Perianal Crohn Disease: Evaluation of Dynamic Contrast-enhanced MR Imaging as an Indicator of Disease Activity

Abstract

To prospectively determine clinical value of dynamic contrast material-enhanced magnetic resonance (MR) imaging in the evaluation of disease activity in perianal Crohn disease (CD). Patients provided written informed consent. Study approval was waived by an institutional review board. Thirty-three patients with perianal CD underwent pelvic MR imaging; 17 were male (mean age, 37.4 years +/- 10.8 [standard deviation]; age range, 18-54 years) and 16 were female (mean age, 32.0 years +/- 8.3; age range, 16-43 years). Dynamic contrast-enhanced MR imaging was performed; time-intensity curves (TICs) were obtained. Each pixel was classified as one of six predefined TIC shape types. For each MR imaging examination, a region of interest (ROI) was drawn around the fistula on the single section corresponding to the most extensive and most hyperintense lesion; maximum enhancement (ME), slope of enhancement, and TIC shapes were calculated. Absolute and relative numbers of pixels for each curve type were calculated in a two-dimensional ROI. These results were compared with Perianal Disease Activity Index (PDAI), C-reactive protein (CRP) level, an MR imaging-based severity score, and clinical outcome. A Spearman rank correlation test was used to calculate correlation coefficients between dynamic contrast-enhanced MR imaging parameters and reference parameters. A Mann-Whitney U test was used to calculate differences in dynamic contrast-enhanced MR imaging parameters between predefined groups of patients. Significant correlations were found between the absolute amounts of the TIC shape types and PDAI and between ROI volume and PDAI. The ratio of quickly enhancing versus slowly enhancing pixels correlated with higher MR imaging scores as did the ROI volume. The absolute amounts of pixels displaying TIC types 2, 3, 4, and 5 correlated significantly with MR imaging score. CRP level showed a significant correlation with mean ME. Larger numbers of quickly enhancing pixels were observed in patients who needed medication changes or developed new abscesses during follow-up. Dynamic contrast-enhanced MR imaging can help determine disease activity in perianal CD and might be helpful in selecting a subpopulation of patients who should be monitored more closely for development of more extensive disease.