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Fluorescence-mediated Tomography for the Detection and Quantification of Macrophage-related Murine Intestinal Inflammation
Published on: December 15, 2017
Diffusion-weighted magnetic resonance imaging for detecting and assessing ileal inflammation in Crohn's disease
A Buisson1, A Joubert, P-F Montoriol
1Department of Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Auvergne University, France. a_buisson@hotmail.fr
Background:
Whether diffusion-weighted imaging (DWI)-MRI is of value in detecting and assessing inflammation of ileal Crohn's disease (CD) remains poorly investigated.
Aim:
To compare DWI-MR enterography (MRE) with conventional MRE in estimating inflammation in small bowel CD, to determine an apparent diffusion coefficient (ADC) threshold to differentiate active from non-active lesions and to assess inter-observer agreement.
Methods:
Thirty-one CD patients from the Clermont-Ferrand IBD unit with ileal involvement were consecutively and prospectively included between April and June 2011. All patients underwent DWI-MRI to detect the digestive segment with the most severe lesions, which was then used to calculate the ADC. Qualitative and quantitative results were compared with conventional MRE including MaRIA (Magnetic Resonance Index of Activity) score calculation and independent activity predictors (wall thickening, oedema, ulcers). Each examination was interpreted independently by two radiologists blinded for clinical assessment.
Results:
Seventeen patients (54.8%) had active CD as defined by the MaRIA score ≥7. DWI hyperintensity was highly correlated with disease activity evaluated using conventional MRE (P = 0.001). Qualitative analysis of DW sequences determined sensitivity, specificity, positive predictive value and negative predictive value as 100%, 92.9%, 94.4% and 100% respectively. Quantitative analysis using a cut-off of 1.6 × 10(-3) mm(2)/s for ADC yielded sensitivity and specificity values of, respectively, 82.4% and 100%. Inter-observer agreement was high with regard to DWI hyperintensity (κ = 0.69, accuracy rate = 85.7%) and ADC (correlation = 0.74, P < 0.001, and concordance = 0.71, P < 0.001).
Conclusion:
DWI-MR enterography is a well-tolerated, non-time-consuming and accurate tool for detecting and assessing inflammation in small bowel Crohn's disease.
Insights
Diffusion-weighted imaging magnetic resonance enterography (DWI-MRE) accurately detects and assesses inflammation in small bowel Crohn's disease. This non-invasive technique offers high sensitivity and specificity for identifying active disease, improving patient management.
Area of Science:
- Radiology
- Gastroenterology
- Medical Imaging
Background:
- The diagnostic value of diffusion-weighted imaging (DWI)-MRI for ileal Crohn's disease (CD) inflammation is not well-established.
- Conventional MRI techniques may not fully capture the extent of small bowel inflammation in CD.
Purpose of the Study:
- To compare DWI-MR enterography (MRE) with conventional MRE in assessing small bowel CD inflammation.
- To establish an apparent diffusion coefficient (ADC) threshold for differentiating active from non-active lesions.
- To evaluate inter-observer agreement for DWI-MRE findings.
Main Methods:
- Prospective inclusion of 31 CD patients with ileal involvement.
- DWI-MRI was performed to identify the most inflamed segment for ADC calculation.
- Qualitative and quantitative analyses were compared with conventional MRE, including the MaRIA score.
Main Results:
- DWI hyperintensity strongly correlated with disease activity (P = 0.001).
- Qualitative DWI analysis showed high sensitivity (100%) and specificity (92.9%).
- Quantitative ADC analysis (cut-off 1.6 × 10(-3) mm(2)/s) achieved 82.4% sensitivity and 100% specificity, with high inter-observer agreement for both DWI and ADC.
Conclusions:
- DWI-MRE is a well-tolerated, efficient, and accurate method for detecting and assessing small bowel CD inflammation.
- The study establishes DWI-MRE as a valuable tool in the management of Crohn's disease.
- High inter-observer agreement supports the reliability of DWI-MRE in clinical practice.
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