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Updated: Mar 15, 2026
Fluorescence-mediated Tomography for the Detection and Quantification of Macrophage-related Murine Intestinal Inflammation
Published on: December 15, 2017
Diffusion-weighted imaging for evaluating inflammatory activity in Crohn's disease: comparison with histopathology,
D A Pendsé1,2, J C Makanyanga1,2, A A Plumb1,2
1University College London Hospitals NHS Foundation Trust, London, UK.
Purpose:
To evaluate whether the extent of enteric diffusion-weighted imaging (DWI) signal abnormality reflects inflammatory burden in Crohn's disease (CD), and to compare qualitative and quantitative grading.
Methods:
69 CD patients (35 male, age 16-78) undergoing MR enterography with DWI (MRE-D) and the same-day faecal calprotectin (cohort 1) were supplemented by 29 patients (19 male, age 16-70) undergoing MRE-D and terminal ileal biopsy (cohort 2). Global (cohort 1) and terminal ileal (cohort 2) DWI signal was graded (0 to 3) by 2 radiologists and segmental apparent diffusion coefficient (ADC) calculated. Data were compared to calprotectin and a validated MRI activity score [MEGS] (cohort 1), and a histopathological activity score (eAIS) (cohort 2) using nonparametric testing and rank correlation.
Results:
Patients with normal (grades 0 and 1) DWI signal had lower calprotectin and MEGS than those with abnormal signal (grades 2 and 3) (160 vs. 492 μg/l, p = 0.0004, and 3.3 vs. 21, p < 0.0001), respectively. Calprotectin was lower if abnormal DWI affected <10 cm of small bowel compared to diffuse small and large bowel abnormality (236 vs. 571 μg, p = 0.009). The sensitivity and specificity for active disease (calprotectin > 120 μg/l) were 83% and 52%, respectively. There was a negative correlation between ileal MEGS and ADC (r = -0.41, p = 0.017). There was no significant difference in eAIS between qualitative DWI scores (p = 0.42). Mean ADC was not different in those with and without histological inflammation (2077 vs. 1622 × 10-6mm2/s, p = 0.10) CONCLUSIONS: Qualitative grading of DWI signal has utility in defining the burden of CD activity. Quantitative ADC measurements have poor discriminatory ability for segmental disease activity.
Insights
Qualitative diffusion-weighted imaging (DWI) grading effectively reflects inflammatory burden in Crohn's disease (CD). However, quantitative apparent diffusion coefficient (ADC) measurements show limited ability to differentiate segmental disease activity.
Area of Science:
- Gastroenterology
- Radiology
- Medical Imaging
Background:
- Crohn's disease (CD) is a chronic inflammatory bowel disease.
- Accurate assessment of inflammatory burden is crucial for effective CD management.
- Diffusion-weighted imaging (DWI) is a promising MRI technique for evaluating intestinal inflammation.
Purpose of the Study:
- To determine if the extent of enteric DWI signal abnormality correlates with inflammatory burden in CD.
- To compare the diagnostic performance of qualitative and quantitative DWI grading in assessing CD activity.
Main Methods:
- MR enterography with DWI (MRE-D) was performed on 98 CD patients.
- Enteric DWI signal was qualitatively graded (0-3) by radiologists.
- Segmental apparent diffusion coefficient (ADC) was calculated and compared with faecal calprotectin, MRI enterography global score (MEGS), and histological activity score (eAIS).
Main Results:
- Patients with normal DWI signals (grades 0-1) had significantly lower calprotectin and MEGS compared to those with abnormal signals (grades 2-3).
- Abnormal DWI affecting less than 10 cm of small bowel was associated with lower calprotectin levels than diffuse involvement.
- Qualitative DWI grading demonstrated 83% sensitivity and 52% specificity for active disease (calprotectin > 120 μg/l).
- A negative correlation was found between ileal MEGS and ADC values (r = -0.41, p = 0.017).
- No significant difference in histological activity score (eAIS) was observed between different qualitative DWI grades.
- Mean ADC values did not differ significantly between patients with and without histological inflammation.
Conclusions:
- Qualitative grading of enteric DWI signal is a useful tool for assessing the overall inflammatory burden in CD.
- Quantitative ADC measurements have limited ability to discriminate segmental disease activity in CD.
- DWI, particularly qualitative assessment, can aid in non-invasively evaluating CD activity.
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