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Published on: December 15, 2017
Free-breathing diffusion-weighted imaging for the assessment of inflammatory activity in Crohn's disease
Shigeru Kiryu1, Keiichi Dodanuki, Hidemasa Takao
1Department of Radiology, Institute of Medical Science, University of Tokyo, Tokyo, Japan. kiryu-tky@umin.ac.jp
Purpose:
To investigate the application of free-breathing diffusion-weighted MR imaging (DWI) to the assessment of disease activity in Crohn's disease.
Materials And Methods:
Thirty-one patients with Crohn's disease were investigated using free-breathing DWI without special patient preparation or IV or intraluminal contrast agent. The bowel was divided into seven segments, and disease activity was assessed visually on DWI. For quantitative analysis, the apparent diffusion coefficient (ADC) was measured in each segment. The findings of a conventional barium study or surgery were regarded as the gold standard for evaluating the diagnostic ability of DWI to assess disease activity.
Results:
Upon visual assessment, the sensitivity, specificity, and accuracy for the detection of disease-active segments were 86.0, 81.4, and 82.4%, respectively. In the quantitative assessment, the ADC value in the disease-active area was lower than that in disease-inactive area in small and large bowels (1.61 +/- 0.44 x 10(-3) mm(2)/s versus 2.56 +/- 0.51 x 10(-3) mm(2)/s in small bowel and 1.52 +/- 0.43 x 10(-3) mm(2)/s versus 2.31 +/- 0.59 x 10(-3) mm(2)/s in large bowel, respectively, P<0.001).
Conclusion:
Free-breathing DWI is useful in the assessment of Crohn's disease. The accuracy of DWI is high in evaluating disease activity, especially in the small bowel, and the ADC may facilitate quantitative analysis of disease activity.
Insights
Free-breathing diffusion-weighted MR imaging (DWI) effectively assesses Crohn's disease activity. This non-invasive technique shows high accuracy, particularly in the small bowel, with apparent diffusion coefficient (ADC) aiding quantitative analysis.
Area of Science:
- Gastroenterology
- Radiology
- Medical Imaging
Background:
- Crohn's disease is a chronic inflammatory bowel disease requiring accurate assessment of disease activity.
- Current imaging modalities may involve contrast agents or radiation, necessitating alternative diagnostic tools.
Purpose of the Study:
- To evaluate the utility of free-breathing diffusion-weighted magnetic resonance imaging (DWI) for assessing Crohn's disease activity.
- To determine the diagnostic accuracy of DWI in identifying active inflammation in the bowel.
Main Methods:
- Thirty-one Crohn's disease patients underwent free-breathing DWI without contrast agents.
- Disease activity was assessed visually, and apparent diffusion coefficient (ADC) values were quantitatively measured in bowel segments.
- Conventional barium studies or surgical findings served as the gold standard for comparison.
Main Results:
- Visual assessment of DWI demonstrated high sensitivity (86.0%), specificity (81.4%), and accuracy (82.4%) for detecting active Crohn's disease segments.
- Quantitative analysis revealed significantly lower ADC values in disease-active bowel segments compared to inactive segments in both small and large bowels (P<0.001).
Conclusions:
- Free-breathing DWI is a valuable tool for assessing Crohn's disease activity.
- The technique offers high diagnostic accuracy, especially for small bowel involvement.
- Apparent diffusion coefficient (ADC) measurements provide a quantitative method to evaluate disease activity in Crohn's disease.
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