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Diffusion-weighted imaging for the detection of mesenteric small bowel tumours with Magnetic Resonance--enterography

  • Gastrointestinal
  • Published:
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Abstract

Purpose

To retrospectively investigate the added value of diffusion-weighted MR imaging (DWI) for detecting mesenteric small bowel tumours (MSBTs) via MR-enterography.

Materials and methods

MR-enterographies of 98 patients with suspected MSBTs were blindly analyzed by two independent readers for the presence of MSBTs. Four imaging sets including “standard” (Haste and TrueFisp), “standard + DWI,” “standard + gadolinium-enhanced” and “standard + DWI + gadolinium-enhanced” were reviewed. Diagnostic performance of different readings were compared with McNemar’s test.

Results

Twenty-nine MSBTs were pathologically confirmed. For R1 (junior radiologist) sensitivity, specificity, PPV, NPV and accuracy for the detection of MSBTs via standard MRI were 52 % [95 % CI: 34 %-70 %] (15/29), 94 % [95 % CI: 89 %-100 %] (65/69), 79 % [95 % CI: 61 %-97 %] (15/19), 82 % [95 % CI: 74 %-91 %] (65/79) and 82 % [95 % CI: 74 %-89 %] (80/98), respectively. For R2 (senior radiologist) they were 76 % [95 % CI: 60 %-91 %] (22/29), 96 % [95 % CI: 91-100 %] (66/69), 88 % [95 % CI: 75 %-100 %] (22/25), 90 % [95 % CI: 84 %-97 %] (66/73) and 90 % [95 % CI: 84 %-96 %] (88/98), respectively. Adding DWI they were 72 % [95 % CI: 56 %-89 %] (21/29), 91 % [95 % CI: 85 %-98 %] (63/69), 78 % [95 % CI: 62 %-94 %] (21/27), 89 % [95 % CI: 81 %-96 %] (63/71) and 87 % [95 % CI: 80 %-94 %] (85/98) for R1 and 79 % [95 % CI: 65 %-94 %] (23/29), 97 % [95 % CI: 93 %-100 %] (67/69), 92 % [95 % CI: 81 %-100 %] (23/25), 92 % [95 % CI: 86 %-98 %] (67/73) and 92 % [95 % CI: 86 %-97 %] (90/98) for R2. Sensitivities for tumour detection were higher after adding DWI to standard MRI, although only for R1 was this significant (P = 0.03). Adding DWI to standard + gadolinium-enhanced MRI did not significantly increase MR performance.

Conclusion

DWI improves MSBT detection via MR-enterography compared to standard unenhanced MR-enterography, especially for unexperienced readers.

Key Points

• MR-enterography is accurate for the detection of mesenteric small-bowel tumours.

• Diffusion-weighted sequencing helps inexperienced readers detect small-bowel tumours with MR-enterography.

• Diffusion-weighted sequencing adds value to standard MR-enterography when gadolinium is contraindicated.

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Abbreviations

MSBT:

Mesenteric small-bowel tumour

VCE:

Videocapsule endoscopy

CT:

Computed tomography

MR:

Magnetic resonance

PEG:

Polyethylene glycol

HASTE:

Half-Fourier single-shot spin echo

TrueFISP:

True free-induction with steady state free precession

VIBE:

Volumetric interpolated breath hold

MDCT:

Multidetector computed tomography

PPV:

Positive predictive value

NPV:

Negative predictive value

CI:

Confidence interval

SD:

Standard deviation

GIST:

Gastrointestinal stromal tumour

DWI:

Diffusion weighted magnetic resonance image

ADC:

Apparent diffusion coefficient

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Acknowledgements

The scientific guarantor of this publication is Pr. Hoeffel. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise: Dr Coralie Barbe. Institutional review board approval was obtained. Written informed consent was not required for this study because the institutional review board waived informed consent for the patients. Approval from the institutional animal care committee was not required because animals were not involved in the study. Some study subjects or cohorts (45 patients) have been previously reported in “Prospective evaluation of magnetic resonance enterography for the detection of mesenteric small bowel tumours. Eur Radiol 2013; 23(7): 1901-10.” Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Hôpital Robert Debré, Avenue du Général Koenig, 51092, Reims Cedex, France

    Elisa Amzallag-Bellenger, Truong Luong Francis Nguyen, Nedjoua Amara & Christine Hoeffel

  2. Department of Radiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France

    Philippe Soyer

  3. Université Paris-Diderot, Sorbonne Paris Cité, 10 Avenue de Verdun, 75010, Paris, France

    Philippe Soyer

  4. Department of Statistics, Hôpital Robert Debré, Avenue du Général Koenig, 51092, Reims Cedex, France

    Coralie Barbe

  5. Pôle d’imagerie, Department of Radiology, Hôpital Robert Debré, 51092, Cedex Reims, France

    Elisa Amzallag-Bellenger, Coralie Barbe, Truong Luong Francis Nguyen, Nedjoua Amara & Christine Hoeffel

Authors
  1. Elisa Amzallag-Bellenger
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  2. Philippe Soyer
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  6. Christine Hoeffel
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Correspondence to Elisa Amzallag-Bellenger.

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Amzallag-Bellenger, E., Soyer, P., Barbe, C. et al. Diffusion-weighted imaging for the detection of mesenteric small bowel tumours with Magnetic Resonance--enterography. Eur Radiol 24, 2916–2926 (2014). https://doi.org/10.1007/s00330-014-3303-x

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  • DOI: https://doi.org/10.1007/s00330-014-3303-x

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