Diffusion and perfusion MRI quantification in ileal Crohn’s disease
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To quantify intravoxel incoherent motion (IVIM)-DWI and dynamic contrast-enhanced (DCE)-MRI parameters in normal and abnormal ileal segments in Crohn’s disease (CD) patients and to assess the association of these parameters with clinical and MRI-based measurements of CD activity.
In this prospective study, 27 CD patients (M/F 18/9, mean age 42 years) underwent MR enterography, including IVIM-DWI and DCE-MRI. IVIM-DWI and DCE-MRI parameters were quantified in normal and abnormal small bowel segments, the latter identified by the presence of inflammatory changes. MRI parameter differences between normal and abnormal bowel were tested using Wilcoxon signed-rank tests. IVIM-DWI and DCE-MRI parameters were correlated with clinical data (C-reactive protein, Harvey-Bradshaw Index), conventional MRI parameters (wall thickness, length of involvement) and MRI activity scores (MaRIA, Clermont). Diagnostic performance of (combined) parameters for differentiation between normal and abnormal bowel was determined using ROC analysis.
The DCE-MRI parameters peak concentration Cpeak, upslope, area-under-the-curve at 60s (AUC60), Ktrans and ve were significantly increased (p<0.023), while IVIM-DWI parameters perfusion fraction (PF) and ADC were significantly decreased (p<0.001) in abnormal bowel segments. None of the DCE-MRI and IVIM-DWI parameters correlated with clinical parameters (p>0.105). DCE-MRI parameters exhibited multiple significant correlations with wall thickness (Cpeak, upslope, AUC60, Ktrans; r range 0.431–0.664, p<0.025) and MaRIA/Clermont scores (Cpeak, AUC60, Ktrans; r range 0.441–0.617, p<0.021). Combined Ktrans+ve+PF+ADC showed highest AUC (0.963) for differentiation between normal and abnormal bowel, while ADC performed best for individual parameters (AUC=0.800).
DCE-MRI and IVIM-DWI, particularly when used in combination, are promising for non-invasive evaluation of small bowel CD.
• IVIM-DWI and DCE-MRI parameters were significantly different between normal and abnormal bowel segments in CD patients.
• DCE-MRI parameters showed a significant association with wall thickness and MRI activity scores.
• Combination of IVIM-DWI and DCE-MRI parameters led to the highest diagnostic performance for differentiation between normal and abnormal bowel segments, while ADC showed the highest diagnostic performance of individual parameters.
KeywordsCrohn disease Diffusion magnetic resonance imaging Perfusion imaging
Apparent diffusion coefficient
Arterial input function
Area under the curve at 60 s
Contrast agent concentration
Crohn’s Disease Endoscopic Index of Severity
Dynamic contrast-enhanced MRI
Intravoxel incoherent motion diffusion-weighted imaging
Magnetic Resonance Index of Activity
Relative contrast enhancement
Region of interest
Variable flip angle
Plasma volume fraction
This study has received funding by research grants from Guerbet LLC and the Sanford J Grossman Charitable Trust for Integrative Studies in IBD at Mount Sinai.
Compliance with ethical standards
The scientific guarantor of this publication is Bachir Taouli, MD.
Conflict of interest
The authors of this manuscript declare relationships with the following companies: Jean-Frederic Colombel is a consultant for AbbVie, Amgen, Boehringer-Ingelheim, Celgene Corporation, Celltrion, Enterome, Ferring, Genentech, Janssen and Janssen, Medimmune, Merck & Co., Pfizer, Protagonist, Second Genome, Seres, Shire, Takeda and Theradiag, a speaker for AbbVie, Ferring and Speaker’s bureau for Amgen and received grant support from AbbVie, Takeda and Janssen and Janssen. Bachir Taouli received grant support from Guerbet and Bayer.
Statistics and biometry
One of the authors has significant statistical expertise.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• performed at one institution
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