Preoperative evaluation of small bowel complications in Crohn’s disease: comparison of diffusion-weighted and contrast-enhanced MR imaging
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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).
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.
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).
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.
• 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.
KeywordsCrohn’s disease Magnetic resonance imaging Comparative studies Diffusion MRI
Half-Fourier acquisition single-shot turbo spin-echo
Magnetic resonance enterography
Magnetic resonance imaging
Negative predictive value
Picture archiving and communication system
Positive predictive value
Tumor necrosis factor
True fast imaging with steady-state precession
Volumetric interpolated breath-hold examination
The authors state that this work has not received any funding.
Compliance with ethical standards
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)
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• diagnosis method
• performed at one institution
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