Diffusion-Weighted MR Enterography to Monitor Bowel Inflammation after Medical Therapy in Crohn's Disease: A Prospective Longitudinal Study.
10.3348/kjr.2017.18.1.162
- Author:
Jimi HUH
1
;
Kyung Jo KIM
;
Seong Ho PARK
;
So Hyun PARK
;
Suk Kyun YANG
;
Byong Duk YE
;
Sang Hyoung PARK
;
Kyunghwa HAN
;
Ah Young KIM
Author Information
1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea. parksh.radiology@gmail.com
- Publication Type:Original Article
- Keywords:
Crohn;
Crohn's;
Diffusion;
Diffusion-weighted;
Magnetic resonance;
Magnetic resonance enterography;
Longitudinal;
Follow-up;
Monitoring
- MeSH:
Adult;
Crohn Disease*;
Diffusion;
Endoscopy;
Follow-Up Studies;
Humans;
Inflammation*;
Longitudinal Studies*;
Magnetic Resonance Imaging;
Prospective Studies*
- From:Korean Journal of Radiology
2017;18(1):162-172
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: To prospectively evaluate the performance of diffusion-weighted imaging (DWI) to monitor bowel inflammation after medical therapy for Crohn's disease (CD). MATERIALS AND METHODS: Before and following 1–2 years of medical therapy, between October 2012 and May 2015, 18 randomly selected adult CD patients (male:female, 13:5; mean age ± SD, 25.8 ± 7.9 years at the time of enrollment) prospectively underwent MR enterography (MRE) including DWI (b = 900 s/mm²) and ileocolonoscopy. Thirty-seven prospectively defined index lesions (one contiguous endoscopy-confirmed inflamed area chosen from each inflamed anatomical bowel segment; 1–4 index lesions per patient; median, 2 lesions) were assessed on pre- and post-treatment MRE and endoscopy. Visual assessment of treatment responses on DWI in 4 categories including complete remission and reduced, unchanged or increased inflammation, and measurements of changes in apparent diffusion coefficient (ΔADC), i.e., pre-treatment–post-treatment, were performed by 2 independent readers. Endoscopic findings and CD MRI activity index (CDMI) obtained using conventional MRE served as reference standards. RESULTS: ΔADC significantly differed between improved (i.e., complete remission and reduced inflammation) and unimproved (i.e., unchanged or increased inflammation) lesions: mean ± SD (× 10⁻³ mm²/s) of -0.65 ± 0.58 vs. 0.06 ± 0.15 for reader 1 (p = 0.022) and -0.68 ± 0.56 vs. 0.10 ± 0.26 for reader 2 (p = 0.025). DWI accuracy for diagnosing complete remission or improved inflammation ranged from 76% (28/37) to 84% (31/37). A significant negative correlation was noted between ΔADC and ΔCDMI for both readers with correlation coefficients of -0.438 and -0.461, respectively (p < 0.05). CONCLUSION: DWI is potentially a feasible tool to monitor quantitatively and qualitatively bowel inflammation of CD after medical treatment.
