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Assessment of patency capsule retention using MR diffusion-weighted imaging

  • Gastrointestinal
  • Published:
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Abstract

Objectives

Evaluate the ability of MR diffusion-weighted imaging (DWI) to predict patency capsule retention in Crohn’s disease (CD).

Methods

Clinical and imaging data were prospectively reviewed for 80 CD patients following patency capsule administration and MR-DWI under institutional review board (IRB) approval with informed consent. Two radiologists separately assessed the presence/absence of restricted diffusion in the distal ileum. Apparent diffusion coefficients (ADC) from three regions of interest on the ileal wall were averaged. The association between restricted diffusion and retention, and sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Ability of ADC to predict retention was assessed with receiver operating characteristic (ROC) curve analysis.

Results

Restricted diffusion in the distal ileum was associated with capsule retention (p = 0.001, p < 0.0001). Sensitivity, specificity, PPV and NPV of restricted diffusion for capsule retention were 100.0%, 46.2%, 30.0%, 100% and 100.0%, 56.9%, 34.9%, 100%, respectively, for two radiologists. Accuracy of ADC to predict retention was high (area under the curve = 0.851, p < 0.0001). An ADC of 1.47 mm2/s showed 90.0% sensitivity and 50.0% specificity for retention.

Conclusions

Sensitivity and NPV of restricted diffusion for patency capsule retention were 100%, suggesting that DWI may predict gastrointestinal tract capability to pass video camera endoscopy.

Key Points

• Capsule endoscopy enables assessment of the gastrointestinal mucosa in Crohn’s disease

• Prior patency capsule administration is recommended to evaluate gastrointestinal tract patency

• MR diffusion-weighted imaging may detect pathological constriction of the ileum

• Restricted diffusion in the distal ileum was associated with capsule retention

• MR-DWI may predict gastrointestinal tract capability to pass capsule endoscopy

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Abbreviations

ADC:

Apparent diffusion coefficient

AUC:

Area under the curve

CDAI:

CD activity index

CD:

Crohn’s disease

ECCO:

European Crohn’s and Colitis Organization

GEM:

Geometry embracing method

IRB:

Institutional review board

MR-DWI:

MR diffusion-weighted imaging

MRE:

MR enterography

NPV:

Negative predictive value

OR:

Odds ratio

PPV:

Positive predictive value

RFID:

Radiofrequency identification

ROI:

Regions of interest

SD:

Standard deviation

VCE:

Video capsule endoscopy (VCE)

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Acknowledgements

The authors wish to thank Shifra Fraifeld, an independent medical writer, for her editorial assistance during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Ramat Gan, 5265601, Israel

    Eyal Klang, Noa Rozendorn & Michal Marianne Amitai

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Eyal Klang, Uri Kopylov, Shomron Ben-Horin, Adi Lahat, Doron Yablecovitch, Noa Rozendorn, Rami Eliakim & Michal Marianne Amitai

  3. Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel

    Uri Kopylov, Shomron Ben-Horin, Adi Lahat, Doron Yablecovitch & Rami Eliakim

Authors
  1. Eyal Klang
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  2. Uri Kopylov
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  3. Shomron Ben-Horin
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  4. Adi Lahat
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  5. Doron Yablecovitch
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  6. Noa Rozendorn
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  7. Rami Eliakim
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  8. Michal Marianne Amitai
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Corresponding author

Correspondence to Michal Marianne Amitai.

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Guarantor

The scientific guarantor of this publication is Dr Michal Amitai.

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.

Funding

This study was partially funded by a generous grant from the Leona M. and Harry B. charitable trust.

Statistics and biometry

One of the authors (EK) 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.

Study subjects or cohorts overlap

Some data from the study subjects have been previously reported. See references 11, 22–24

Methodology

• prospective data collection, retrospective analysis

• observational

• performed at one institution

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Klang, E., Kopylov, U., Ben-Horin, S. et al. Assessment of patency capsule retention using MR diffusion-weighted imaging. Eur Radiol 27, 4979–4985 (2017). https://doi.org/10.1007/s00330-017-4857-1

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  • DOI: https://doi.org/10.1007/s00330-017-4857-1

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