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Diffusion and perfusion MRI quantification in ileal Crohn's disease
Stefanie J Hectors1,2, Sonja Gordic1,3, Sahar Semaan1,2
1Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
European Radiology
|July 19, 2018
Summary
Intravoxel incoherent motion (IVIM)-DWI and dynamic contrast-enhanced (DCE)-MRI parameters effectively differentiate normal from abnormal bowel segments in Crohn's disease (CD). Combining these MRI techniques offers promising non-invasive evaluation for small bowel CD.
Area of Science:
- Gastroenterology
- Radiology
- Medical Imaging
Background:
- Crohn's disease (CD) is a chronic inflammatory bowel disease affecting the small intestine.
- Accurate assessment of disease activity is crucial for effective management.
- Current methods for evaluating small bowel CD involve invasive procedures or less specific imaging techniques.
Purpose of the Study:
- To quantify intravoxel incoherent motion (IVIM)-DWI and dynamic contrast-enhanced (DCE)-MRI parameters in normal and abnormal ileal segments of CD patients.
- To assess the association of these parameters with clinical and MRI-based measurements of CD activity.
- To evaluate the diagnostic performance of these MRI parameters for differentiating between normal and inflamed bowel segments.
Main Methods:
- A prospective study involving 27 CD patients undergoing MR enterography with IVIM-DWI and DCE-MRI.
- Quantification of IVIM-DWI and DCE-MRI parameters in normal and abnormal small bowel segments.
- Correlation analysis with clinical data (CRP, HBI), conventional MRI (wall thickness, length), and MRI activity scores (MaRIA, Clermont).
- Receiver Operating Characteristic (ROC) analysis to determine diagnostic performance.
Main Results:
- Significantly increased DCE-MRI parameters (Cpeak, upslope, AUC60, Ktrans, ve) and decreased IVIM-DWI parameters (PF, ADC) were observed in abnormal bowel segments (p<0.023 and p<0.001, respectively).
- DCE-MRI parameters correlated significantly with wall thickness and MRI activity scores (MaRIA, Clermont).
- The combination of Ktrans+ve+PF+ADC yielded the highest AUC (0.963) for differentiating normal from abnormal bowel, while ADC showed the best individual performance (AUC=0.800).
Conclusions:
- IVIM-DWI and DCE-MRI parameters are significantly different between normal and abnormal bowel segments in CD patients.
- DCE-MRI parameters demonstrate a significant association with established measures of disease severity like wall thickness and MRI activity scores.
- The combination of IVIM-DWI and DCE-MRI parameters offers high diagnostic performance for evaluating small bowel CD, with ADC being the best individual parameter.