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Assessment of patency capsule retention using MR diffusion-weighted imaging



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.

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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Apparent diffusion coefficient


Area under the curve


CD activity index


Crohn’s disease


European Crohn’s and Colitis Organization


Geometry embracing method


Institutional review board


MR diffusion-weighted imaging


MR enterography


Negative predictive value


Odds ratio


Positive predictive value


Radiofrequency identification


Regions of interest


Standard deviation


Video capsule endoscopy (VCE)


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

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Correspondence to Michal Marianne Amitai.

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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.

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


• 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).

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