging (DWI) tracking images of b = 800 s/mm2 along with low signal intensity (SI) in the apparent diffusion coefficient (ADC) map, and early mucosal hyperenhancement in the post-Gd series [40]
The duration of medical history prior to the Magnetic resonance enterography (MRE) examination was more than two years in three adult patients—from 6 till 12 months, but in one adult patient, CD was asymptomatic, of unknown length, and it was detected upon performing a set of infertility tests

Summary

Introduction

Crohn’s disease (CD) is an idiopathic chronic relapsing inflammatory bowel condition, which manifests itself in fistulae, abscesses and strictures [1]. Since 2019, according to ECCO-ESGAR Guideline for Diagnostic Assessment in inflammatory bowel diseases, cross-sectional. Diagnostics 2020, 10, 347 imaging modalities are recognised to be an alternative for the evaluation of the disease activity [5]. Techniques: DWI with SPIR (DWISPIR ) and DWI with STIR (DWISTIR ), to estimate their eligibility for quantitative assessment of Crohn’s disease activity in children and adults. Methods: In inflamed terminal ileum segments (n = 32 in adults, n = 46 in children), Magnetic Resonance Index of Activity (MaRIA) was calculated, ADC values of both DWI techniques were measured, and the corresponding. ADC values of both DWI techniques were compared between both and within each patient group, assessing their mutual correlation. Correlations between MaRIA and the corresponding ADC values, and Clermont scores based on both DWI techniques were estimated

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