Abstract
BackgroundCross-sectional imaging techniques as magnetic resonance enterography (MRE) may offer additional information on transmural inflammation, stricturing and fistulising complications in Crohn’s disease (CD). The purpose of our study was to evaluate the diagnostic accuracy of Magnetic Resonance Imaging (MRI) combined with Diffusion-weighted Imaging (DWI) and MRE for determination of inflammation in small bowel CD.MethodsMR imaging examination was performed with a GE Signa EXCITE 3.0 T MRI scanner. The optimal b value in DWI with a learning cohort of patients was determined. The diagnostic accuracy for active lesions and disease activity were accessed by MRE combined with DWI.ResultsThe b value 800 s/mm2 group showed the highest diagnostic sensitivity (74.19%) for diagnostic assessment of active Crohn’s lesions on DWI. MRE combined with DWI showed the highest sensitivity (93.55%), specificity (89.47%) and diagnostic accuracy (92%) compared with MRE or DWI alone. The segmental MR score (MR-score-S) showed a significantly positive correlation with the Capsule Endoscopy Crohn’s Disease Activity Index Score (CECDAI-S) (r = 0.717, p < 0.01). The total MR score (MR-score-T) showed significant association with C-reactive protein (CRP) (r = 0.445, p = 0.019) and erythrocyte sedimentation rate (ESR) (r = 0.688, p < 0.01).ConclusionsMRE combined with DWI improves the diagnostic accuracy for active lesions and correlates the endoscopic disease activity. MRE with DWI could represent a non-invasive tool in assessing active inflammation in CD.
Highlights
Cross-sectional imaging techniques as magnetic resonance enterography (MRE) may offer additional information on transmural inflammation, stricturing and fistulising complications in Crohn’s disease (CD)
MRE combined with Diffusion-weighted Imaging (DWI) improves the diagnostic accuracy for active lesions Three different protocols were adopted for image evaluation in this session
There was significant differences existed in signal-to-noise ratio (SNR) (F = 17.074, p < 0.01) and contrast-to-noise ratio (CNR) (F = 14.920, p < 0.01) when b value as 800 s/mm2 and 1500 s/mm2, respectively
Summary
Cross-sectional imaging techniques as magnetic resonance enterography (MRE) may offer additional information on transmural inflammation, stricturing and fistulising complications in Crohn’s disease (CD). The purpose of our study was to evaluate the diagnostic accuracy of Magnetic Resonance Imaging (MRI) combined with Diffusion-weighted Imaging (DWI) and MRE for determination of inflammation in small bowel CD. Crohn’s disease (CD) is characterized by chronic inflammation with a relapsing and remitting natural history. Preliminary evidence has suggested that therapeutic strategy for endoscopic remission might be associated with better outcome [1]. Mucosal healing (MH) or deep remission emerges as the therapeutic endpoint in patients with CD, especially in severe or complicated cases. Monitoring the disease with endoscopy and cross-sectional imaging is proposed to assess MH. Endoscopy allows direct visualization of the mucosa and acquisition of biopsies.
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