Celiac disease: evaluation with dynamic contrast-enhanced MR imaging.
OBJECTIVE
To prospectively determine mural perfusion dynamics in patients with untreated celiac disease by using dynamic contrast material-enhanced magnetic resonance (MR) imaging and to compare these dynamics with those in a control population and in patients with celiac disease treated with a gluten-free diet.


METHODS
Institutional review board approval and informed consent from all participants were obtained. Sixty consecutive patients with untreated celiac disease, 45 patients with celiac disease treated with a gluten-free diet for at least 1 year, and 30 control subjects were enrolled in this study. Dynamic contrast-enhanced MR imaging was performed by using a 1.5-T MR unit. For each MR imaging examination, maximum enhancement, slope of enhancement, and time-signal intensity curves were calculated at the level of the descending duodenal wall. Duodenal wall thickness was also evaluated. Statistical evaluation was performed by using one-way analysis of variance, and the results were confirmed by using the Bartlett test for equal variances and complemented by using Bonferroni multiple comparison, linear correlation, and the Student t test for paired data.


RESULTS
Mean maximum enhancement of the duodenal wall was significantly higher in patients with untreated celiac disease (229.1 +/- 46.4 [standard deviation]) than in patients with treated celiac disease (109.8 +/- 27.8) and control subjects (94.7 +/- 17.9) (P < .001 for each comparison). All 60 untreated patients showed a curve characterized by fast enhancement and washout (type 4), while all 45 treated patients and the 30 control subjects showed a curve characterized by slow constant enhancement (type 2). Mean duodenal wall thickness was not significantly different between untreated patients (2.2 mm +/- 0.4), treated patients (2.0 mm +/- 0.3), and control subjects (2.0 mm +/- 0.4) (one-way analysis of variance, P = .4177; Bartlett test, P = .6951).


CONCLUSIONS
The results of this study suggest that dynamic evaluation of the bowel wall by using contrast-enhanced MR imaging can be an effective and reproducible way to show the inflammation state in celiac disease.
Masselli
Gabriele
G
Department of Radiology, Gastroenterology, and Surgery, Umberto I Hospital, La Sapienza University, Rome, Italy. gabrielemasselli@libero.it
Picarelli
Antonio
A
Di Tola
Marco
M
Libanori
Valerio
V
Donato
Giuseppe
G
Polettini
Elisabetta
E
Piermattei
Alessandra
A
Palumbo
Piergaspare
P
Pittalis
Angelo
A
Saponara
Annarita
A
Gualdi
Gianfranco
G
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001706:Biopsy; D002446:Celiac Disease / Q000178:diet therapy / Q000473:pathology*; D003287:Contrast Media; D055050:Diet, Gluten-Free; D004573:Electrolytes; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008536:Meglumine; D008875:Middle Aged; D009942:Organometallic Compounds; D011092:Polyethylene Glycols; D011446:Prospective Studies; D015203:Reproducibility of Results
D003287:Contrast Media; D004573:Electrolytes; C033608:Golytely; D009942:Organometallic Compounds; D011092:Polyethylene Glycols; D008536:Meglumine; C072417:gadoterate meglumine