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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.
Objectives:
To quantify intravoxel incoherent motion (IVIM)-DWI and dynamic contrast-enhanced (DCE)-MRI parameters in normal and abnormal ileal segments in Crohn's disease (CD) patients and to assess the association of these parameters with clinical and MRI-based measurements of CD activity.
Methods:
In this prospective study, 27 CD patients (M/F 18/9, mean age 42 years) underwent MR enterography, including IVIM-DWI and DCE-MRI. IVIM-DWI and DCE-MRI parameters were quantified in normal and abnormal small bowel segments, the latter identified by the presence of inflammatory changes. MRI parameter differences between normal and abnormal bowel were tested using Wilcoxon signed-rank tests. IVIM-DWI and DCE-MRI parameters were correlated with clinical data (C-reactive protein, Harvey-Bradshaw Index), conventional MRI parameters (wall thickness, length of involvement) and MRI activity scores (MaRIA, Clermont). Diagnostic performance of (combined) parameters for differentiation between normal and abnormal bowel was determined using ROC analysis.
Results:
The DCE-MRI parameters peak concentration Cpeak, upslope, area-under-the-curve at 60s (AUC60), Ktrans and ve were significantly increased (p<0.023), while IVIM-DWI parameters perfusion fraction (PF) and ADC were significantly decreased (p<0.001) in abnormal bowel segments. None of the DCE-MRI and IVIM-DWI parameters correlated with clinical parameters (p>0.105). DCE-MRI parameters exhibited multiple significant correlations with wall thickness (Cpeak, upslope, AUC60, Ktrans; r range 0.431-0.664, p<0.025) and MaRIA/Clermont scores (Cpeak, AUC60, Ktrans; r range 0.441-0.617, p<0.021). Combined Ktrans+ve+PF+ADC showed highest AUC (0.963) for differentiation between normal and abnormal bowel, while ADC performed best for individual parameters (AUC=0.800).
Conclusions:
DCE-MRI and IVIM-DWI, particularly when used in combination, are promising for non-invasive evaluation of small bowel CD.
Key Points:
• IVIM-DWI and DCE-MRI parameters were significantly different between normal and abnormal bowel segments in CD patients. • DCE-MRI parameters showed a significant association with wall thickness and MRI activity scores. • Combination of IVIM-DWI and DCE-MRI parameters led to the highest diagnostic performance for differentiation between normal and abnormal bowel segments, while ADC showed the highest diagnostic performance of individual parameters.
Insights
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.