Abstract
Background and objectives: The aim of the study was to assess whether there were differences between apparent diffusion coefficient (ADC) values of diffusion-weighted imaging (DWI) and diffusion-weighted imaging with background body signal suppression (DWIBS) sequences in non-prepared and prepared bowels before and after preparation with an enteric hyperosmolar agent, to assess whether ADC measurements have the potential to avoid bowel preparation and whether ADC-DWIBS has advantages over ADC-DWI. Materials and Methods: 106 adult patients without evidence of inflammatory bowel disease (IBD) underwent magnetic resonance (MR) enterography before and after bowel preparation. ADC-DWI and ADC-DWIBS values were measured in the intestinal and colonic walls demonstrating high signal intensity (SI) at DWI tracking images of b = 800 s/mm2 before and after preparation. Results: There were significant difference (p < 0.0001) in both ADC-DWI and ADC-DWIBS results between non-prepared and prepared jejunum for DWI being 1.09 × 10−3 mm2/s and 1.76 × 10−3 mm2/s, respectively, and for DWIBS being 0.91 × 10−3 mm2/s and 1.75 × 10−3 mm2/s, respectively. Both ADC-DWI and DWIBS also showed significant difference between non-prepared and prepared colon (p < 0.0001), with DWI values 1.41 × 10−3 mm2/s and 2.13 × 10−3 mm2/s, and DWIBS—1.01 × 10−3 mm2/s and 2.04 × 10−3 mm2/s, respectively. No significant difference between ADC-DWI and ADC-DWIBS was found in prepared jejunum (p = 0.84) and prepared colon (p = 0.58), whereas a significant difference was found in non-prepared jejunum and non-prepared colon (p = 0.0001 in both samples). Conclusions: ADC between DWI and DWIBS does not differ in prepared bowel walls but demonstrates a difference in non-prepared bowel. ADC in non-prepared bowel is lower than in prepared bowel and possible overlap with the ADC range of IBD is possible in non-prepared bowel. ADC-DWIBS has no advantage over ADC-DWI in regard to IBD assessment.
Highlights
Crohn’s disease (CD) is a chronic inflammatory bowel disease (IBD) of rising incidence and prevalence [1]
The results showed that apparent diffusion coefficient (ADC) values in both diffusion-weighted imaging (DWI) and diffusion-weighted imaging with background body signal suppression (DWIBS) were dependent on colonic intraluminal content and in the presence of low signal intensity faeces were nearly two times lower than in the presence of high signal intensity mannitol
The study has found that ADC ranges of the non-prepared bowel are significantly lower when compared to the ADC ranges of prepared bowels in both intestines and the colon, potentially overlapping ADC ranges of the inflamed bowel in both DWI and DWIBS sequences
Summary
Crohn’s disease (CD) is a chronic inflammatory bowel disease (IBD) of rising incidence and prevalence [1] It has high complication rates [2], requiring surgical treatment upon progression [3]. Materials and Methods: 106 adult patients without evidence of inflammatory bowel disease (IBD) underwent magnetic resonance (MR) enterography before and after bowel preparation. In both ADC-DWI and ADC-DWIBS results between non-prepared and prepared jejunum for DWI being 1.09 × 10−3 mm2 /s and 1.76 × 10−3 mm2 /s, respectively, and for DWIBS being 0.91 × 10−3 mm2 /s and 1.75 × 10−3 mm2 /s, respectively Both ADC-DWI and DWIBS showed significant difference between non-prepared and prepared colon (p < 0.0001), with DWI values 1.41 × 10−3 mm2 /s and. ADC-DWIBS has no advantage over ADC-DWI in regard to IBD assessment
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