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Diffusion‐weighted magnetic resonance imaging for detecting and assessing ileal inflammation in C rohn's disease
Author(s) -
Buisson A.,
Joubert A.,
Montoriol P.F.,
Ines D. D.,
Hordonneau C.,
Pereira B.,
Garcier J.M.,
Bommelaer G.,
Petitcolin V.
Publication year - 2013
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.12201
Subject(s) - medicine , magnetic resonance imaging , diffusion mri , effective diffusion coefficient , hyperintensity , concordance , nuclear medicine , kappa , radiology , predictive value of tests , gastroenterology , pathology , philosophy , linguistics
Summary Background Whether diffusion‐weighted imaging ( DWI )‐ MRI is of value in detecting and assessing inflammation of ileal Crohn's disease ( CD ) remains poorly investigated. Aim To compare DWI ‐ MR enterography ( MRE ) with conventional MRE in estimating inflammation in small bowel CD , to determine an apparent diffusion coefficient ( ADC ) threshold to differentiate active from non‐active lesions and to assess inter‐observer agreement. Methods Thirty‐one CD patients from the Clermont‐Ferrand IBD unit with ileal involvement were consecutively and prospectively included between April and June 2011. All patients underwent DWI ‐ MRI to detect the digestive segment with the most severe lesions, which was then used to calculate the ADC . Qualitative and quantitative results were compared with conventional MRE including Ma RIA (Magnetic Resonance Index of Activity) score calculation and independent activity predictors (wall thickening, oedema, ulcers). Each examination was interpreted independently by two radiologists blinded for clinical assessment. Results Seventeen patients (54.8%) had active CD as defined by the Ma RIA score ≥7. DWI hyperintensity was highly correlated with disease activity evaluated using conventional MRE ( P = 0.001). Qualitative analysis of DW sequences determined sensitivity, specificity, positive predictive value and negative predictive value as 100%, 92.9%, 94.4% and 100% respectively. Quantitative analysis using a cut‐off of 1.6 × 10 −3 mm²/s for ADC yielded sensitivity and specificity values of, respectively, 82.4% and 100%. Inter‐observer agreement was high with regard to DWI hyperintensity (κ = 0.69, accuracy rate = 85.7%) and ADC (correlation = 0.74, P < 0.001, and concordance = 0.71, P < 0.001). Conclusion DWI ‐ MR enterography is a well‐tolerated, non‐time‐consuming and accurate tool for detecting and assessing inflammation in small bowel Crohn's disease .