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Small-bowel MRI in children and young adults with Crohn disease: retrospective head-to-head comparison of contrast-enhanced and diffusion-weighted MRI

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Abstract

Background

Small-bowel MRI based on contrast-enhanced T1-weighted sequences has been challenged by diffusion-weighted imaging (DWI) for detection of inflammatory bowel lesions and complications in patients with Crohn disease.

Objective

To evaluate free-breathing DWI, as compared to contrast-enhanced MRI, in children, adolescents and young adults with Crohn disease.

Materials and methods

This retrospective study included 33 children and young adults with Crohn disease ages 17 ± 3 years (mean ± standard deviation) and 27 matched controls who underwent small-bowel MRI with contrast-enhanced T1-weighted sequences and DWI at 1.5 T. The detectability of Crohn manifestations was determined. Concurrent colonoscopy as reference was available in two-thirds of the children with Crohn disease.

Results

DWI and contrast-enhanced MRI correctly identified 32 and 31 patients, respectively. All 22 small-bowel lesions and all Crohn complications were detected. False-positive findings (two on DWI, one on contrast-enhanced MRI), compared to colonoscopy, were a result of large-bowel lumen collapse. Inflammatory wall thickening was comparable on DWI and contrast-enhanced MRI. DWI was superior to contrast-enhanced MRI for detection of lesions in 27% of the assessed bowel segments and equal to contrast-enhanced MRI in 71% of segments.

Conclusion

DWI facilitates fast, accurate and comprehensive workup in Crohn disease without the need for intravenous administration of contrast medium. Contrast-enhanced MRI is superior in terms of spatial resolution and multiplanar acquisition.

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Acknowledgments

We would like to thank our Medical Radiation Technologists Mrs. C. Doernfeld and Mrs. U. Pytlik and the MR imaging team for performing the MRI scans and for taking care of patients and parents. We also thank Dr. N. Hassold for correcting the manuscript and spell-checking.

Conflicts of interest

The authors have no conflicts of interest to declare.

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Authors and Affiliations

  1. Institute of Radiology, Department of Paediatric Radiology, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080, Wuerzburg, Germany

    Henning Neubauer, Laura Evangelista, Clemens Wirth & Meinrad Beer

  2. Institute of Radiology, University Hospital Wuerzburg, 97080, Wuerzburg, Germany

    Thomas Pabst, Wolfram Machann, Herbert Köstler & Dietbert Hahn

  3. Department of Paediatrics, University Hospital Wuerzburg, 97080, Wuerzburg, Germany

    Anke Dick

Authors
  1. Henning Neubauer
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  2. Thomas Pabst
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  3. Anke Dick
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  4. Wolfram Machann
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  5. Laura Evangelista
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  6. Clemens Wirth
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  7. Herbert Köstler
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  8. Dietbert Hahn
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  9. Meinrad Beer
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Correspondence to Henning Neubauer.

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Neubauer, H., Pabst, T., Dick, A. et al. Small-bowel MRI in children and young adults with Crohn disease: retrospective head-to-head comparison of contrast-enhanced and diffusion-weighted MRI. Pediatr Radiol 43, 103–114 (2013). https://doi.org/10.1007/s00247-012-2492-1

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  • DOI: https://doi.org/10.1007/s00247-012-2492-1

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