High b-value computed diffusion-weighted imaging for differentiating bowel inflammation in Crohn's disease

Area of Science:

• Medical Imaging
• Gastroenterology
• Radiology

Background:

• Crohn's disease (CD) is a chronic inflammatory bowel disease.
• Accurate assessment of bowel inflammation is crucial for effective CD management.
• Current imaging techniques may have limitations in differentiating inflammatory severity.

Purpose of the Study:

• To evaluate if high b-value computed diffusion-weighted imaging (cDWI) improves the detection and differentiation of bowel inflammation in CD patients.
• To compare the diagnostic performance of cDWI with standard diffusion-weighted imaging (DWI) and contrast-enhanced magnetic resonance enterography (CE-MRE).

Main Methods:

• Retrospective analysis of 54 CD patients who underwent magnetic resonance enterography (MRE) and endoscopy.
• Generation of cDWI with a b-value of 1500 s/mm² (cDWI1500) from standard DWI (aDWI800).
• Assessment of signal intensities (SIs), SI ratios (bowel wall-to-iliopsoas muscle), and apparent diffusion coefficient (ADC) values; comparison of lesion detection using Likert scales and receiver operating characteristic curve analysis (AUC).

Main Results:

• cDWI1500 significantly suppressed intraluminal fluid signal intensity compared to aDWI800 (98.3% vs 44.7% of segments).
• AUCs for SI ratios were higher for cDWI1500 (82.0%) than aDWI800 (75.2%), approaching ADC values (81.5%).
• Diagnostic performance followed the order: CE-MRE > plain MRE with cDWI1500 > plain MRE with aDWI800.

Conclusions:

• High b-value cDWI (cDWI1500) effectively suppresses intraluminal fluid in MRE for CD patients.
• cDWI1500 enhances contrast between inflamed and non-inflamed bowel segments, improving diagnostic accuracy.
• This technique aids in the evaluation of bowel inflammation in Crohn's disease.