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DWI ratios: New indexes for Crohn’s disease activity at magnetic resonance enterography?

  • Abdominal Radiology
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Abstract

Background

The aim of the study was to provide radiologists and clinicians a rapid tool for assessment of intestinal inflammation in Crohn’s disease (CD) patients through quantification of diffusion-weighted imaging (DWI) signal intensity while performing magnetic resonance enterography (MRE).

Materials and methods

A monocentric retrospective study was conducted between September 2018 and July 2021 on CD patients who underwent MRE. Two radiologists measured signal intensity on DWI scans at the highest b-value (800 s/mm2) within pathologic intestinal walls, lymph nodes, spleen and psoas muscle and calculated the relative ratios. Spearman, Mann–Whitney and Jonckheere–Terpstra tests were applied for estimating correlation among ratios, significant differences between the two patient groups and determining the trend in relation to endoscopic classes. Wilcoxon’s and Cronbach’s alpha tests were employed for comparison of DWI measurements and ratios between the two observers.

Results

Fifty-nine patients were enrolled in the study. In the non-surgical group, correlation has been found among Simple Endoscopic Score for Crohn’s Disease (SES-CD) classes and the different ratios: bowel/spleen (p = 0.034), bowel/psoas (p = 0.008) and bowel/lymph node (p = 0.010).

Within the surgical group, positive correlation was found only between bowel/lymph node ratio and bowel/psoas ratio (p = 0.014). The J–T test demonstrated an increasing monotonic trend for bowel/psoas ratio and bowel/lymph node ratio and SES-CD classes. Inter-reader evaluation demonstrated no statistical differences for DWI measurements and high degree of concordance for the final ratios.

Conclusion

DWI ratios correlate with endoscopic classes in non-surgical patients and have inter-observer reproducibility.

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Authors and Affiliations

  1. Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico “G. Martino” Via Consolare Valeria 1, 98100, Messina, Italy

    Giuseppe Cicero, Alfredo Blandino & Silvio Mazziotti

  2. Division of Statistical and Mathematical Sciences, Department of Economics, University of Messina, Messina, Italy

    Angela Alibrandi

  3. Diagnostic and Interventional Radiology Unit, University of Milan, Milan, Italy

    Velio Ascenti

  4. Inflammatory Bowel Disease Unit, A.O.U. Policlinico “G. Martino”, Messina, Italy

    Walter Fries & Anna Viola

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  1. Giuseppe Cicero
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Correspondence to Giuseppe Cicero.

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Cicero, G., Alibrandi, A., Blandino, A. et al. DWI ratios: New indexes for Crohn’s disease activity at magnetic resonance enterography?. Radiol med 128, 16–26 (2023). https://doi.org/10.1007/s11547-022-01573-7

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