Diffusionweighted magnetic resonance imaging in ileocolonic Crohns disease

Diffusion-weighted magnetic resonance imaging in ileocolonic Crohn’s disease Juel 1 MA , Rafaelsen 2 S, Nathan 3 T, Jensen 4 MD , Kjeldsen 4 J 1 Department of Hepatology and Gastroenterology, Aarhus University Hospital, Denmark; 2 Department of Radiology, Lillebaelt Hospital Vejle, Denmark; 3 Department of Internal Medicine, Lillebaelt Hospital Vejle, Denmark; 4 Department of Medical Gastroenterology, Odense University Hospital, Denmark. 1. INTRODUCTION Diffusion-weighted magnetic resonance imaging (dw-MRI) utilizes differences in the motion of water molecules between tissues for image formation without administration of contrast materials. Inflammation in the bowel wall slows water transit resulting in lower apparent diffusions coefficients (ADC). Previous studies have shown that dw-MRI combined with conventional MR sequences can be useful for detection of Crohn’s disease in the terminal ileum and colon. The aim of this study was to examine the diagnostic performance of free-breathing dw-MRI without fasting, bowel preparation or contrast administration in ileocolonic Crohn’s disease. 2. METHODS § 10 patients with known Crohn’s disease were included in this prospective and blinded study. Table 1. ADC (x 10 -3 mm 2/s) in bowel segments with and without active Crohn’s disease. 95% confidence intervals are displayed in parenthesis. In the transverse colon, dw-MRI significantly discriminated active from inactive Crohn’s disease (1. 58 x 10− 3 mm 2/s vs. 1. 18 x 10 − 3 mm 2/s, P = 0. 01) ROC-analysis for all segments § dw-MRI was performed with a Philips Achieva 1. 5 T MR system and body coil (Philips Medical Systems, Eindhoven, The Netherlands). The MR protocol contained coronal e-thrive and SSh. T 2 with free-breathing and a factor b fixed at 800 s/mm 2. § Patients were examined in the prone position before and after intravenous administration of 20 mg Hyoscin Butylbromide (Buscopan®, Boehringer Ingelheim, Basel, Switzerland). § Ileocolonoscopy with Simple Endoscopic Score for Crohn’s disease (SES-CD) served as gold standard. Active Crohn’s disease was defined as a segmental score ≥ 1. dw-MRI with Buscopan: AUC 0. 56 dw-MRI without Buscopan: AUC 0. 64 Figure 2. ROC-analysis revealed an area under the curve (AUC) of 0. 56 and 0. 64 for dw-MRI with and without Buscopan, respectively (P = 0. 3). 3. RESULTS Demographics § All patients had active Crohn’s disease. § Previous ileocecal resection in 3 patients. § Medical treatment in 7 patients (glucocorticoid 4, glucocoticoid + azathioprine 3). Gold standard assessment § 46 bowel segments were assessed with ileocolonoscopy and dw. MRI. § 22 (48%) segments were inflamed according to the gold standard. § Median SES-CD segmental score 4 (range 2 -8). Figure 3. Upper image: dw-MRI showing an increased signal intensity of the ascending colon on b-800 image. Lower image: Measurement of the corresponding ADC mapping resulted in an ADC of 0. 645 x 10 -3 mm 2/s 4. CONCLUSIONS Inactive CD Active CD Figure 1. Without Buscopan, there was a trend towards lower ADC in segments with Crohn’s disease compared to segments without inflammation (1. 43 x 10 − 3 mm 2/s vs. 1. 48 x 10 − 3 mm 2/s, P = 0. 08). However, this difference was not observed with Buscopan (P = 0. 49) The ability of dw-MRI to discriminate Crohn’s disease from normal bowel segments is inadequate. Large variations of ADC in normal and diseased bowel segments emphasize the importance of optimal anatomical distinction for obtaining precise measurements. 5. REFERENCES 1. Hordonneau C, Buisson A, Scanzi J et al. Am J Gastroenterol 2014; 109: 89 -98. 2. Oussalah A, Laurent V, Brout O et al. Gut 2010; 59: 1056 -1065.