Assessment of patency capsule retention using MR diffusion-weighted imaging
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Evaluate the ability of MR diffusion-weighted imaging (DWI) to predict patency capsule retention in Crohn’s disease (CD).
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.
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.
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.
• 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
KeywordsCrohn disease Diffusion-weighted magnetic resonance imaging Magnetic resonance imaging Constriction, pathologic Capsule endoscopy
Apparent diffusion coefficient
Area under the curve
CD activity index
European Crohn’s and Colitis Organization
Geometry embracing method
Institutional review board
MR diffusion-weighted imaging
Negative predictive value
Positive predictive value
Regions of interest
Video capsule endoscopy (VCE)
The authors wish to thank Shifra Fraifeld, an independent medical writer, for her editorial assistance during the preparation of this manuscript.
Compliance with ethical standards
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.
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.
Written informed consent was obtained from all subjects (patients) in this study.
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
• prospective data collection, retrospective analysis
• performed at one institution
- 27.Greener T, Klang E, Yablecovitch D et al (2016) The impact of magnetic resonance enterography and capsule endoscopy on the re-classification of disease in patients with known Crohn's disease: a prospective Israeli IBD Research Nucleus (IIRN) Study. J Crohns Colitis. doi: 10.1093/ecco-jcc/jjw006 PubMedPubMedCentralGoogle Scholar