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Assessment of inflammatory activity in Crohn’s disease by means of dynamic contrast-enhanced MRI

Valutazione dell’attività infiammatoria nel morbo di Crohn mediante l’utilizzo di risonanza magnetica con mezzo di contrasto

  • Abdominal Radiology Radiologia Addominale
  • Published:
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Abstract

Purpose

Our aim was to perform a dynamic study of contrast enhancement of the intestinal wall in patients with Crohn’s disease to quantitatively assess local inflammatory activity.

Materials and methods

We studied a population of 50 patients with histologically proven Crohn’s disease. Magnetic resonance imaging (MRI) was performed using a 1.5-T magnet with a phased-array coil and acquisition of T2-weighted single-shot fast spin echo (SSFSE) half Fourier sequences before intravenous administration of gadolinium, and T1-weighted fast spoiled gradient (FSPGR) fat-saturated sequences before and after contrast administration. Before the examination, patents received oral polyethylene glycol (PEG) (1,000 ml for adults; 10 ml/Kg of body weight for children). Regions of interest (ROI) were placed on the normal and diseased intestinal wall to assess signal intensity and rate of increase in contrast enhancement over time. Data were compared with the Crohn’s Disease Activity Index (CDAI).

Results

The diseased bowel wall showed early and intense uptake of contrast that increases over time until a plateau is reached. In patients in the remission phase after treatment, signal intensity was only slightly higher in diseased bowel loops than in healthy loops. There was a significant correlation between the peak of contrast uptake and CDAI.

Conclusions

Dynamic MRI is a good technique for quantifying local inflammatory activity of bowel wall in patients with Crohn’s disease.

Riassunto

Obiettivo

Studiare dinamicamente l’accumulo di contrasto della parete intestinale in pazienti con morbo di Crohn per correlarlo quantitativamente con il grado di attività di infiammazione locale.

Materiali e metodi

Abbiamo studiato un campione di 50 pazienti con diagnosi istologica di morbo di Crohn (37 in fase attiva di malattia; 13 in remissione clinica); abbiamo utilizzato un magnete da 1,5 T, bobina phased array e sequenze T2 dipendenti SSFSE half Fourier in fase precontrastografica e T1 dipendenti FSPGR fat-sat in fase pre-e post-contrastografica. Prima di eseguire l’esame è stato somministrato per os glicole polietilenico (PEG) (1000 ml per adulti; 10 ml/Kg del peso corporeo per bambini). Abbiamo tracciato ROI (region of interest) per valutare l’intensit`a del segnale nella parete intestinale normale e patologica e la percentuale d’incremento nel tempo. Tali dati sono stati correlati con un indice di attività della malattia, il Crohn’s Disease Activity Index (CDAI).

Risultati

Abbiamo osservato che la parete intestinale patologica ha un uptake contrastografico precoce ed elevato che aumenta nel tempo fino a una fase di plateau. In caso di remissione della malattia dopo terapia, per contro, si ha una significativa riduzione dell’incremento di segnale, di poco aumentato rispetto a quello delle anse normali. Inoltre abbiamo notato una buona correlazione tra il livello di massimo uptake contrastografico e il CDAI.

Conclusioni

Lo studio dinamico con risonanza magnetica (RM) ci consente di quantificare l’attività infiammatoria locale della parete intestinale.

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Authors and Affiliations

  1. Dipartimento di Diagnostica per Immagini, Università degli Studi di L’Aquila, Via della Mainetta, 88D, I-67010, Coppito, L’Aquila, Italy

    V. A. Pupillo, E. Di Cesare, N. Limbucci & C. Masciocchi

  2. Dipartimento di Gastroenterologia, Università degli Studi di L’Aquila, Via della Mainetta, 88D, I-67010, Coppito, L’Aquila, Italy

    G. Frieri & M. Tanga

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  1. V. A. Pupillo
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  2. E. Di Cesare
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  3. G. Frieri
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  4. N. Limbucci
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  6. C. Masciocchi
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Correspondence to V. A. Pupillo.

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Pupillo, V.A., Di Cesare, E., Frieri, G. et al. Assessment of inflammatory activity in Crohn’s disease by means of dynamic contrast-enhanced MRI. Radiol med 112, 798–809 (2007). https://doi.org/10.1007/s11547-007-0192-y

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  • DOI: https://doi.org/10.1007/s11547-007-0192-y

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