Diffusion-weighted magnetic resonance imaging in ileocolonic Crohn's disease

Mie A Juel, Søren Rafael Rafaelsen, Torben Nathan, Jens Kjeldsen

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Abstract

Background: Diffusion-weighted magnetic resonance imaging (dw- MRI) utilizes differences in the motion of water molecules between tissues for image formation without administration of contrast materials. Inflammation in the bowel wall slows water transit resulting in lower apparent diffusions coefficients (ADC). Previous studies have shown that dw-MRI combined with conventional MR sequences can be useful for detection of Crohn's disease in the terminal ileum and colon. The present feasibility study examined the diagnostic performance of free-breathing dw-MRI without fasting, bowel preparation or contrast administration in ileocolonic Crohn's disease. Methods: A total of 10 patients with known Crohn's disease were included in this prospective and blinded study. dw-MRI was performed with a Philips Achieva 1.5T MR system and body coil (Philips Medical Systems, Eindhoven, The Netherlands). The MR protocol contained coronal e-thrive and SShT2 with free-breathing and a factor b fixed at 800 s/mm2. Patients were examined in the prone position before and after intravenous administration of 20 mg Hyoscin Butylbromide (Buscopan®, Boehringer Ingelheim, Basel, Switzerland). Ileocolonoscopy with Simple Endoscopic Score for Crohn's disease (SES-CD) served as gold standard. Active Crohn's disease was defined as a segmental score ≥ 1. Results: A total of 46 bowel segments were assessed with ileocolonoscopy and dw-MRI of which 22 (48%) were inflamed according to the gold standard (median SES-CD segmental score 4, range 2-8). ADC obtained with and without Buscopan correlated with a Spearman's rho of 0.64 (P < 0.001). Without Buscopan, there was a trend towards lower ADC in segments with Crohn's disease compared to segments without inflammation (1.43 x 10 − ³3 mm2/s vs. 1.48 x 10 − ³ mm2/s, P = 0.08, Table 1). However, this difference was not observed with Buscopan (P = 0.49). ROCanalysis revealed an area under the curve (AUC) of 0.56 and 0.64 with and without Buscopan, respectively (P = 0.3). In the transverse colon, dw-MRI significantly discriminated active from inactive Crohn's disease (1.58 x 10 − ³ mm2/s vs. 1.18 x 10 − ³ mm2/s, P = 0.01). Conclusions: The ability of dw-MRI to discriminate Crohn's disease from normal bowel segments is inadequate. Large variations of ADC in normal and diseased bowel segments emphasize the importance of optimal anatomical distinction for obtaining precise measurements.
Original languageEnglish
Publication date1. Feb 2015
Number of pages2
DOIs
Publication statusPublished - 1. Feb 2015
EventECCO 2015 - Spainen, Barcelona, Denmark
Duration: 18. Feb 201521. Jun 2015
Conference number: 10

Conference

ConferenceECCO 2015
Number10
LocationSpainen
CountryDenmark
CityBarcelona
Period18/02/201521/06/2015

Fingerprint

Crohn Disease
Feasibility Studies
Ileum
Netherlands
Contrast Media
Area Under Curve
Fasting
Respiration
Colon
Prospective Studies

Bibliographical note

JOURNAL OF CROHNS & COLITIS 2015;9:S159-160
OXFORD UNIV PRESS

Keywords

  • Crohn Disease
  • MRI
  • Diffusion

Cite this

Juel, Mie A ; Rafaelsen, Søren Rafael ; Nathan, Torben ; Kjeldsen, Jens. / Diffusion-weighted magnetic resonance imaging in ileocolonic Crohn's disease. Poster session presented at ECCO 2015, Barcelona, Denmark.2 p.
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title = "Diffusion-weighted magnetic resonance imaging in ileocolonic Crohn's disease",
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keywords = "Crohn Disease, MRI, Diffusion",
author = "Juel, {Mie A} and Rafaelsen, {S{\o}ren Rafael} and Torben Nathan and Jens Kjeldsen",
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Diffusion-weighted magnetic resonance imaging in ileocolonic Crohn's disease. / Juel, Mie A; Rafaelsen, Søren Rafael; Nathan, Torben; Kjeldsen, Jens.

2015. Poster session presented at ECCO 2015, Barcelona, Denmark.

Research output: Contribution to conference without publisher/journalPosterResearchpeer-review

TY - CONF

T1 - Diffusion-weighted magnetic resonance imaging in ileocolonic Crohn's disease

AU - Juel, Mie A

AU - Rafaelsen, Søren Rafael

AU - Nathan, Torben

AU - Kjeldsen, Jens

N1 - JOURNAL OF CROHNS & COLITIS 2015;9:S159-160 OXFORD UNIV PRESS

PY - 2015/2/1

Y1 - 2015/2/1

N2 - Background: Diffusion-weighted magnetic resonance imaging (dw- MRI) utilizes differences in the motion of water molecules between tissues for image formation without administration of contrast materials. Inflammation in the bowel wall slows water transit resulting in lower apparent diffusions coefficients (ADC). Previous studies have shown that dw-MRI combined with conventional MR sequences can be useful for detection of Crohn's disease in the terminal ileum and colon. The present feasibility study examined the diagnostic performance of free-breathing dw-MRI without fasting, bowel preparation or contrast administration in ileocolonic Crohn's disease. Methods: A total of 10 patients with known Crohn's disease were included in this prospective and blinded study. dw-MRI was performed with a Philips Achieva 1.5T MR system and body coil (Philips Medical Systems, Eindhoven, The Netherlands). The MR protocol contained coronal e-thrive and SShT2 with free-breathing and a factor b fixed at 800 s/mm2. Patients were examined in the prone position before and after intravenous administration of 20 mg Hyoscin Butylbromide (Buscopan®, Boehringer Ingelheim, Basel, Switzerland). Ileocolonoscopy with Simple Endoscopic Score for Crohn's disease (SES-CD) served as gold standard. Active Crohn's disease was defined as a segmental score ≥ 1. Results: A total of 46 bowel segments were assessed with ileocolonoscopy and dw-MRI of which 22 (48%) were inflamed according to the gold standard (median SES-CD segmental score 4, range 2-8). ADC obtained with and without Buscopan correlated with a Spearman's rho of 0.64 (P < 0.001). Without Buscopan, there was a trend towards lower ADC in segments with Crohn's disease compared to segments without inflammation (1.43 x 10 − ³3 mm2/s vs. 1.48 x 10 − ³ mm2/s, P = 0.08, Table 1). However, this difference was not observed with Buscopan (P = 0.49). ROCanalysis revealed an area under the curve (AUC) of 0.56 and 0.64 with and without Buscopan, respectively (P = 0.3). In the transverse colon, dw-MRI significantly discriminated active from inactive Crohn's disease (1.58 x 10 − ³ mm2/s vs. 1.18 x 10 − ³ mm2/s, P = 0.01). Conclusions: The ability of dw-MRI to discriminate Crohn's disease from normal bowel segments is inadequate. Large variations of ADC in normal and diseased bowel segments emphasize the importance of optimal anatomical distinction for obtaining precise measurements.

AB - Background: Diffusion-weighted magnetic resonance imaging (dw- MRI) utilizes differences in the motion of water molecules between tissues for image formation without administration of contrast materials. Inflammation in the bowel wall slows water transit resulting in lower apparent diffusions coefficients (ADC). Previous studies have shown that dw-MRI combined with conventional MR sequences can be useful for detection of Crohn's disease in the terminal ileum and colon. The present feasibility study examined the diagnostic performance of free-breathing dw-MRI without fasting, bowel preparation or contrast administration in ileocolonic Crohn's disease. Methods: A total of 10 patients with known Crohn's disease were included in this prospective and blinded study. dw-MRI was performed with a Philips Achieva 1.5T MR system and body coil (Philips Medical Systems, Eindhoven, The Netherlands). The MR protocol contained coronal e-thrive and SShT2 with free-breathing and a factor b fixed at 800 s/mm2. Patients were examined in the prone position before and after intravenous administration of 20 mg Hyoscin Butylbromide (Buscopan®, Boehringer Ingelheim, Basel, Switzerland). Ileocolonoscopy with Simple Endoscopic Score for Crohn's disease (SES-CD) served as gold standard. Active Crohn's disease was defined as a segmental score ≥ 1. Results: A total of 46 bowel segments were assessed with ileocolonoscopy and dw-MRI of which 22 (48%) were inflamed according to the gold standard (median SES-CD segmental score 4, range 2-8). ADC obtained with and without Buscopan correlated with a Spearman's rho of 0.64 (P < 0.001). Without Buscopan, there was a trend towards lower ADC in segments with Crohn's disease compared to segments without inflammation (1.43 x 10 − ³3 mm2/s vs. 1.48 x 10 − ³ mm2/s, P = 0.08, Table 1). However, this difference was not observed with Buscopan (P = 0.49). ROCanalysis revealed an area under the curve (AUC) of 0.56 and 0.64 with and without Buscopan, respectively (P = 0.3). In the transverse colon, dw-MRI significantly discriminated active from inactive Crohn's disease (1.58 x 10 − ³ mm2/s vs. 1.18 x 10 − ³ mm2/s, P = 0.01). Conclusions: The ability of dw-MRI to discriminate Crohn's disease from normal bowel segments is inadequate. Large variations of ADC in normal and diseased bowel segments emphasize the importance of optimal anatomical distinction for obtaining precise measurements.

KW - Crohn Disease

KW - MRI

KW - Diffusion

U2 - 10.1093/ecco-jcc/jju027.285

DO - 10.1093/ecco-jcc/jju027.285

M3 - Poster

ER -