title: Diffusion-weighted magnetic resonance imaging in ileocolonic Crohn's disease: validation of quantitative index of activity.
abstract: OBJECTIVE
  Magnetic resonance imaging (MRI) allows accurate assessment of Crohn's disease (CD), but requires gadolinium injection. Diffusion-weighted (DW)-MRI yields comparable performances in small bowel CD. We compared the accuracy of DW-MR enterocolonography (MREC) and the magnetic resonance index of activity (MaRIA), and performed an external validation of the Clermont score in assessing inflammation in CD.
  
  
  METHODS
  This was an observational prospective study of a single-center cohort. A total of 130 CD patients underwent consecutively MREC with gadolinium injection and DWI sequences between July 2011 and December 2012.
  
  
  RESULTS
  Of the 848 evaluated segments (small bowel=352, colon/rectum=496), 175 (20.6%) were active (small bowel=111, colon/rectum=64) defined as MaRIA ≥7. Using a receiver operating characteristic (ROC) curve, we determined an apparent coefficient of diffusion (ADC) threshold of 1.9 × 10(-3) mm(2)/s that yielded a sensitivity and a specificity in discriminating active from nonactive CD of 96.9% and 98.1%, respectively, for the colon/rectum, and 85.9% and 81.6%, respectively, for the ileum. ADC was better correlated to MaRIA ≥7 than related contrast enhancement obtained with injected sequences (P<0.001). The Clermont score (=1.646 × bowel thickness-1.321 × ADC+5.613 × edema+8.306 × ulceration+5.039) was highly correlated with the MaRIA (rho=0.99) in ileal CD but not in colonic CD (rho <0.80). Interobserver agreement was high with regard to ADC measurement (correlation >0.9, P<0.001, and concordance >0.9, P<0001).
  
  
  CONCLUSIONS
  DW-MREC is a reliable tool to assess inflammation in colonic (ADC) and ileal (Clermont score) CD and its use in daily practice would avoid gadolinium injection.
authors.affiliation: 1] Department of Radiology, University Hospital Estaing of Clermont-Ferrand, Clermont-Ferrand, France [2] These authors contributed equally to this work.
authors.forename: C
authors.initials: C
authors.lastname: Hordonneau
authors.affiliation: 1] Department of Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Clermont-Ferrand, France [2] Microbes, Inflammation, Intestine and Susceptibility of the Host, UMR 1071 INSERM/Auvergne University USC-INRA 2018, Clermont-Ferrand, France [3] These authors contributed equally to this work.
authors.forename: A
authors.initials: A
authors.lastname: Buisson
authors.affiliation: Department of Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: J
authors.initials: J
authors.lastname: Scanzi
authors.affiliation: Department of Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: F
authors.initials: F
authors.lastname: Goutorbe
authors.affiliation: Biostatistics Unit, University Hospital of Clermont-Ferrand, DRCI, Clermont-Ferrand, France.
authors.forename: B
authors.initials: B
authors.lastname: Pereira
authors.affiliation: Department of Paediatrics, University Hospital Estaing of Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: C
authors.initials: C
authors.lastname: Borderon
authors.affiliation: Department of Radiology, University Hospital Estaing of Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: D
authors.initials: D
authors.lastname: Da Ines
authors.affiliation: Department of Radiology, University Hospital Estaing of Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: P F
authors.initials: PF
authors.lastname: Montoriol
authors.affiliation: Department of Radiology, University Hospital Estaing of Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Garcier
authors.affiliation: Department of Radiology, University Hospital Estaing of Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: L
authors.initials: L
authors.lastname: Boyer
authors.affiliation: 1] Department of Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Clermont-Ferrand, France [2] Microbes, Inflammation, Intestine and Susceptibility of the Host, UMR 1071 INSERM/Auvergne University USC-INRA 2018, Clermont-Ferrand, France.
authors.forename: G
authors.initials: G
authors.lastname: Bommelaer
authors.affiliation: Department of Radiology, University Hospital Estaing of Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: V
authors.initials: V
authors.lastname: Petitcolin
mesh_terms: D000328:Adult; D003106:Colon / Q000473:pathology; D057186:Comparative Effectiveness Research; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D005682:Gadolinium; D006801:Humans; D007082:Ileum / Q000473:pathology; D007249:Inflammation / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D062072:Patient Acuity; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index
chemical_list: D005682:Gadolinium