Significance of diffusion weighted imaging (DWI) as an improving factor in contrast enhanced magnetic resonance imaging (MRI) enterography in evaluation of patients with Crohn’s disease
Aim To determine capabilities and potential of contrast enhanced magnetic resonance imaging (MRI) enterography in order to establish the diagnosis and to evaluate severity and activity of intestinal inflammation. Methods Fifty-five patients with suspicion for presence of Crohn's disease were evaluated. All patients underwent contrast enhanced MRI enterography and diffusion weighted imaging (DWI), and subsequently endoscopic examination or surgical treatment. Four parameters were analysed: thickening of the bowel wall, and presence of abscess, fistula and lymphadenopathy. Results Comparing results of DWI and contrast enhanced MRI enterography a significant difference between results given through diffusion and histopathological test was found, e.g. a significant difference between results obtained through diffusion and MRI enterography was found. MRI enterography sensitiveness for bowel wall thickening was 97.7% and specificity 70%, whilst DWI sensitivity for bowel wall thickening was 84% and specificity 100%. The diagnostics of abscess and fistula showed no significant difference between DWI and MRI, while in lymphadenopathy significant difference between contrast enhanced MRI enterography and DWI was found. Conclusion Contrast enhanced MRI enterography in combination with DWI allows for excellent evaluation of disease activity, but also problems or complications following it. The examination can be repeated, controlled, and it can contribute to monitoring of patients with this disease.
Kilcoyne A, Kaplan J, Gee M. Inflammatory bowel disease imaging: current practice and future directions. World J Gastroenterol. 2016;917–32.
2.
Santos M, Gomes C, Torres J. Familial and ethnic risk in inflammatory bowel disease. Ann Gastroenterol. 2018;14–23.
3.
Yamamoto T, Watanabe T. Surgery for luminal Crohn’s disease. World J Gastroenterol. 2014;78–90.
4.
Hansmann J, Eichholz J. Radiological diagnostics of the small bowel. Radiologe. 2012;849–66.
5.
Zhu Q, Wang Z, Wu J, Wang S. Assessment of the diagnostic value of CT and X-ray enterography for small intestinal Crohn disease. Zhonghua Wei Chang Wai Ke Za Zhi. 2013;443–7.
6.
Liu W, Liu J, Luo X, G. A diagnostic accuracy meta-analysis of CT and MRI for the evaluation of small bowel Crohn disease. Acad Radiol. 2017;1216–25.
7.
Paparo F, Denegri A, Revelli M, Puppo C, Garello I, Bacigalupo L, et al. Crohn’s disease: value of diagnostic imaging in the evaluation of anastomotic recurrence. Ann Ital Chir. 2014;271–81.
8.
Al-Bawardy B, Hansel S, Fidler J, Barlow J, Bruining D. Endoscopic and radiographic assessment of Crohn’s disease. Gastroenterol Clin North Am. 2017;493–513.
9.
Rollandi G, Martinoli C, Conzi R, Cittadini G, Molinari F, Bertolotto M, et al. Magnetic resonance imaging of the small intestine and colon in Crohn’s disease. Radiol Med. 1996;81–5.
10.
Gourtsoyiannis N, Papanikolaou N, Grammatikakis J, Maris T, Prassopoulos P. MR enteroclysis protocol optimization: comparison between 3D FLASH with fat saturation after intravenous gadolinium injection and true FISP sequences. Eur Radiol. 2001;908–13.
11.
Greer M. How we do it: MR enterography. Pediatr Radiol. 2016;818–28.
12.
Ippolito D, Invernizzi F, Galimberti S, Panelli M, Sironi S. MR enterography with polyethylene glycol as oral contrast medium in the follow-up of patients with Crohn disease: comparison with CT enterography. Abdom Imaging. 2010;563–70.
13.
Siddiki H, Fidler J, Fletcher J, Burton S, Huprich J, Hough D, et al. Prospective comparison of state-of-the-art MR enterography and CT enterography in small-bowel Crohn’s disease. AJR Am J Roentgenol. 2009;113–21.
14.
Tillack C, Seiderer J, Brand S, Göke B, Reiser M, Schaefer C, et al. Correlation of magnetic resonance enteroclysis (MRE) and wireless capsule endoscopy (CE) in the diagnosis of small bowel lesions in Crohn’s disease. Inflamm Bowel Dis. 2008;1219–28.
15.
Costa-Silva L, Brandão A. MR Enterography for the assessment of small bowel diseases. Magn Reson Imaging Clin N Am. 2013;365–83.
16.
Oto A, Zhu F, Kulkarni K, Karczmar G, Turner J, Rubin D. Evaluation of diffusion-weighted MR imaging for detection of bowel inflammation in patients with Crohn’s disease. Acad Radiol. 2009;597–603.
17.
Oto A, Kayhan A, Williams J, Yun F, Arkani L, Rubin S, et al. Active Crohn’s disease in the small bowel: evaluation by diffusion weighted imaging and quantitative dynamic contrast enhanced MR imaging. J Magn Reson Imaging. 2011;615–24.
18.
Park S. DWI at MR enterography for evaluating bowel inflammation in Crohn disease. AJR Am J Roentgenol. 2016;40–8.
19.
Agutter P, Malone P, Wheatley D. Diffusion theory in biology: a relic of mechanistic materialism. J Hist Biol. 2000;71–111.
20.
Takenaka K, Ohtsuka K, Kitazume Y, Nagahori M, Fujii T, Saito E, et al. Correlation of the endoscopic and magnetic resonance scoring systems in the deep small intestine in Crohn’s disease. Inflamm Bowel Dis. 2015;1832–8.
21.
Ellen M, Mah M. Magnetic resonance imaging of the small bowel in patients with Crohn’s disease. Curr Opin Gastroenterol. 2011;132–8.
22.
Florie J, Wasser M, Arts-Cieslik K, Akkerman E, Siersema P, Stoker J. Dynamic contrast-enhanced MRI of the bowel wall for assessment of disease activity in Crohn’s disease. AJR Am J Roentgenol. 2006;1384–92.
23.
Kumar S, Hakim A, Alexakis C, Chhaya V, Tzias D, Pilcher J, et al. Small intestinal contrast ultrasonography for the detection of small bowel complications in Crohn’s disease: correlation with intraoperative findings and magnetic resonance enterography. J Gastroenterol Hepatol. 2015;86–91.
24.
Achitei D, Gologan E, Stefănescu G, Balan G. Clinical, biological and epidemiological aspects of inflammatory bowel diseases in north-east Romania. Rev Med Chir Soc Med Nat Iasi. 2013;16–22.
25.
Buisson A, Joubert A, Montoriol P, Ines D, Hordonneau C, Pereira B, et al. Diffusion-weighted magnetic resonance imaging for detecting and assessing ileal inflammation in Crohn’s disease. Aliment Pharmacol Ther. 2013;537–45.
26.
Horsthuis K, Bipat S, Bennink R, Stoker J. Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta-analysis of prospective studies. Radiology. 2008;64–79.
27.
Maccioni F, Ansari A, Mazzamurro N, Civitelli F, Viola F, Cucchiara F, et al. Detection of Crohn disease lesions of the small and large bowel in pediatric patients: diagnostic value of MR enterography versus reference examinations. AJR Am J Roentgenol. 2014;533–42.
28.
Ah Y. Role of computed tomography enterography/magnetic resonance enterography: Is it in prime time? Clin Endosc. 2012;269–73.
29.
Seo N, Park S, Kim K, Kang B, Lee Y, Yang S, et al. MR enterography for the evaluation of small-bowel inflammation in Crohn disease by using Diffusionweighted imaging without intravenous contrast material: A prospective noninferiority study. Radiology. 2016;762–72.
30.
Oussalah A, Laurent V, Bruot O, Bressenot A, Bigard M, Régent D, et al. Diffusion-weighted magnetic resonance without bowel preparation for detecting colonic inflammation in inflammatory bowel disease. Gut. 2010;1056–65.
31.
Castiglione F, Mainenti P, Palma D, Testa G, Bucci A, Pesce L, et al. Noninvasive diagnosis of small bowel Crohn’s disease: direct comparison of bowel sonography and magnetic resonance enterography. Inflamm Bowel Dis. 2013;991–8.
32.
Ziech M, Hummel T, Smets A, Nievelstein R, Lavini C, Caan M, et al. Accuracy of abdominal ultrasound and MRI for detection of Crohn disease and ulcerative colitis in children. Pediatr Radiol. 2014;1370–8.
33.
Sato H, Tamura C, Narimatsu K, Shimizu M, Takajyo T, Yamashita M, et al. Magnetic resonance enterocolonography in detecting erosion and redness in intestinal mucosa of patients with Crohn’s disease. J Gastroenterol Hepatol. 2015;667–73.
34.
Hordonneau C, Buisson A, Scanzi J, Goutorbe F, Pereira B, Borderon C, et al. Diffusion-weighted magnetic resonance imaging in ileocolonic Crohn’s disease: validation of quantitative index of activity. Am J Gastroenterol. 2014;89–98.
35.
Tielbeek J, Ziech M, Li Z, Lavini C, Bipat S, Bemelman W, et al. Evaluation of conventional, dynamic contrast enhanced and diffusion weighted MRI for quantitative Crohn’s disease assessment with histopathology of surgical specimens. Eur Radiol. 2014;619–29.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
,
