Abstract
PurposeThe 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.MethodsThree 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.ResultsSixty-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.ConclusionsThere 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.
Highlights
The purpose of the study was to compare the performance of contrast-enhanced (CE)-Magnetic resonance imaging (MRI) and diffusion-weighted imaging (DW)-MRI in grading Crohn’s disease activity of the terminal ileum
A recent study by Kim et al found that the addition of DW sequences to contrast-enhanced (CE-)MRI did not provide a substantial benefit in terms of diagnostic accuracy
Crohn’s Disease Endoscopic Index of Severity (CDEIS), Crohn’s disease endoscopic index of activity; CRP, C-reactive protein; IQR, interquartile range; MRI magnetic resonance imaging syndrome (n = 4), and unclear diagnosis (n = 1). These patients were included in the analysis, as these diagnoses were unknown before MRI and ileocolonoscopy, and prior indication for MRI was the same as for other patients
Summary
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. A typical MRI protocol for Crohn’s disease evaluation includes a non-enhanced T2-weighted sequence with fat-suppression and T1weighted sequences before and after intravenous administration of a gadolinium chelated contrast agent [2, 3]. DW-MRI and CEMRI 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). A study by Schmid-Tannwald et al included 14 patients with internal fistulas and sinus tracts of different etiologies They found no significant difference in the detection rate of fistulas and sinus tracts between CE-MRI (96%) and DW-MRI (76%) [12]
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