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European Radiology
Published in: European Radiology 10/2018

01-10-2018 | Magnetic Resonance

Mesenteric lymph nodes in MR enterography: are they reliable followers of bowel in active Crohn’s disease?

Authors: Amir Reza Radmard, Rana Eftekhar Vaghefi, Seyed Ali Montazeri, Sara Naybandi Atashi, Amir Pejman Hashemi Taheri, Sepehr Haghighi, Aneseh Salehnia, Mehrdad Dadgostar, Reza Malekzadeh

Published in: European Radiology | Issue 10/2018

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Abstract

Objectives

To demonstrate magnetic resonance enterography (MRE) features of mesenteric lymph nodes (LN) in patients with Crohn’s disease (CD) and investigate whether they follow enhancement or apparent diffusion coefficient (ADC) parameters of bowel.

Methods

This study was approved by the institutional review board. A total of 788 MREs from patients with CD were retrospectively reviewed. Eighty-eight patients, aged 16-66 years, including 59 active cases, were enrolled based on inclusion criteria. In each MRE, two segments (normal and abnormal) and two LNs (regional and non-regional) were independently suggested, consensually chosen, and analyzed by two radiologists. Signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were calculated to assess signal intensities (SI) at 30, 60 and 180 s after contrast administration, as well as slope of enhancement (SOE). Enhancement parameters and ADC values were compared.

Results

Regional LNs showed significantly higher SI30, SI60 and SI180 (CNR&SNR) and lower ADC values in active vs. inactive groups (all p<0.05) without significant difference in number or size. Strong correlations were demonstrated between abnormal segments and regional LNs in active group in terms of SI30, SI60, SI180, SOE0-30 and ADC values (r = 0.679 to 0.774, all p<0.001). SI180, SOE60-180 and ADC values were moderately correlated between abnormal segments and regional LNs in inactive group (r = 0.448 to 0.595, all p<0.05). In logistic regression analyses, SOE0-30 and ADC value of regional LNs independently predicted active CD.

Conclusion

Mesenteric LNs follow quantitative enhancement and diffusion parameters of bowel in active CD. SOE0-30 and ADC value of LN could predict disease activity.

Key Points

• Mesenteric LNs may strongly follow enhancement pattern of bowel in active CD.
• DWI parameters of LNs and bowel were strongly correlated in active CD.
• SI180 was moderately correlated between bowel and LNs in inactive CD.
• DWI parameters were moderately correlated between LNs and bowel in inactive CD.
• SOE0-30 and ADC value of mesenteric LN could predict disease activity.
Literature
1.
Sinha R, Verma R, Verma S, Rajesh A (2011) MR enterography of Crohn disease: part 1, rationale, technique, and pitfalls. AJR Am J Roentgenol 197:76–79CrossRef
2.
Li Y, Hauenstein K (2015) New Imaging Techniques in the Diagnosis of Inflammatory Bowel Diseases. Viszeralmedizin 31:227–234PubMedPubMedCentral
3.
Rimola J, Rodriguez S, Garcia-Bosch O et al (2009) Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn's disease. Gut 58:1113–1120CrossRef
4.
von der Weid PY, Rehal S, Ferraz JG (2011) Role of the lymphatic system in the pathogenesis of Crohn's disease. Curr Opin Gastroenterol 27:335–341CrossRef
5.
Gourtsoyianni S, Papanikolaou N, Amanakis E et al (2009) Crohn's disease lymphadenopathy: MR imaging findings. Eur J Radiol 69:425–428CrossRef
6.
Schunk K, Kern A, Oberholzer K et al (2000) Hydro-MRI in Crohn's disease: appraisal of disease activity. Invest Radiol 35:431–437CrossRef
7.
Koh DM, Miao Y, Chinn RJ et al (2001) MR imaging evaluation of the activity of Crohn's disease. AJR Am J Roentgenol 177:1325–1332CrossRef
8.
Best WR, Becktel JM, Singleton JW, Kern F (1976) Development of a Crohn's disease activity index. Gastroenterology 70:439–444PubMed
9.
Chenevert TL, Malyarenko DI, Newitt D et al (2014) Errors in Quantitative Image Analysis due to Platform-Dependent Image Scaling. Transl Oncol 7:65–71CrossRef
10.
Li Y, Zhu W, Zuo L, Shen B (2016) The Role of the Mesentery in Crohn's Disease: The Contributions of Nerves, Vessels, Lymphatics, and Fat to the Pathogenesis and Disease Course. Inflamm Bowel Dis 22:1483–1495CrossRef
11.
Becker F, Yi P, Al-Kofahi M, Ganta VC, Morris J, Alexander JS (2014) Lymphatic dysregulation in intestinal inflammation: new insights into inflammatory bowel disease pathomechanisms. Lymphology 47:3–27PubMed
12.
Behr MA (2010) The path to Crohn's disease: is mucosal pathology a secondary event? Inflamm Bowel Dis 16:896–902CrossRef
13.
Van Kruiningen HJ, Colombel JF (2008) The forgotten role of lymphangitis in Crohn's disease. Gut 57:1–4CrossRef
14.
Al-Kofahi M, Yun JW, Minagar A, Alexander JS (2017) Anatomy and roles of lymphatics in inflammatory diseases. Clin Exp Neuroimmunol
15.
Kalima TV (1970) Experimental lymphatic obstruction in the ileum. Ann Chir Gynaecol Fenn 59:187–201PubMed
16.
Kalima TV, Saloniemi H, Rahko T (1976) Experimental regional enteritis in pigs. Scand J Gastroenterol 11:353–362PubMed
17.
Heatley RV, Bolton PM, Hughes LE, Owen EW (1980) Mesenteric lymphatic obstruction in Crohn's disease. Digestion 20:307–313CrossRef
18.
Wu TF, Carati CJ, Macnaughton WK, von der Weid PY (2006) Contractile activity of lymphatic vessels is altered in the TNBS model of guinea pig ileitis. Am J Physiol Gastrointest Liver Physiol 291:G566–G574CrossRef
19.
Jurisic G, Sundberg JP, Detmar M (2013) Blockade of VEGF receptor-3 aggravates inflammatory bowel disease and lymphatic vessel enlargement. Inflamm Bowel Dis 19:1983–1989PubMedPubMedCentral
20.
D'Alessio S, Correale C, Tacconi C et al (2014) VEGF-C-dependent stimulation of lymphatic function ameliorates experimental inflammatory bowel disease. J Clin Invest 124:3863–3878CrossRef
21.
Coffey JC, O'Leary DP, Kiernan MG, Faul P (2016) The mesentery in Crohn's disease: friend or foe? Curr Opin Gastroenterol 32:267–273CrossRef
22.
Westerland O, Griffin N (2016) Magnetic Resonance Enterography in Crohns Disease. Semin Ultrasound CT MR 37:282–291CrossRef
23.
Choi SH, Kim KW, Lee JY, Kim KJ, Park SH (2016) Diffusion-weighted Magnetic Resonance Enterography for Evaluating Bowel Inflammation in Crohn's Disease: A Systematic Review and Meta-analysis. Inflamm Bowel Dis 22:669–679CrossRef
24.
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 16:597–603CrossRef
25.
Ninivaggi V, Missere M, Restaino G et al (2016) MR-enterography with diffusion weighted imaging: ADC values in normal and pathological bowel loops, a possible threshold ADC value to differentiate active from inactive Crohn's disease. Eur Rev Med Pharmacol Sci 20:4540–4546PubMed
26.
Spalinger J, Patriquin H, Miron MC et al (2000) Doppler US in patients with crohn disease: vessel density in the diseased bowel reflects disease activity. Radiology 217:787–791CrossRef
27.
Ludwig D, Wiener S, Bruning A, Schwarting K, Jantschek G, Stange EF (1999) Mesenteric blood flow is related to disease activity and risk of relapse in Crohn's disease: a prospective follow-up study. Am J Gastroenterol 94:2942–2950CrossRef
28.
Tielbeek JA, Ziech ML, Li Z et al (2014) Evaluation of conventional, dynamic contrast enhanced and diffusion weighted MRI for quantitative Crohn's disease assessment with histopathology of surgical specimens. Eur Radiol 24:619–629CrossRef
29.
Rimola J, Planell N, Rodriguez S et al (2015) Characterization of inflammation and fibrosis in Crohn's disease lesions by magnetic resonance imaging. Am J Gastroenterol 110:432–440CrossRef
30.
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 17:984–993CrossRef
31.
Gourtsoyiannis N, Papanikolaou N, Grammatikakis J, Papamastorakis G, Prassopoulos P, Roussomoustakaki M (2004) Assessment of Crohn’s disease activity in the small bowel with MR and conventional enteroclysis: preliminary results. Eur Radiol 14:1017–1024CrossRef
32.
Church PC, Turner D, Feldman BM et al (2015) Systematic review with meta-analysis: magnetic resonance enterography signs for the detection of inflammation and intestinal damage in Crohn's disease. Aliment Pharmacol Ther 41:153–166CrossRef
33.
de Souza HS, Fiocchi C (2016) Immunopathogenesis of IBD: current state of the art. Nat Rev Gastroenterol Hepatol 13:13–27CrossRef
Metadata
Title
Mesenteric lymph nodes in MR enterography: are they reliable followers of bowel in active Crohn’s disease?
Authors
Amir Reza Radmard
Rana Eftekhar Vaghefi
Seyed Ali Montazeri
Sara Naybandi Atashi
Amir Pejman Hashemi Taheri
Sepehr Haghighi
Aneseh Salehnia
Mehrdad Dadgostar
Reza Malekzadeh
Publication date
01-10-2018
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 10/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5441-z

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