Abstract

ObjectiveQuantitative Magnetic Resonance Imaging sequences have been investigated as objective imaging biomarkers of fibrosis and inflammation in Crohn’s disease.AimTo determine the repeatability and inter- and intra-observer agreement of these measures in the prepared small bowel wall.MethodsTen healthy participants were scanned at 3 T on 2 separate occasions using T1 and T2 relaxometry, IVIM-DWI and MT sequences. Test–retest repeatability was assessed using the coefficient of variation (CoV) and intra-class correlation coefficients (ICCs) were used to evaluate the intra- and inter-observer agreementResultsTest–retest repeatability in the bowel wall was excellent for apparent diffusion coefficient (ADC), magnetisation transfer ratio (MTR), T1, and diffusion coefficient D (CoV 5%, 7%, 8%, and 10%, respectively), good for perfusion fraction (PF) (CoV 20%) and acceptable for T2 (CoV 21%). Inter-observer agreement was good for the T2, D and ADC (ICC = 0.89, 0.86, 0.76, respectively) and moderate for T1 (ICC = 0.55). Intra-observer agreement was similar to inter-observer agreement.DiscussionThis study showed variable results between the different parameters measured. Test–retest repeatability was at least acceptable for all parameters except pseudo-diffusion coefficient D*. Good inter- and intra-observer agreement was obtained for T2, ADC and D, with these parameters performing best in this technical validation study.

Highlights

  • Magnetic Resonance Imaging (MRI) is a gold-standard modality for non-invasively assessing disease activity and extent in small bowel Crohn’s disease (CD) [1, 2]

  • The main goal of this study was a technical validation of MRI-based quantitative measures of T1 and T2, magnetisation transfer ratio (MTR) and IVIM-diffusionweighted imaging (DWI) in the small bowel wall on a 3 T MRI platform

  • We have shown that the test–retest repeatability coefficient of variation (CoV) was excellent for apparent diffusion coefficient (ADC), MTR, T1 and D, good for D, and acceptable for T2, but poor for D*

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Summary

Introduction

Magnetic Resonance Imaging (MRI) is a gold-standard modality for non-invasively assessing disease activity and extent in small bowel Crohn’s disease (CD) [1, 2]. T1-weighted and T2-weighted images cannot reliably differentiate fibrosis from inflammation in the bowel wall; an important determinant in decision-making for treatment options. Quantitative sequences such as diffusionweighted imaging (DWI) [6, 7] and magnetisation transfer (MT) [8, 9] have been investigated as potential imaging biomarkers in CD. Quantitative relaxometry T1 and T2 measures have shown potential as markers of fibrosis and inflammation in the liver [14, 15], pancreas [16, 17] and kidneys [18] and T2 of the small bowel wall has been shown to be related to intestinal permeability [19]. T1 and T2 measures have not been widely investigated in intestinal wall imaging

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