Pediatric Radiology

, Volume 43, Issue 9, pp 1077–1085 | Cite as

MRI diffusion-weighted imaging (DWI) in pediatric small bowel Crohn disease: correlation with MRI findings of active bowel wall inflammation

  • Justin M. Ream
  • Jonathan R. DillmanEmail author
  • Jeremy Adler
  • Shokoufeh Khalatbari
  • Jonathan B. McHugh
  • Peter J. Strouse
  • Muhammad Dhanani
  • Benjamin Shpeen
  • Mahmoud M. Al-Hawary
Original Article



Restricted diffusion on diffusion-weighted imaging (DWI) sequences during magnetic resonance enterography (MRE) has been shown in segments of bowel affected by Crohn disease. However, the exact meaning of this finding, particularly within the pediatric Crohn disease population, is poorly understood.


The purpose of this study was to determine the significance of bowel wall restricted diffusion in children with small bowel Crohn disease by correlating apparent diffusion coefficient (ADC) values with other MRI markers of disease activity.

Materials and methods

A retrospective review of pediatric patients (≤ 18 years of age) with Crohn disease terminal ileitis who underwent MRE with DWI at our institution between May 1, 2009 and May 31, 2011 was undertaken. All of the children had either biopsy-proven Crohn disease terminal ileitis or clinically diagnosed Crohn disease, including terminal ileal involvement by imaging. The mean minimum ADC value within the wall of the terminal ileum was determined for each examination. ADC values were tested for correlation/association with other MRI findings to determine whether a relationship exists between bowel wall restricted diffusion and disease activity.


Forty-six MRE examinations with DWI in children with terminal ileitis were identified (23 girls and 23 boys; mean age, 14.3 years). There was significant negative correlation or association between bowel wall minimum ADC value and established MRI markers of disease activity, including degree of bowel wall thickening (R = (−)0.43; P = 0.003), striated pattern of arterial enhancement (P = 0.01), degree of arterial enhancement (P = 0.01), degree of delayed enhancement (P = 0.045), amount of mesenteric inflammatory changes (P < 0.0001) and presence of a stricture (P = 0.02). ADC values were not significantly associated with bowel wall T2-weighted signal intensity, length of disease involvement or mesenteric fibrofatty proliferation.


Increasing bowel wall restricted diffusion (lower ADC values) is associated with multiple MRI findings that are traditionally associated with active inflammation in pediatric small bowel Crohn disease.


Magnetic resonance enterography Crohn disease Diffusion-weighted imaging Small bowel Children 


Conflict of interest



  1. 1.
    Cosnes J, Gower-Rousseau C, Seksik P et al (2011) Epidemiology and natural history of inflammatory bowel disease. Gastroenterology 140:1785–1794PubMedCrossRefGoogle Scholar
  2. 2.
    Malaty HM, Fan X, Opekun AR et al (2010) Rising incidence of inflammatory bowel disease among children: a 12-year study. J Pediatr Gastroenterol Nutr 50:27–31PubMedCrossRefGoogle Scholar
  3. 3.
    Dillman JR, Adler J, Zimmerman EM et al (2010) CT enterography of pediatric Crohn disease. Pediatr Radiol 40:97–105PubMedCrossRefGoogle Scholar
  4. 4.
    Hara AK, Swartz PG (2009) CT enterography of Crohn’s disease. Abdom Imaging 34:289–295PubMedCrossRefGoogle Scholar
  5. 5.
    Jaffe TA, Gaca AM, Delaney S et al (2007) Radiation doses from small-bowel follow through and abdominopelvic MDCT in Crohn’s disease. AJR Am J Roentgenol 189:1015–1022PubMedCrossRefGoogle Scholar
  6. 6.
    Brenner DJ, Elliston CD, Hall EJ et al (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176:289–296PubMedCrossRefGoogle Scholar
  7. 7.
    Feng ST, Law MW, Huang B et al (2010) Radiation dose and cancer risk from pediatric CT examinations on a 64-slice CT: a phantom study. Eur J Radiol 76:19–23CrossRefGoogle Scholar
  8. 8.
    Brenner DJ (2008) Should CT enterography be the modality of choice for imaging Crohn’s disease in children? Gut 57:1489–1490PubMedCrossRefGoogle Scholar
  9. 9.
    Siddiki HA, Fidler JL, Fletcher JG et al (2009) Prospective comparison of state-of-the-art MR enterography and CT enterography in small-bowel Crohn’s disease. AJR Am J Roentgenol 193:113–121PubMedCrossRefGoogle Scholar
  10. 10.
    Lee SS, Kim AY, Yang S-K et al (2009) Crohn disease of the small bowel: comparison of CT enterography, MR enterography, and small bowel follow through as diagnostic techniques. Radiology 251:751–761PubMedCrossRefGoogle Scholar
  11. 11.
    Gee MS, Nimkin K, Hsu M et al (2011) Prospective evaluation of MR enterography as the primary imaging modality for pediatric Crohn disease assessment. AJR Am J Roentgenol 197:224–231PubMedCrossRefGoogle Scholar
  12. 12.
    Dillman JR, Ladino-Torres MF, Adler J et al (2011) Comparison of MR enterography and histopathology in the evaluation of pediatric Crohn disease. Pediatr Radiol 41:1552–1558PubMedCrossRefGoogle Scholar
  13. 13.
    Ippolito D, Invernezzi F, Galimberti S et al (2010) MR enterography with polyethylene glycol as oral contrast medium in the follow-up of patients with Crohn disease: comparison with CT enterography. Abdom Imaging 35:563–570PubMedCrossRefGoogle Scholar
  14. 14.
    Fiorino G, Bonifacio C, Peyrin-Biroulet L et al (2011) Prospective comparison of computed tomography enterography and magnetic resonance enterography for assessment of disease activity and complications in ileocolonic Crohn’s disease. Inflamm Bowel Dis 17:1073–1080PubMedCrossRefGoogle Scholar
  15. 15.
    Jensen MD, Kjeldsen J, Rafaelsen SR et al (2011) Diagnostic accuracies of MR enterography and CT enterography in symptomatic Crohn’s disease. Scand J Gastroenterol 46:1449–1457PubMedCrossRefGoogle Scholar
  16. 16.
    Qayyam A (2009) Diffusion-weighted imaging in the abdomen and pelvis: concepts and applications. Radiographics 29:1797–1810CrossRefGoogle Scholar
  17. 17.
    Oto A, Zhu F, Kulkarni K et al (2009) Evaluation of diffusion-weighted MR imaging for detection of bowel inflammation in patients with Crohn’s disease. Acad Radiol 16:597–603PubMedCrossRefGoogle Scholar
  18. 18.
    Kiryu S, Dodanuki K, Takao H et al (2009) Free-breathing diffusion-weighted imaging for the assessment of inflammatory activity in Crohn’s disease. J Magn Reson Imaging 29:880–886PubMedCrossRefGoogle Scholar
  19. 19.
    Oto A, Kayhan A, Williams JTB et al (2011) Active Crohn’s disease in the small bowel: evaluation by diffusion weighted imaging and quantitative dynamic contrast enhanced MR imaging. J Magn Reson Imaging 33:615–624PubMedCrossRefGoogle Scholar
  20. 20.
    Oussalah A, Laurent V, Bruot O et al (2010) Diffusion-weighted magnetic resonance without bowel preparation for detecting colonic inflammation in inflammatory bowel disease. Gut 59:1056–1065PubMedCrossRefGoogle Scholar
  21. 21.
    Girometti R, Zuiani C, Toso F et al (2008) MRI scoring system including dynamic motility valuation in assessing the activity of Crohn’s disease of the terminal ileum. Acad Radiol 15:153–164PubMedCrossRefGoogle Scholar
  22. 22.
    Rimola J, Rodríguez S, Garcia-Bosch O et al (2009) Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn’s disease. Gut 58:1113–1120PubMedCrossRefGoogle Scholar
  23. 23.
    Adler J, Swanson SD, Schmiedlin-Ren P et al (2011) Magnetization transfer helps detect intestinal fibrosis in an animal model of Crohn disease. Radiology 259:127–135PubMedCrossRefGoogle Scholar
  24. 24.
    Adler J, Punglia D, Dillman JR et al (2012) Computed tomography enterography findings correlate with tissue inflammation, not fibrosis in resected small bowel Crohn’s disease. Inflamm Bowel Dis 18:849–856PubMedCrossRefGoogle Scholar
  25. 25.
    Zappa M, Stefanescu C, Cazals-Hatem D et al (2011) Which magnetic resonance imaging findings accurately evaluate inflammation in small bowel Crohn’s disease? A retrospective comparison with surgical pathological analysis. Inflamm Bowel Dis 17:984–993PubMedCrossRefGoogle Scholar
  26. 26.
    Schirin-Sokhan R, Winograd R, Tischendorf S et al (2011) Assessment of inflammatory and fibrotic stenoses in patients with Crohn’s disease using contrast-enhanced ultrasound and computerized algorithm: a pilot study. Digestion 83:263–268PubMedCrossRefGoogle Scholar
  27. 27.
    Koh D-M, Collins DJ, Orton MR (2011) Incoherent motion in body diffusion-weighted MRI: reality and challenges. AJR Am J Roentgenol 196:1351–1361PubMedCrossRefGoogle Scholar
  28. 28.
    Freiman M, Perez-Rossello JM, Callahan MJ et al (2012) Characterization of fast and slow diffusion from diffusion-weighted MRI of pediatric Crohn’s disease. J Magn Reson Imaging 37:156–163PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Justin M. Ream
    • 1
  • Jonathan R. Dillman
    • 1
    • 2
    Email author
  • Jeremy Adler
    • 3
  • Shokoufeh Khalatbari
    • 4
  • Jonathan B. McHugh
    • 5
  • Peter J. Strouse
    • 1
    • 2
  • Muhammad Dhanani
    • 6
  • Benjamin Shpeen
    • 3
  • Mahmoud M. Al-Hawary
    • 1
    • 7
  1. 1.Department of RadiologyUniversity of Michigan Health SystemAnn ArborUSA
  2. 2.Section of Pediatric RadiologyC.S. Mott Children’s HospitalAnn ArborUSA
  3. 3.Department of Pediatrics and Communicable Diseases, Division of Pediatric GastroenterologyUniversity of Michigan Health SystemAnn ArborUSA
  4. 4.Michigan Institute for Clinical & Health Research (MICHR)University of Michigan Health SystemAnn ArborUSA
  5. 5.Department of PathologyUniversity of Michigan Health SystemAnn ArborUSA
  6. 6.University of Michigan Medical SchoolUniversity of Michigan Health SystemAnn ArborUSA
  7. 7.Division of Abdominal RadiologyUniversity of Michigan Health SystemAnn ArborUSA

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