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Preoperative evaluation of small bowel complications in Crohn’s disease: comparison of diffusion-weighted and contrast-enhanced MR imaging

  • Magnetic Resonance
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Abstract

Purpose

To compare the accuracy of MR enterography (MRE) using combined T2-weighted and contrast-enhanced (CE) sequences with that of combined T2- and diffusion-weighted (DW) sequences for the detection of complex enteric Crohn’s disease (CD).

Materials

Thirty-eight patients who underwent surgery for CD complications and preoperative MRE from 2011 to 2016 were included. MRE examinations were blindly analyzed independently by one junior and one senior abdominal radiologist for the presence of fistula, stenosis and abscesses. During a first reading session, T2-weighted images (WI), steady-state sequences and DW-MRE were reviewed (set 1). During a separate distant session, T2-WI, True-FISP and CE-MRE were reviewed (set 2). Performance of each reader was evaluated by comparison with the standard of reference established using intraoperative and pathological findings.

Results

Forty-eight fistulas, 43 stenoses and 11 abscesses were found. For the senior radiologist, sensitivity for the detection of fistula, stenosis and abscess ranged from 80% to 100% for set 1 and 88% to 100% for set 2 and specificity ranged from 56% to 70% for set 1 and 53% to 93% for set 2, with no significant difference between the sets (p = 0.342–0.429). For the junior radiologist, sensitivity ranged from 53% to 63% for set 1 and 64% to 88% for set 2 and specificity ranged from 0% to 25% for set 1 and 17% to 40% for set 2 (p = 0.001 and 0.007, respectively).

Conclusion

For a senior radiologist, DW-MRE has similar sensitivity as CE-MRE for the detection of CD complications. For a junior radiologist, CE-MRE yields the best results compared with DW-MRE.

Key Points

• For experienced readers, DWI has similar diagnostic capability as contrast-enhanced MR imaging for the diagnosis of Crohn’s disease complications.

• For senior radiologists, gadolinium chelate injection could be waived for the diagnosis of Crohn’s disease complications.

• The interpretation of DWI for Crohn’s disease complications requires some experience.

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Abbreviations

CD:

Crohn’s disease

CE:

Contrast-enhanced

DWI:

Diffusion-weighted imaging

HASTE:

Half-Fourier acquisition single-shot turbo spin-echo

MRE:

Magnetic resonance enterography

MRI:

Magnetic resonance imaging

NA:

Non applicable

NPV:

Negative predictive value

PACS:

Picture archiving and communication system

PPV:

Positive predictive value

SD:

Standard deviation

TNF:

Tumor necrosis factor

TP:

True positive

True-FISP:

True fast imaging with steady-state precession

VIBE:

Volumetric interpolated breath-hold examination

WI:

Weighted imaging

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Abdominal and Interventional Imaging, Hôpital Cochin, AP-HP, 27 rue du Faubourg St Jacques, 75014, Paris, France

    M. Barat, R. Dautry, M. Boudiaf, P. Soyer & A. Dohan

  2. UMR INSERM 965, Hôpital Lariboisière, 2 rue Amboise Paré, 75010, Paris, France

    M. Barat, M. Bouquot, C. Eveno, M. Pocard, P. Soyer & A. Dohan

  3. Department of Radiology, Hôpital Robert-Debré, Reims, France

    C. Hoeffel

  4. Department of Digestive and Oncologic Surgery, Hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75475, Paris cedex 10, France

    M. Bouquot, K. Pautrat, C. Eveno & M. Pocard

  5. INSERM-UMRS 1138 Team 22, Cordeliers Research Center, Paris Descartes University, Paris, France

    A. S. Jannot

  6. Department of Medical Informatics and Public Health, European George Pompidou Hospital, AP-HP, 20 Rue Leblanc, 75015, Paris, France

    A. S. Jannot

  7. Department of Pathology, Hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010, Paris, France

    R. Kaci

  8. Department of Gastroenterology, Hôpital Saint-Antoine (AP-HP), Sorbonne University, Pierre et Marie Curie, Paris, France

    M. Camus

  9. Université Sorbonne-Paris Cité, Paris-Diderot, 10 rue de Verdun, 75010, Paris, France

    C. Eveno & M. Pocard

  10. Université Sorbonne Paris Cité, Paris-Descartes, 12 Rue de l’École de Médecine, 75006, Paris, France

    P. Soyer & A. Dohan

Authors
  1. M. Barat
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  2. C. Hoeffel
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  3. M. Bouquot
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  5. R. Dautry
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  6. M. Boudiaf
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  9. M. Camus
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  10. C. Eveno
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  11. M. Pocard
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  12. P. Soyer
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  13. A. Dohan
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Corresponding author

Correspondence to M. Barat.

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Guarantor

The scientific guarantor of this publication is P. Soyer, MD, PhD.

Conflict of interest

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.

Statistics and Biometry

Statistical analysis was performed by an expert senior statistician (Dr. AS Jannot)

Informed Consent

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

Ethical Approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnosis method

• performed at one institution

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Barat, M., Hoeffel, C., Bouquot, M. et al. Preoperative evaluation of small bowel complications in Crohn’s disease: comparison of diffusion-weighted and contrast-enhanced MR imaging. Eur Radiol 29, 2034–2044 (2019). https://doi.org/10.1007/s00330-018-5734-2

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  • DOI: https://doi.org/10.1007/s00330-018-5734-2

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