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Assessment of dynamic contrast enhancement of the small bowel in active Crohn's disease using 3D MR enterography
Patrick R Knuesel1, Rahel A Kubik, David W Crook
1Department of Radiology, Kantonsspital Baden, CH-5404 Baden, Switzerland.
Purpose:
To retrospectively compare the dynamic contrast enhancement of the small bowel segments with and without active Crohn's disease at 3D MR enterography (MRE).
Materials And Methods:
Thirteen patients (five men, eight women; mean age 41.2 years; range 29-56) were imaged on a 1.5-T MR scanner (Sonata, Siemens Medical) with standard MR sequences after having ingested 1000 ml of a 3% mannitol solution. Subsequently, high resolution 3D gradient-echo (volumetric interpolated breath-hold examination=VIBE) data sets were obtained pre-contrast and 20-40s, 60-80s, and 120-140 s after i.v. Gd-DOTA administration (0.2 mmol/kg). Signal enhancement was measured on single slices both in normal and histologically confirmed (12/13) inflamed small bowel wall segments as well as in the aorta, the psoas muscle, and the background to calculate signal-to-noise (SNR) and contrast-to-noise ratios (CNR).
Results:
Small bowel wall enhancement was significantly higher (p<0.05) in inflamed compared to normal segments at 20-40s (SNR inflamed: 58.7+/-33.8 vs normal: 36.0+/-19.8; p=0.048; CNR inflamed: 34.8+/-23.4 vs normal: 16.3+/-11.2; p=0.017) and at 60-80s (SNR: 60.3+/-25.1 vs 41.9+/-20.0; p=0.049; CNR: 34.9+/-15.1 vs 19.3+/-13.2; p=0.01) after i.v. contrast administration, respectively. Even at 120-140 s CNR was still increased in inflamed segments (33.7+/-16.0 vs 18.1+/-13.2; p=0.04), while differences in SNR did not attain statistical significance (63.0+/-26.2 vs 45.3+/-23.3; p=0.15).
Conclusion:
In active Crohn's disease, histologically confirmed inflamed small bowel wall segments demonstrate a significantly increased early uptake of gadolinium on 3D VIBE sequences compared to normal small bowel segments.
Insights
Active Crohn's disease shows significantly increased early gadolinium uptake in inflamed small bowel segments compared to normal ones. This finding was confirmed using 3D MR enterography (MRE) dynamic contrast enhancement.
Area of Science:
- Radiology
- Gastroenterology
- Medical Imaging
Background:
- Crohn's disease is a chronic inflammatory bowel disease affecting the small intestine.
- Accurate assessment of active inflammation is crucial for effective management.
- Dynamic contrast-enhanced 3D MR enterography (MRE) is a non-invasive imaging technique.
Purpose of the Study:
- To compare dynamic contrast enhancement patterns in small bowel segments with and without active Crohn's disease using 3D MRE.
- To evaluate the utility of 3D MRE in differentiating inflamed from normal small bowel.
Main Methods:
- Retrospective analysis of 13 patients (mean age 41.2 years) with suspected Crohn's disease.
- 1.5-T MRI with oral mannitol solution followed by 3D gradient-echo (VIBE) sequences.
- Measurement of signal-to-noise (SNR) and contrast-to-noise (CNR) ratios in inflamed and normal segments at various time points post-contrast.
Main Results:
- Inflamed small bowel segments showed significantly higher SNR and CNR at 20-40s and 60-80s post-contrast compared to normal segments (p<0.05).
- Elevated CNR persisted in inflamed segments at 120-140s (p=0.04).
- Histological confirmation of active Crohn's disease in 12 out of 13 patients.
Conclusions:
- Histologically confirmed inflamed small bowel segments in active Crohn's disease exhibit significantly increased early gadolinium uptake on 3D VIBE sequences.
- 3D MRE effectively detects enhanced contrast uptake in active inflammation of the small bowel.
- This technique aids in differentiating active disease from normal bowel segments.
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