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European Radiology

, Volume 29, Issue 2, pp 993–1002 | Cite as

Diffusion and perfusion MRI quantification in ileal Crohn’s disease

  • Stefanie J. Hectors
  • Sonja Gordic
  • Sahar Semaan
  • Octavia Bane
  • Robert Hirten
  • Xiaoyu Jia
  • Jean-Frederic Colombel
  • Bachir TaouliEmail author
Gastrointestinal
  • 275 Downloads

Abstract

Objectives

To quantify intravoxel incoherent motion (IVIM)-DWI and dynamic contrast-enhanced (DCE)-MRI parameters in normal and abnormal ileal segments in Crohn’s disease (CD) patients and to assess the association of these parameters with clinical and MRI-based measurements of CD activity.

Methods

In this prospective study, 27 CD patients (M/F 18/9, mean age 42 years) underwent MR enterography, including IVIM-DWI and DCE-MRI. IVIM-DWI and DCE-MRI parameters were quantified in normal and abnormal small bowel segments, the latter identified by the presence of inflammatory changes. MRI parameter differences between normal and abnormal bowel were tested using Wilcoxon signed-rank tests. IVIM-DWI and DCE-MRI parameters were correlated with clinical data (C-reactive protein, Harvey-Bradshaw Index), conventional MRI parameters (wall thickness, length of involvement) and MRI activity scores (MaRIA, Clermont). Diagnostic performance of (combined) parameters for differentiation between normal and abnormal bowel was determined using ROC analysis.

Results

The DCE-MRI parameters peak concentration Cpeak, upslope, area-under-the-curve at 60s (AUC60), Ktrans and ve were significantly increased (p<0.023), while IVIM-DWI parameters perfusion fraction (PF) and ADC were significantly decreased (p<0.001) in abnormal bowel segments. None of the DCE-MRI and IVIM-DWI parameters correlated with clinical parameters (p>0.105). DCE-MRI parameters exhibited multiple significant correlations with wall thickness (Cpeak, upslope, AUC60, Ktrans; r range 0.431–0.664, p<0.025) and MaRIA/Clermont scores (Cpeak, AUC60, Ktrans; r range 0.441–0.617, p<0.021). Combined Ktrans+ve+PF+ADC showed highest AUC (0.963) for differentiation between normal and abnormal bowel, while ADC performed best for individual parameters (AUC=0.800).

Conclusions

DCE-MRI and IVIM-DWI, particularly when used in combination, are promising for non-invasive evaluation of small bowel CD.

Key Points

• IVIM-DWI and DCE-MRI parameters were significantly different between normal and abnormal bowel segments in CD patients.

• DCE-MRI parameters showed a significant association with wall thickness and MRI activity scores.

• Combination of IVIM-DWI and DCE-MRI parameters led to the highest diagnostic performance for differentiation between normal and abnormal bowel segments, while ADC showed the highest diagnostic performance of individual parameters.

Keywords

Crohn disease Diffusion magnetic resonance imaging Perfusion imaging 

Abbreviations

ADC

Apparent diffusion coefficient

AIF

Arterial input function

AUC60

Area under the curve at 60 s

[CA]

Contrast agent concentration

CD

Crohn’s disease

CDEIS

Crohn’s Disease Endoscopic Index of Severity

Cpeak

Peak concentration

CRP

C-reactive protein

D

Diffusion coefficient

D*

Pseudodiffusion coefficient

DCE-MRI

Dynamic contrast-enhanced MRI

DWI

Diffusion-weighted imaging

HBI

Harvey-Bradshaw index

IVIM-DWI

Intravoxel incoherent motion diffusion-weighted imaging

kep

Wash-out constant

Ktrans

Transfer constant

MaRIA

Magnetic Resonance Index of Activity

OR

Odds ratio

PF

Perfusion fraction

RCE

Relative contrast enhancement

ROI

Region of interest

SD

Standard deviation

SI

Signal intensity

T1WI

T1-weighted imaging

T2WI

T2-weighted imaging

TTP

Time-to-peak

VFA

Variable flip angle

vp

Plasma volume fraction

Notes

Funding

This study has received funding by research grants from Guerbet LLC and the Sanford J Grossman Charitable Trust for Integrative Studies in IBD at Mount Sinai.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Bachir Taouli, MD.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Jean-Frederic Colombel is a consultant for AbbVie, Amgen, Boehringer-Ingelheim, Celgene Corporation, Celltrion, Enterome, Ferring, Genentech, Janssen and Janssen, Medimmune, Merck & Co., Pfizer, Protagonist, Second Genome, Seres, Shire, Takeda and Theradiag, a speaker for AbbVie, Ferring and Speaker’s bureau for Amgen and received grant support from AbbVie, Takeda and Janssen and Janssen. Bachir Taouli received grant support from Guerbet and Bayer.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• observational

• performed at one institution

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Stefanie J. Hectors
    • 1
    • 2
  • Sonja Gordic
    • 1
    • 3
  • Sahar Semaan
    • 1
    • 2
  • Octavia Bane
    • 1
    • 2
  • Robert Hirten
    • 4
  • Xiaoyu Jia
    • 5
  • Jean-Frederic Colombel
    • 4
  • Bachir Taouli
    • 1
    • 2
    Email author
  1. 1.Translational and Molecular Imaging InstituteIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Department of RadiologyIcahn School of Medicine at Mount SinaiNew YorkUSA
  3. 3.Institute of Diagnostic and Interventional RadiologyUniversity Hospital ZurichZurichSwitzerland
  4. 4.IBD Center, Division of Gastroenterology, Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkUSA
  5. 5.Department of Population Health Science and Policy, Institute for Healthcare Delivery ScienceIcahn School of Medicine at Mount SinaiNew YorkUSA

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