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European Radiology
Published in: European Radiology 2/2019

01-02-2019 | Gastrointestinal

Diffusion and perfusion MRI quantification in ileal Crohn’s disease

Authors: Stefanie J. Hectors, Sonja Gordic, Sahar Semaan, Octavia Bane, Robert Hirten, Xiaoyu Jia, Jean-Frederic Colombel, Bachir Taouli

Published in: European Radiology | Issue 2/2019

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Abstract

Objectives

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.

Methods

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.

Results

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).

Conclusions

DCE-MRI and IVIM-DWI, particularly when used in combination, are promising for non-invasive evaluation of small bowel CD.

Key Points

• 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.
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Metadata
Title
Diffusion and perfusion MRI quantification in ileal Crohn’s disease
Authors
Stefanie J. Hectors
Sonja Gordic
Sahar Semaan
Octavia Bane
Robert Hirten
Xiaoyu Jia
Jean-Frederic Colombel
Bachir Taouli
Publication date
01-02-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 2/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5627-4

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