title: Diffusion-weighted magnetic resonance imaging is effective to detect ileocolonic ulcerations in Crohn's disease.
abstract: BACKGROUND
  Magnetic resonance entero-colonography enables accurate assessment of ileocolonic Crohn's disease, but the need for bowel cleansing and rectal enema limits considerably its use in daily practice.
  
  
  OBJECTIVE
  We evaluated the accuracy of diffusion-weighted magnetic resonance entero-colonography with neither bowel cleansing nor rectal enema to assess endoscopic activity.
  
  
  METHODS
  Forty-four Crohn's disease patients underwent prospectively and consecutively diffusion-weighted magnetic resonance entero-colonography [with apparent diffusion coefficient (ADC) and Clermont score calculation] and ileocolonoscopy [with Crohn's Disease Endoscopic Index of Severity (CDEIS) and Simplified Endoscopic score for Crohn's Disease (SES-CD) calculation].
  
  
  RESULTS
  Mean ADC was inversely correlated with total CDEIS (ρ = -0.40; P = 0.0067) and total SES-CD (ρ = -0.33; P = 0.032). Considering the 194 segments, ADC was inversely correlated with segmental CDEIS (-0.48; P < 0.001) and segmental SES-CD (-0.44; P < 0.001). ADC values were lower in segments with deep ulcers (1.30 ± 0.23) or superficial ulcerations (1.75 ± 0.64) than in non-ulcerated segments (2.15 ± 0.5) (P = 0.001). Using a receiver operating curve, we determined that segmental ADC <1.42 detected endoscopic deep ulcerations with sensitivity = 0.91 and specificity = 0.83 (Area under the curve = 0.84; P < 0.001). Segmental ADC <1.88 detected endoscopic superficial ulcerations with sensitivity = 0.64 and specificity = 0.75. The segmental ADC values decreased when the ulcerations size increased (P = 0.0001). Clermont score correlated with ileal CDEIS (0.63; P < 0.05) and ileal SES-CD (0.58; P < 0.05). Clermont score was higher in ulcerated segments (23.3 ± 8.4) than in non-ulcerated segments (12.4 ± 10.0) (P = 0.006) and increased with ulcers size (P = 0.012). Clermont score >18.9 detected ulcerations with sensitivity = 0.79 and specificity = 0.73.
  
  
  CONCLUSIONS
  Diffusion-weighted magnetic resonance entero-colonography using apparent diffusion coefficient and Clermont score was effective to indirectly detect endoscopic ulcerations in ileocolonic Crohn's disease.
authors.affiliation: Gastroenterology department, University Hospital Estaing, Clermont-Ferrand, France.|Microbes, Intestine, Inflammation and Susceptibility of the Host, UMR 1071 Inserm/Université d'Auvergne; USCINRA 2018, Clermont-Ferrand, France.
authors.forename: A
authors.initials: A
authors.lastname: Buisson
authors.affiliation: Radiology Department, University Hospital Estaing, Clermont-Ferrand, France.
authors.forename: C
authors.initials: C
authors.lastname: Hordonneau
authors.affiliation: Gastroenterology department, University Hospital Estaing, Clermont-Ferrand, France.|Microbes, Intestine, Inflammation and Susceptibility of the Host, UMR 1071 Inserm/Université d'Auvergne; USCINRA 2018, Clermont-Ferrand, France.
authors.forename: M
authors.initials: M
authors.lastname: Goutte
authors.affiliation: Radiology Department, University Hospital Estaing, Clermont-Ferrand, France.|ISIT UMR 6284 CNRS UdA, Clermont-Ferrand, France.
authors.forename: L
authors.initials: L
authors.lastname: Boyer
authors.affiliation: Biostatistics Unit- DRCI, GM Clermont-Ferrand University and Medical Center, Clermont-Ferrand, France.
authors.forename: B
authors.initials: B
authors.lastname: Pereira
authors.affiliation: Gastroenterology department, University Hospital Estaing, Clermont-Ferrand, France.|Microbes, Intestine, Inflammation and Susceptibility of the Host, UMR 1071 Inserm/Université d'Auvergne; USCINRA 2018, Clermont-Ferrand, France.
authors.forename: G
authors.initials: G
authors.lastname: Bommelaer
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003424:Crohn Disease / Q000175:diagnosis*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007082:Ileum / Q000473:pathology*; D007422:Intestines / Q000473:pathology*; D008297:Male; D012680:Sensitivity and Specificity; D055815:Young Adult