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01-03-2014 | Gastrointestinal

Evaluation of conventional, dynamic contrast enhanced and diffusion weighted MRI for quantitative Crohn’s disease assessment with histopathology of surgical specimens

Authors: Jeroen A. W. Tielbeek, Manon L. W. Ziech, Zhang Li, Cristina Lavini, Shandra Bipat, Willem A. Bemelman, Joris J. T. H. Roelofs, Cyriel Y. Ponsioen, Frans M. Vos, Jaap Stoker

Published in: European Radiology | Issue 3/2014

Abstract

Objectives

To prospectively compare conventional MRI sequences, dynamic contrast enhanced (DCE) MRI and diffusion weighted imaging (DWI) with histopathology of surgical specimens in Crohn’s disease.

Methods

3-T MR enterography was performed in consecutive Crohn’s disease patients scheduled for surgery within 4 weeks. One to four sections of interest per patient were chosen for analysis. Evaluated parameters included mural thickness, T1 ratio, T2 ratio; on DCE-MRI maximum enhancement (ME), initial slope of increase (ISI), time-to-peak (TTP); and on DWI apparent diffusion coefficient (ADC). These were compared with location-matched histopathological grading of inflammation (AIS) and fibrosis (FS) using Spearman correlation, Kruskal–Wallis and Chi-squared tests.

Results

Twenty patients (mean age 38 years, 12 female) were included and 50 sections (35 terminal ileum, 11 ascending colon, 2 transverse colon, 2 descending colon) were matched to AIS and FS. Mural thickness, T1 ratio, T2 ratio, ME and ISI correlated significantly with AIS, with moderate correlation (r = 0.634, 0.392, 0.485, 0.509, 0.525, respectively; all P < 0.05). Mural thickness, T1 ratio, T2 ratio, ME, ISI and ADC correlated significantly with FS (all P < 0.05).

Conclusions

Quantitative parameters from conventional, DCE-MRI and DWI sequences correlate with histopathological scores of surgical specimens. DCE-MRI and DWI parameters provide additional information.

Key points

• Conventional MR enterography can be used to assess Crohn’s disease activity.

• Several MRI parameters correlate with inflammation and fibrosis scores from histopathology.

• Dynamic contrast enhanced imaging and diffusion weighted imaging give additional information.

• Quantitative MRI parameters can be used as biomarkers to evaluate Crohn’s disease activity.

Horsthuis K, Bipat S, Bennink RJ, Stoker J (2008) Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta-analysis of prospective studies. Radiology 247:64–79PubMedCrossRef

Baumgart DC, Sandborn WJ (2012) Crohn’s disease. Lancet 6736:1–16

Panes J, Bouhnik Y, Reinisch W et al (2013) Imaging techniques for assessment of inflammatory bowel disease: Joint ECCO and ESGAR evidence-based consensus guidelines. J Crohns Colitis 7:556–585PubMedCrossRef

Horsthuis K, Bipat S, Stokkers PCF, Stoker J (2009) Magnetic resonance imaging for evaluation of disease activity in Crohn’s disease: a systematic review. Eur Radiol 19:1450–1460PubMedCrossRef

Florie J, Wasser MNJM, Arts-Cieslik K, Akkerman EM, Siersema PD, Stoker J (2006) Dynamic contrast-enhanced MRI of the bowel wall for assessment of disease activity in Crohn’s disease. Am J Roentgenol 186:1384–1392CrossRef

Del Vescovo R, Sansoni I, Caviglia R et al (2008) Dynamic contrast enhanced magnetic resonance imaging of the terminal ileum: differentiation of activity of Crohn’s disease. Abdom Imaging 33:417–424PubMedCrossRef

Taylor SA, Punwani S, Rodriguez-Justo M et al (2009) Mural Crohn disease: correlation of dynamic contrast-enhanced MR imaging findings with angiogenesis and inflammation at histologic examination–pilot study. Radiology 251:369–379PubMedCrossRef

Oto A, Zhu F, Kulkarni K, Karczmar GS, Turner JR, Rubin D (2009) Evaluation of diffusion-weighted MR imaging for detection of bowel inflammation in patients with Crohn’s disease. Acad Radiol 16:597–603PubMedCentralPubMedCrossRef

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 29:880–886PubMedCrossRef

10.

Giusti S, Faggioni L, Neri E et al (2010) Dynamic MRI of the small bowel: usefulness of quantitative contrast-enhancement parameters and time-signal intensity curves for differentiating between active and inactive Crohn’s disease. Abdom Imaging 35:646–653PubMedCrossRef

11.

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 59:1056–1065PubMedCrossRef

12.

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 33:615–624PubMedCrossRef

13.

Ziech MLW, Lavini C, Caan MWA et al (2012) Dynamic contrast-enhanced MRI in patients with luminal Crohn’s disease. Eur J Radiol 81:3019–3027PubMedCrossRef

14.

Buisson A, Joubert A, Montoriol P-F et al (2013) Diffusion-weighted magnetic resonance imaging for detecting and assessing ileal inflammation in Crohn’s disease. Aliment Pharmacol Ther 37:537–545PubMedCrossRef

15.

Punwani S, Rodriguez-Justo M, Bainbridge A et al (2009) Mural inflammation in Crohn disease: location-matched histologic validation of MR imaging features. Radiology 252:712–720PubMedCrossRef

16.

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 pathologic analysis. Inflamm Bowel Dis 17:984–993PubMed

17.

Ziech MLW, Bipat S, Roelofs JJTH et al (2011) Retrospective comparison of magnetic resonance imaging features and histopathology in Crohn’s disease patients. Eur J Radiol 80:e299–e305PubMedCrossRef

18.

Best WR, Becktel JM, Singleton JW, Kern F (1976) Development of a Crohn’s disease activity index. National Cooperative Crohn's Disease Study. Gastroenterology 70:439–444PubMed

19.

Ziech MLW, Bossuyt PMM, Laghi A, Lauenstein TC, Taylor SA, Stoker J (2012) Grading luminal Crohn’s disease: which MRI features are considered as important? Eur J Radiol 81:e467–e472PubMedCrossRef

20.

Vos FM, Tielbeek JAW, Naziroglu RE et al (2012) Computational modeling for assessment of IBD: to be or not to be? Conference proceedings: Annual international conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society 2012:3974–3977

21.

Yushkevich PA, Piven J, Hazlett HC et al (2006) User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. NeuroImage 31:1116–1128PubMedCrossRef

22.

Lavini C, Maas M (2008) DCE-MRI analysis package comprising pixel-by-pixel classification of time intensity curves shapes, permeability maps and Gd concentration calculation. MAGMA 21:486

23.

Borley NR, Mortensen NJ, Jewell DP, Warren BF (2000) The relationship between inflammatory and serosal connective tissue changes in ileal Crohn’s disease: evidence for a possible causative link. J Pathol 190:196–202PubMedCrossRef

24.

Chiorean MV, Sandrasegaran K, Saxena R, Maglinte DD, Nakeeb A, Johnson CS (2007) Correlation of CT enteroclysis with surgical pathology in Crohn’s disease. Am J Gastroenterol 102:2541–2550PubMedCrossRef

25.

Zou KH, Tuncali K, Silverman SG (2003) Correlation and simple linear regression. Radiology 227:617–622PubMedCrossRef

26.

Rimola J, Ordás I, Rodriguez S et al (2011) Magnetic resonance imaging for evaluation of Crohn’s disease: validation of parameters of severity and quantitative index of activity. Inflamm Bowel Dis 17:1759–1768PubMed

27.

Steward MJ, Punwani S, Proctor I et al (2012) Non-perforating small bowel Crohn’s disease assessed by MRI enterography: derivation and histopathological validation of an MR-based activity index. Eur J Radiol 81:2080–2088PubMedCrossRef

28.

Adler J, Punglia DR, 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 18:849–856PubMed

29.

Van Assche G, Dignass A, Panes J et al (2010) The second European evidence-based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis. J Crohns Colitis 4:7–27PubMedCrossRef

30.

Makanyanga J, Punwani S, Taylor SA (2012) Assessment of wall inflammation and fibrosis in Crohn’s disease: value of T1-weighted gadolinium-enhanced MR imaging. Abdom Imaging 37:933–943PubMedCrossRef

31.

Sharman A, Zealley I, Greenhalgh R, Bassett P, Taylor S (2009) MRI of small bowel Crohn’s disease: determining the reproducibility of bowel wall gadolinium enhancement measurements. Eur Radiol 19:1960–1967PubMedCrossRef

32.

Tielbeek JAW, Makanyanga J, Bipat S et al (2013) Grading Crohn’s disease activity with MRI: interobserver variability of MRI features. MRI scoring of severity and correlation with Crohn's Disease Endoscopic Index of Severity. Am J Roentgenol. doi:10.2214/AJR.12.10341

Title: Evaluation of conventional, dynamic contrast enhanced and diffusion weighted MRI for quantitative Crohn’s disease assessment with histopathology of surgical specimens
Authors: Jeroen A. W. Tielbeek
Manon L. W. Ziech
Zhang Li
Cristina Lavini
Shandra Bipat
Willem A. Bemelman
Joris J. T. H. Roelofs
Cyriel Y. Ponsioen
Frans M. Vos
Jaap Stoker
Publication date: 01-03-2014
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 3/2014
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-013-3015-7

At a glance: The STEP trials

Springer Medicine

Evaluation of conventional, dynamic contrast enhanced and diffusion weighted MRI for quantitative Crohn’s disease assessment with histopathology of surgical specimens

Abstract

Objectives

Methods

Results

Conclusions

Key points

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key points

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