Evaluating the inflammatory activity in Crohn\u2019s disease using magnetic resonance diffusion kurtosis imaging

Jingyun Cheng,Guobin Xu,Guangyao Wu,Xiaoyuan Leng,Yan Wang,Ke Wang

doi:10.1007/s00261-019-02013-3

Abstract

ObjectivesTo explore the feasibility of diffusion kurtosis imaging (DKI) for evaluating inflammatory activity in Crohn’s disease (CD).Materials and methodsIn all, 51 CD patients were included, who were performed with consecutive enteroscopy, MR and DKI (b values = 0–2000 mm2/s). The lesions of bowel segments were graded as inactive (0–2), mild (3–6), and moderate–severe group (> 6) based on simplified endoscopic activity score for Crohn’s disease (SES-CD), The abilities of the parameters of DKI and DWI in grading different activity lesions were compared.ResultsOne hundred and twenty-seven bowel segments including inactive (15), mild (45) and moderate–severe (67) were analyzed. ADC (r = − 0.627, p < 0.001), Dapp (r = − 0.381, p < 0.001) and Kapp (r = 0.641, p < 0.001) were correlated with SES-CD. These parameters were significantly different among the three groups (all p < 0.001). ROC analysis found ADC had the highest accuracy (AUC = 0.884, p < 0.001) to differentiate inactive from active group with the threshold at 0.865 × 10−3 mm2/s, which was slightly higher than Kapp (AUC = 0.867, p < 0.001) with the threshold at 0.645, and was obviously higher than Dapp (AUC = 0.726, p = 0.005). Similarly, ADC also had the highest accuracy (AUC = 0.846, p < 0.001) to differentiate inactive–mild from moderate–severe group with the threshold at 0.825 × 10−3 mm2/s, and minimally higher than Kapp (AUC = 0.843, p < 0.001) with the threshold at 0.695, and obviously higher than Dapp (AUC = 0.690, p < 0.001).ConclusionDKI is feasible and comparable to conventional DWI for the evaluation of inflammatory activity in CD.

Highlights

Crohn’s disease (CD) is a chronic relapsing and remitting disorder that can involve entire gastrointestinal tract and cause irreversible intestinal damage [1]
Segmental magnetic resonance index of activity (MaRIA) was correlated with segmental simplified endoscopic activity score for Crohn’s disease (SES-CD) (r = 0.741, p < 0.001)
It was observed that apparent diffusion coefficient (ADC) and Dapp values inversely correlated, and Kapp positively correlated with disease activity

Summary

Introduction

Crohn’s disease (CD) is a chronic relapsing and remitting disorder that can involve entire gastrointestinal tract and cause irreversible intestinal damage [1]. Magnetic resonance enterography (MRE) is increasingly used for diagnosis and assessment of CD benefitting from its non-ionizing radiation and excellent soft tissue contrast. Several studies have demonstrated that the magnetic resonance index of activity (MaRIA) is well correlated with Crohn’s Disease Endoscopic Index of Severity (CDEIS) or SES-CD [2, 5, 6] and widely used for monitoring therapeutic response [2,3,4]. Diffusion weighted imaging (DWI), as a method of the only non-invasive assessment of free diffusion of water molecules, has been increasingly applied to evaluate pediatric. Apparent diffusion coefficient (ADC), the quantitative parameter of DWI, has been increasingly used for evaluating disease activity in CD [8, 9]. Water molecular diffusion in complex biological tissue tends to deviate from a Gaussian distribution, owing to cellular microstructural barriers

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