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Abdominal Radiology

, Volume 42, Issue 12, pp 2783–2791 | Cite as

Increasing efficiency of MRE for diagnosis of Crohn’s disease activity through proper sequence selection: a practical approach for clinical trials

  • Jordi RimolaEmail author
  • Almudena Alvarez-Cofiño
  • Tamara Pérez-Jeldres
  • Sonia Rodríguez
  • Ignacio Alfaro
  • Ingrid Ordás
  • Elena Ricart
  • Julián Panés
Article

Abstract

Purpose

To derive the best magnetic resonance enterography (MRE) approach for detecting activity and severe lesions in Crohn’s disease (CD) to use for selecting patients and measuring response to treatment in clinical trials.

Methods

We compared the accuracies of MRE (T2-weighted sequences, DWI (b = 800 s/mm2) sequences, combined T2-weighted and DWI sequences, combined T2-weighted or DWI sequences, and MaRIA score based on T2-weighted and contrast-enhanced T1-weighted sequences) versus ileocolonoscopy (SES-CD) performed within 1 month. Bowel segments were classified as inactive (SES-CD < 2), active (SES-CD ≥ 2), or active with severe lesions (ulcers seen at endoscopy). McNemar’s test was used to compare the accuracies of the different approaches against endoscopy.

Results

224 segments in 43 patients were analyzed. For detecting active disease, the combination of findings from T2 and DWI sequences results in the highest specific and accurate sequence combination. Combined T2-weighted and DWI sequences had similar sensitivity to those of MaRIA (P = 0.25) but lower specificity (P = 0.007) and accuracy (P = 0.0013) than MaRIA score. For detecting severe lesions, T2-weighted sequences alone had greater accuracy [similar to MaRIA score (P > 0.999)] than other noncontrast approaches.

Conclusions

T2-weighted sequences should be used as a first screening step, and followed by contrast-enhanced T1-weighted sequences only when abnormal findings are identified; adding DWI does not improve the accuracy of MRE.

Keywords

Crohn’s disease MR enterography MaRIA Activity 

Abbreviations

CD

Crohn’s disease

DWI

Diffusion-weighted imaging

MRE

Magnetic resonance enterography

CI

Confidence interval

SES-CD

Simplified endoscopic score for Crohn disease

Anti-TNF

Anti-tumor necrosis factor

Notes

Compliance with ethical standards

Conflict of interest

Authors have nothing to disclose.

Supplementary material

261_2017_1203_MOESM1_ESM.docx (99 kb)
Supplementary material 1 (DOCX 98 kb)

References

  1. 1.
    Peyrin-Biroulet L, Reinisch W, Colombel J-F, et al. (2014) Clinical disease activity, C-reactive protein normalisation and mucosal healing in Crohn’s disease in the SONIC trial. Gut 63:88–95CrossRefPubMedGoogle Scholar
  2. 2.
    Jauregui-Amezaga A, Rimola J, Ordás I, et al. (2015) Value of endoscopy and MRI for predicting intestinal surgery in patients with Crohn’s disease in the era of biologics. Gut 64:1397–1402CrossRefPubMedGoogle Scholar
  3. 3.
    Coimbra AJF, Rimola J, O’Byrne S, et al. (2016) Magnetic resonance enterography is feasible and reliable in multicenter clinical trials in patients with Crohn’s disease, and may help select subjects with active inflammation. Aliment Pharmacol Ther 43:61–72CrossRefPubMedGoogle Scholar
  4. 4.
    Panes J, Bouhnik Y, Reinisch W, et al. (2013) Imaging techniques for assessment of inflammatory bowel disease: joint ECCO and ESGAR evidence-based consensus guidelines. J Crohns Colitis 7:556–585CrossRefPubMedGoogle Scholar
  5. 5.
    Horsthuis K, Bipat S, Bennink RJ, Stoker J (2008) Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta- analysis of prospective studies. Radiology 247:64–79CrossRefPubMedGoogle Scholar
  6. 6.
    Panés J, Bouzas R, Chaparro M, et al. (2011) Systematic review: the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn’s disease. Aliment Pharmacol Ther 34:125–145CrossRefPubMedGoogle Scholar
  7. 7.
    ACR Committe on Drgs and Contrast Media (2015) ACR manual on contrast media version 10.1. ACRGoogle Scholar
  8. 8.
    Seo N, Park SH, Kim K-J, et al. (2016) MR Enterography for the evaluation of small-bowel inflammation in Crohn disease by using diffusion- weighted Imaging without intravenous contrast material: a prospective noninferiority study. Radiology 278:762–772CrossRefPubMedGoogle Scholar
  9. 9.
    Choi SH, Kim KW, Lee JY, Kim K, Park SH (2016) Diffusion-weighted magnetic resonance enterography for evaluating bowel inflammation in Crohn ’ s disease : a systematic. Inflamm Bowel Dis 22:669–679CrossRefPubMedGoogle Scholar
  10. 10.
    Oussalah A, Laurent V, Bruot O, et al. (2010) Diffusion-weighted magnetic resonance without bowel preparation for detecting colonic inflammation in inflammatory bowel disease. Gut 59:1056–1065CrossRefPubMedGoogle Scholar
  11. 11.
    Kim K-J, Lee Y, Park SH, et al. (2015) Diffusion-weighted MR enterography for evaluating Crohn’s disease: how does it add diagnostically to conventional MR enterography? Inflamm Bowel Dis 21:101–109CrossRefPubMedGoogle Scholar
  12. 12.
    Harvey RF, Bradshaw JM (1980) A simple index of Crohn’s-disease activity. Lancet 1:514CrossRefPubMedGoogle Scholar
  13. 13.
    Daperno M, D’Haens G, Van Assche G, et al. (2004) Development and validation of a new, simplified endoscopic activity score for Crohn’s disease: the SES-CD. Gastrointest Endosc 60:505–512CrossRefPubMedGoogle Scholar
  14. 14.
    Rimola J, Rodriguez S, Garcia-Bosch O, et al. (2009) Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn’s disease. Gut 58:1113–1120CrossRefPubMedGoogle Scholar
  15. 15.
    Rimola J, Ordás I, Rodriguez S, et al. (2011) Magnetic resonance imaging for evaluation of Crohn's disease. Inflamm Bowel Dis 17:1759–1768CrossRefPubMedGoogle Scholar
  16. 16.
    Steward MJ, Punwani S, Proctor I, et al. (2012) Non-perforating small bowel Crohn’s disease assessed by MRI enterography: derivation and histopathological validation of an MR-based activity index. Eur J Radiol 81:2080–2088CrossRefPubMedGoogle Scholar
  17. 17.
    Dohan A, Taylor S, Hoeffel C, et al. (2016) Diffusion-weighted MRI in Crohn ’ s disease: current status and recommendations. J Magn Reson Imaging 44:1381–1396CrossRefPubMedGoogle Scholar
  18. 18.
    Maccioni F, Bruni A, Viscido A, Colaiacomo MC, Cocco A (2006) MR imaging in patients with Crohn disease : value of T2- versus T1-weighted gadolinium-enhanced MR sequences with use of an oral superparamagnetic contrast agent. Radiology 238:517–530CrossRefPubMedGoogle Scholar
  19. 19.
    Sato H, Tamura C, Narimatsu K, et al. (2015) Magnetic resonance enterocolonography in detecting erosion and redness in intestinal mucosa of patients with Crohn’s disease. J Gastroenterol Hepatol 30:667–673CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Jordi Rimola
    • 1
    Email author
  • Almudena Alvarez-Cofiño
    • 2
  • Tamara Pérez-Jeldres
    • 3
  • Sonia Rodríguez
    • 1
  • Ignacio Alfaro
    • 4
  • Ingrid Ordás
    • 4
  • Elena Ricart
    • 4
    • 5
  • Julián Panés
    • 4
    • 5
  1. 1.Department of Radiology, Centre de Diagnòstic per la Imatge (CDI), Hospital Clínic BarcelonaUniversity of BarcelonaBarcelonaSpain
  2. 2.Department of RadiologyFundación Hospital de JoveGijónSpain
  3. 3.Gastroenterology DepartmentHospital San Borja ArriaranSantiagoChile
  4. 4.Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPSUniversity of BarcelonaBarcelonaSpain
  5. 5.Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)BarcelonaSpain

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