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European Radiology

, Volume 27, Issue 12, pp 4979–4985 | Cite as

Assessment of patency capsule retention using MR diffusion-weighted imaging

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

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

Keywords

Crohn disease Diffusion-weighted magnetic resonance imaging Magnetic resonance imaging Constriction, pathologic Capsule endoscopy 

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)

Notes

Acknowledgements

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

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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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Eyal Klang
    • 1
    • 2
  • Uri Kopylov
    • 2
    • 3
  • Shomron Ben-Horin
    • 2
    • 3
  • Adi Lahat
    • 2
    • 3
  • Doron Yablecovitch
    • 2
    • 3
  • Noa Rozendorn
    • 1
    • 2
  • Rami Eliakim
    • 2
    • 3
  • Michal Marianne Amitai
    • 1
    • 2
  1. 1.Department of Diagnostic ImagingSheba Medical CenterRamat GanIsrael
  2. 2.Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  3. 3.Department of GastroenterologySheba Medical CenterRamat GanIsrael

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