title: Quantification of inflammatory activity in patients with Crohn's disease using diffusion weighted imaging (DWI) in MR enteroclysis and MR enterography.
abstract: Background Individual studies have demonstrated the potential of diffusion-weighted magnetic resonance imaging (DWI-MRI) for identifying inflamed bowel segments. However, these studies were conducted with rather small patient cohorts and in most cases by means of MR enterography only. Purpose To demonstrate the feasibility of detecting inflamed bowel segments in a large collective of patients with Crohn's disease using DWI in MR enteroclysis and MR enterography and to compare the results of both techniques, also considering clinical parameters by means of the Harvey-Bradshaw Index (HBI). Material and Methods Ninety-six patients underwent MRI enteroclysis and 35 patients MR enterography, both with additional DWI. The HBI as well as apparent diffusion coefficients (ADC) in areas of inflamed and normal bowel wall were determined. Thus resulting in 208 bowel segments that were visualized and subsequently statistically analyzed. Results There were no significant differences in ADC values in MR enteroclysis and MR enterography ( P = 0.383 in inflammation, P = 0.223 in normal wall). Areas of inflammation showed statistically highly significant lower ADC values than areas of normal bowel wall ( P < 0.001). An ADC threshold of 1.56 × 10-3mm2/s can distinguish between normal and inflamed bowel segments with a sensitivity of 97.4% and a specificity of 99.2%. A highly significant correlation could be shown between ADC and HBI values ( P = 0.001). Conclusion DWI-MRI facilitates recognition of inflamed bowel segments in patients with Crohn's disease and the ADC values show an excellent correlation to the HBI. There were no significant differences in ADC values in MR enteroclysis and MR enterography. An ADC threshold of 1.56 × 10-3mm2/s differentiates between normal and inflamed bowel wall.
authors.affiliation: 1 Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany.
authors.forename: Nora
authors.initials: N
authors.lastname: Stanescu-Siegmund
authors.affiliation: 1 Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany.
authors.forename: Yessica
authors.initials: Y
authors.lastname: Nimsch
authors.affiliation: 1 Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany.
authors.forename: Arthur P
authors.initials: AP
authors.lastname: Wunderlich
authors.affiliation: 2 Department of Internal Medicine I, University Hospital of Ulm, Ulm, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Wagner
authors.affiliation: 1 Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Meier
authors.affiliation: 3 Department of Diagnostic and Interventional Radiology, Konstanz Hospital, Konstanz, Germany.
authors.forename: Markus S
authors.initials: MS
authors.lastname: Juchems
authors.affiliation: 1 Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany.
authors.forename: Meinrad
authors.initials: M
authors.lastname: Beer
authors.affiliation: 1 Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany.
authors.forename: Stefan A
authors.initials: SA
authors.lastname: Schmidt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003424:Crohn Disease / Q000150:complications / Q000000981:diagnostic imaging*; D038524:Diffusion Magnetic Resonance Imaging; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007249:Inflammation / Q000000981:diagnostic imaging* / Q000209:etiology; D007422:Intestines / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: Abdomen/GI; inflammation; magnetic resonance diffusion/perfusion; magnetic resonance imaging (MRI); small bowel