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Diagnostic accuracy of three different MRI protocols in patients with inflammatory bowel disease
Kayalvily Jesuratnam-Nielsen1, Vibeke Berg Løgager2, Pia Munkholm3
1Department of Diagnostic Radiology, Copenhagen University Hospital Herlev, Herlev, Denmark ; Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Background:
Magnetic resonance imaging (MRI) is used for workup and control of inflammatory bowel disease (IBD); however, disagreement remains as to how the MRI should be performed.
Purpose:
To compare prospectively the diagnostic accuracy of MRI with neither oral nor intravenous contrast medium (plain MRI), magnetic resonance follow-through (MRFT) and MR enteroclysis (MRE) using MRE as the reference standard in patients with inflammatory bowel disease.
Material And Methods:
Plain MRI and MRE were carried out in addition to MRFT. All patients underwent both plain MR and MRFT on the same day and MRE within seven days. For the evaluation, the bowel was divided into nine segments. One radiologist, blinded to clinical findings, evaluated bowel wall thickness, diffusion weighted imaging (DWI), mural hyperenhancement, and other inflammatory changes in each bowel segment.
Results:
Twenty patients (6 men, 14 women; median age, 43.5 years; age range, 26-76 years) underwent all three examinations; 10 with Crohn's disease (CD), three with ulcerative colitis (UC), and seven with IBD unclassified (IBD-U). Sensitivity, specificity, and accuracy were in the range of 0-75%, 81-96%, and 75-95% for wall thickening, and 0-37%, 59-89%, and 50-86% for DWI in plain MRI, respectively. Sensitivity, specificity, and accuracy were in the range of 0-50%, 96-100%, and 90-100% for wall thickening, 0-50%, 84-97%, and 82-95% for DWI, and 0-71%, 94-100%, and 85-100% for mural hyperenhancement in MRFT, respectively.
Conclusion:
The use of oral and intravenous contrast agent improves detection of bowel lesions resulting in MRFT remaining the superior choice over plain MRI for diagnostic workup in patients with IBD.
Insights
Magnetic resonance imaging (MRI) is crucial for inflammatory bowel disease (IBD) diagnosis. Magnetic resonance follow-through (MRFT) with contrast agents offers superior diagnostic accuracy compared to plain MRI for evaluating IBD patients.
Area of Science:
- Radiology
- Gastroenterology
- Medical Imaging
Background:
- Magnetic resonance imaging (MRI) is a key tool for diagnosing and monitoring inflammatory bowel disease (IBD).
- Standardized MRI protocols for IBD remain a subject of debate.
- Optimizing MRI techniques is essential for accurate IBD assessment.
Purpose of the Study:
- To prospectively compare the diagnostic accuracy of three MRI techniques for IBD.
- The techniques compared were plain MRI (no contrast), magnetic resonance follow-through (MRFT), and MR enteroclysis (MRE).
- MR enteroclysis (MRE) was used as the reference standard.
Main Methods:
- Twenty patients with IBD underwent plain MRI, MRFT, and MRE.
- The bowel was segmented into nine sections for evaluation.
- A radiologist assessed bowel wall thickness, diffusion-weighted imaging (DWI), and mural hyperenhancement, blinded to clinical data.
Main Results:
- MRFT demonstrated higher sensitivity and accuracy for detecting wall thickening and hyperenhancement compared to plain MRI.
- Plain MRI showed variable sensitivity (0-75%) and specificity (81-96%) for wall thickening.
- MRFT exhibited superior performance, with sensitivity, specificity, and accuracy ranging from 0-71%, 94-100%, and 85-100% for various inflammatory indicators.
Conclusions:
- Contrast agents significantly improve the detection of bowel lesions in IBD patients via MRI.
- Magnetic resonance follow-through (MRFT) is the preferred MRI technique over plain MRI for IBD diagnostic workup.
- Utilizing contrast agents in MRI enhances diagnostic yield for inflammatory bowel disease.
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