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Can diffusion weighting replace gadolinium enhancement in magnetic resonance enterography for inflammatory bowel
Farah Khachab1, Anderson Loundou2, Céline Roman3
1Pediatric Radiology Department, Hopital de la Timone, Assistance Publique des Hopitaux de Marseille, 264 Rue Saint-Pierre, 13385, Marseille Cedex 5, Marseille, France.
Background:
Contrast-enhanced MRI is often used for diagnosis and follow-up of children with inflammatory bowel disease.
Objective:
To compare the accuracy of diffusion-weighted MRI (DWI) to contrast-enhanced MRI in children with known or suspected inflammatory bowel disease.
Materials And Methods:
This retrospective, consecutive study included 55 children. We used ileo-colonoscopy and histology as the reference standard from the terminal ileum to the rectum, and contrast-enhanced MRI as the reference standard proximal to the terminal ileum. DWI and contrast-enhanced MRI sequences were independently reviewed and compared per patient and per segment to these reference standards and to the follow-up for each child.
Results:
We obtained endoscopic data for 340/385 colonic and ileal segments (88%). The rate of agreement per segment between DWI and endoscopy was 64%, and the rate of agreement between contrast-enhanced MRI and endoscopy was 59%. Per patient, sensitivity and specificity of bowel wall abnormalities as compared to the endoscopy were 87% and 100% for DWI, and 70% and 100% for contrast-enhanced MRI, respectively. Positive and negative predictive values were, respectively, 100% and 57% for DWI, and 96% and 41% for contrast-enhanced MRI. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of DWI compare to contrast-enhanced MRI in the segments proximal to the terminal ileum were 90%, 98%, 90%, 98% and 96%, respectively.
Conclusion:
The diagnostic performance of DWI is competitive to that of contrast-enhanced MRI in children with known or suspected inflammatory bowel disease.
Insights
Diffusion-weighted MRI (DWI) shows diagnostic performance comparable to contrast-enhanced MRI for pediatric inflammatory bowel disease. DWI offers high sensitivity and specificity, making it a valuable tool for diagnosing and monitoring these conditions in children.
Area of Science:
- Pediatric Radiology
- Gastroenterology
- Medical Imaging
Background:
- Contrast-enhanced MRI is a standard imaging technique for diagnosing and monitoring pediatric inflammatory bowel disease (IBD).
- Accurate and sensitive imaging is crucial for effective management of IBD in children.
Purpose of the Study:
- To compare the diagnostic accuracy of diffusion-weighted MRI (DWI) against contrast-enhanced MRI in pediatric patients with known or suspected IBD.
- To evaluate the effectiveness of DWI as an alternative or complementary imaging modality.
Main Methods:
- Retrospective analysis of 55 children with known or suspected IBD.
- Comparison of DWI and contrast-enhanced MRI sequences against ileo-colonoscopy, histology, and MRI findings as reference standards.
- Independent review of imaging sequences per patient and per segment.
Main Results:
- DWI demonstrated higher per-patient sensitivity (87% vs. 70%) and specificity (100% vs. 100%) compared to contrast-enhanced MRI when assessed against endoscopy.
- DWI showed superior agreement rates per segment (64% vs. 59%) compared to contrast-enhanced MRI.
- For segments proximal to the terminal ileum, DWI exhibited high sensitivity (90%), specificity (98%), and accuracy (96%) compared to contrast-enhanced MRI.
Conclusions:
- Diffusion-weighted MRI (DWI) exhibits diagnostic performance competitive with contrast-enhanced MRI in children with IBD.
- DWI is a promising imaging technique for the diagnosis and follow-up of pediatric inflammatory bowel disease.
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