Dynamic contrast enhanced magnetic resonance imaging of the terminal ileum: differentiation of activity of Crohn’s disease
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To prospectively investigate a new high resolution MRI technique for dynamic evaluation of the enhancement kinetics of bowel parietal layers and to correlate it with CDAI, CRP, endoscopic activity and histologic features.
About 16 consecutive patients with proven diagnosis of CD underwent ileocolonoscopy with biopsy and serial bowel dynamic contrasted-MRI (D-CE-MRI) evaluated in blind fashion. Quantitative analysis of bowel wall enhancement kinetics was performed basing on signal to noise ratio (SNR) of inner parietal layers (Mucosa–Submucosa, M–SM) and outer parietal layers (Muscular–Serosa, Ms–S). Disease activity was defined by CDAI > 150, serum CRP > 5 mg/dL and histologic results.
About 9 patients showed a layered enhancement of bowel wall (8 active, 1 inactive), whereas inactive (7 cases) group presented a homogeneous pattern. In active patients we found a significant difference in parietal layered enhancement curves (M–SM vs. Ms–S, P < 0.03) not observed in inactive disease and controls (intra-group analysis). M–SM and Ms–S enhanced curves in clinically active patients were significantly different respect to those of patients with inactive CD (P < 0.001) (inter-group analysis). Parietal D-CE-MRI pattern well correlated with histologic features (r = 0.8; P < 0.001, Spearman test).
D-CE-MRI can be a useful tool for clinical follow-up and in the treatment strategies in CD patients.
Key words:Crohn’s disease Dynamic MRI Crohn’s disease activity Bowel wall vascularity Contrast enhancement
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