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Albano D, Bruno F, Agostini A, Angileri SA, Benenati M, Bicchierai G, Cellina M, Chianca V, Cozzi D, Danti G, De Muzio F, Di Meglio L, Gentili F, Giacobbe G, Grazzini G, Grazzini I, Guerriero P, Messina C, Micci G, Palumbo P, Rocco MP, Grassi R, Miele V, Barile A. Dynamic contrast-enhanced (DCE) imaging: state of the art and applications in whole-body imaging. Jpn J Radiol 2022; 40:341-366. [PMID: 34951000 DOI: 10.1007/s11604-021-01223-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/17/2021] [Indexed: 12/18/2022]
Abstract
Dynamic contrast-enhanced (DCE) imaging is a non-invasive technique used for the evaluation of tissue vascularity features through imaging series acquisition after contrast medium administration. Over the years, the study technique and protocols have evolved, seeing a growing application of this method across different imaging modalities for the study of almost all body districts. The main and most consolidated current applications concern MRI imaging for the study of tumors, but an increasing number of studies are evaluating the use of this technique also for inflammatory pathologies and functional studies. Furthermore, the recent advent of artificial intelligence techniques is opening up a vast scenario for the analysis of quantitative information deriving from DCE. The purpose of this article is to provide a comprehensive update on the techniques, protocols, and clinical applications - both established and emerging - of DCE in whole-body imaging.
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Affiliation(s)
- Domenico Albano
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento Di Biomedicina, Neuroscienze E Diagnostica Avanzata, Sezione Di Scienze Radiologiche, Università Degli Studi Di Palermo, via Vetoio 1L'Aquila, 67100, Palermo, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy.
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Andrea Agostini
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Clinical, Special and Dental Sciences, Department of Radiology, University Politecnica delle Marche, University Hospital "Ospedali Riuniti Umberto I - G.M. Lancisi - G. Salesi", Ancona, Italy
| | - Salvatore Alessio Angileri
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Radiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Benenati
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario A. Gemelli IRCCS, Oncologia ed Ematologia, RadioterapiaRome, Italy
| | - Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Michaela Cellina
- Department of Radiology, ASST Fatebenefratelli Sacco, Ospedale Fatebenefratelli, Milan, Italy
| | - Vito Chianca
- Ospedale Evangelico Betania, Naples, Italy
- Clinica Di Radiologia, Istituto Imaging Della Svizzera Italiana - Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Diletta Cozzi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Ginevra Danti
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Letizia Di Meglio
- Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Francesco Gentili
- Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Giuliana Giacobbe
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Giulia Grazzini
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Irene Grazzini
- Department of Radiology, Section of Neuroradiology, San Donato Hospital, Arezzo, Italy
| | - Pasquale Guerriero
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | | | - Giuseppe Micci
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Dipartimento Di Biomedicina, Neuroscienze E Diagnostica Avanzata, Sezione Di Scienze Radiologiche, Università Degli Studi Di Palermo, via Vetoio 1L'Aquila, 67100, Palermo, Italy
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Abruzzo Health Unit 1, Department of diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, L'Aquila, Italy
| | - Maria Paola Rocco
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Roberto Grassi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Antonio Barile
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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D'Souza N, Hicks G, Beable R, Higginson A, Rud B. Magnetic resonance imaging (MRI) for diagnosis of acute appendicitis. Cochrane Database Syst Rev 2021; 12:CD012028. [PMID: 34905621 PMCID: PMC8670723 DOI: 10.1002/14651858.cd012028.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Appendicitis remains a difficult disease to diagnose, and imaging adjuncts are commonly employed. Magnetic resonance imaging (MRI) is an imaging test that can be used to diagnose appendicitis. It is not commonly regarded as a first-line imaging test for appendicitis, but the reported diagnostic accuracy in some studies is equivalent to computed tomography (CT) scans. As it does not expose patients to radiation, it is an attractive imaging modality, particularly in women and children. OBJECTIVES The primary objective was to determine the diagnostic accuracy of MRI for detecting appendicitis in all patients. Secondary objectives: To investigate the accuracy of MRI in subgroups of pregnant women, children, and adults. To investigate the potential influence of MRI scanning variables such as sequences, slice thickness, or field of view. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase until February 2021. We searched the references of included studies and other systematic reviews to identify further studies. We did not exclude studies that were unpublished, published in another language, or retrospective. SELECTION CRITERIA We included studies that compared the outcome of an MRI scan for suspected appendicitis with a reference standard of histology, intraoperative findings, or clinical follow-up. Three study team members independently filtered search results for eligible studies. DATA COLLECTION AND ANALYSIS We independently extracted study data and assessed study quality using the Quality Assessment of Studies of Diagnostic Accuracy - Revised (QUADAS-2) tool. We used the bivariate model to calculate pooled estimates of sensitivity and specificity. MAIN RESULTS We identified 58 studies with sufficient data for meta-analysis including a total of 7462 participants (1980 with and 5482 without acute appendicitis). Estimates of sensitivity ranged from 0.18 to 1.0; estimates of specificity ranged from 0.4 to 1.0. Summary sensitivity was 0.95 (95% confidence interval (CI) 0.94 to 0.97); summary specificity was 0.96 (95% CI 0.95 to 0.97). Sensitivity and specificity remained high on subgroup analysis for pregnant women (sensitivity 0.96 (95% CI 0.88 to 0.99); specificity 0.97 (95% CI 0.95 to 0.98); 21 studies, 2282 women); children (sensitivity 0.96 (95% CI 0.95 to 0.97); specificity 0.96 (95% CI 0.92 to 0.98); 17 studies, 2794 children); and adults (sensitivity 0.96 (95% CI 0.93 to 0.97); specificity 0.93 (95% CI 0.80 to 0.98); 9 studies, 1088 participants), as well as different scanning techniques. In a hypothetical cohort of 1000 patients, there would be 12 false-positive results and 30 false-negative results. Methodological quality of the included studies was poor, and the risk of bias was high or unclear in 53% to 83% of the QUADAS-2 domains. AUTHORS' CONCLUSIONS MRI appears to be highly accurate in confirming and excluding acute appendicitis in adults, children, and pregnant women regardless of protocol. The methodological quality of the included studies was generally low due to incomplete and low standards of follow-up, so summary estimates of sensitivity and specificity may be biased. We could not assess the impact and direction of potential bias given the very low number of high-quality studies. Studies comparing MRI protocols were few, and although we found no influence of MRI protocol variables on the summary estimates of accuracy, our results do not rule out that some MRI protocols are more accurate than others.
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Affiliation(s)
| | | | | | | | - Bo Rud
- Gastrounit, Copenhagen University Hospital Hvidovre , Hvidovre, Denmark
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Evaluation of celiac disease with uniphasic and multiphasic dynamic MDCT imaging. Abdom Radiol (NY) 2021; 46:5564-5573. [PMID: 34415409 DOI: 10.1007/s00261-021-03253-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE An analysis of dynamic contrast MRI has been shown to provide valuable information about disease activity in Crohn's disease and Celiac disease (CD). However, there are no reports of dynamic multi-detector computer tomography use in patients with CD. The aim of this study is to determine and compare the perfusion dynamics of the patients treated with control subjects and the perfusion dynamics in patients with untreated CD, using dynamic contrast in MDCT and compare studying contrast dynamics in Marsh types as well. METHODS In this retrospective study, uniphasic and multiphasic MDCT, untreated, treated, incompatible CD patients and healthy control group duodenum wall thickness and HU values were compared in terms of patient groups and modified Marsh types. RESULT In dynamic CT, the highest contrast curve was observed in the untreated group and Marsh type 1. While the contrast curve of the untreated and non-compliant patients increased rapidly and showed wash out, the type 4 contrast curve was observed, whereas the treated and control group slowly increased type 5 contrast curve. In the contrast-enhanced CT in the venous phase, in the ROC analysis between Marsh 1-2 and Marsh 3a-c, the sensitivity was 97% and the specificity was 87% when the cut off was taken as 4.45 mm for wall thickness (p: 0.005). CONCLUSION Contrast-enhanced single-phase and dynamic MDCT imaging in CD patients may be useful in evaluating the inflammatory and pathological process in the small intestine.
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Abstract
ABSTRACT In this review article, we present the latest developments in quantitative imaging biomarkers based on magnetic resonance imaging (MRI), applied to the diagnosis, assessment of response to therapy, and assessment of prognosis of Crohn disease. We also discuss the biomarkers' limitations and future prospects. We performed a literature search of clinical and translational research in Crohn disease using diffusion-weighted MRI (DWI-MRI), dynamic contrast-enhanced MRI (DCE-MRI), motility MRI, and magnetization transfer MRI, as well as emerging topics such as T1 mapping, radiomics, and artificial intelligence. These techniques are integrated in and combined with qualitative image assessment of magnetic resonance enterography (MRE) examinations. Quantitative MRI biomarkers add value to MRE qualitative assessment, achieving substantial diagnostic performance (area under receiver-operating curve = 0.8-0.95). The studies reviewed show that the combination of multiple MRI sequences in a multiparametric quantitative fashion provides rich information that may help for better diagnosis, assessment of severity, prognostication, and assessment of response to biological treatment. However, the addition of quantitative sequences to MRE examinations has potential drawbacks, including increased scan time and the need for further validation before being used in therapeutic drug trials as well as the clinic.
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Evaluation of Crohn Disease Activity Using a Potential Abbreviated MRE Protocol Consisting of Balanced Steady-State Free Precession MRI Only Versus Full-Protocol MRE. AJR Am J Roentgenol 2021; 216:384-392. [DOI: 10.2214/ajr.20.22856] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Wu YC, Xiao ZB, Lin XH, Zheng XY, Cao DR, Zhang ZS. Dynamic contrast-enhanced magnetic resonance imaging and diffusion-weighted imaging in the activity staging of terminal ileum Crohn's disease. World J Gastroenterol 2020; 26:6057-6073. [PMID: 33132655 PMCID: PMC7584052 DOI: 10.3748/wjg.v26.i39.6057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/06/2020] [Accepted: 09/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The activity staging of Crohn’s disease (CD) in the terminal ileum is critical in developing an accurate clinical treatment plan. The activity of terminal ileum CD is associated with the microcirculation of involved bowel walls. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) can reflect perfusion and permeability of bowel walls by providing microcirculation information. As such, we hypothesize that DCE-MRI and DWI parameters can assess terminal ileum CD, thereby providing an opportunity to stage CD activity.
AIM To evaluate the value of DCE-MRI and DWI in assessing activity of terminal ileum CD.
METHODS Forty-eight patients with CD who underwent DCE-MRI and DWI were enrolled. The patients’ activity was graded as remission, mild and moderate-severe. The transfer constant (Ktrans), wash-out constant (Kep), and extravascular extracellular volume fraction (Ve) were calculated from DCE-MRI and the apparent diffusion coefficient (ADC) was obtained from DWI. Magnetic Resonance Index of Activity (MaRIA) was calculated from magnetic resonance enterography. Differences in these quantitative parameters were compared between normal ileal loop (NIL) and inflamed terminal ileum (ITI) and among different activity grades. The correlations between these parameters, MaRIA, the Crohn’s Disease Activity Index (CDAI), and Crohn’s Disease Endoscopic Index of Severity (CDEIS) were examined. Receiver operating characteristic curve analyses were used to determine the diagnostic performance of these parameters in differentiating between CD activity levels.
RESULTS Higher Ktrans (0.07 ± 0.04 vs 0.01 ± 0.01), Kep (0.24 ± 0.11 vs 0.15 ± 0.05) and Ve (0.27 ± 0.07 vs 0.08 ± 0.03), but lower ADC (1.41 ± 0.26 vs 2.41 ± 0.30) values were found in ITI than in NIL (all P < 0.001). The Ktrans, Kep, Ve and MaRIA increased with disease activity, whereas the ADC decreased (all P < 0.001). The Ktrans, Kep, Ve and MaRIA showed positive correlations with the CDAI (r = 0.866 for Ktrans, 0.870 for Kep, 0.858 for Ve, 0.890 for MaRIA, all P < 0.001) and CDEIS (r = 0.563 for Ktrans, 0.567 for Kep, 0.571 for Ve, 0.842 for MaRIA, all P < 0.001), while the ADC showed negative correlations with the CDAI (r = -0.857, P < 0.001) and CDEIS (r = -0.536, P < 0.001). The areas under the curve (AUC) for the Ktrans, Kep, Ve, ADC and MaRIA values ranged from 0.68 to 0.91 for differentiating inactive CD (CD remission) from active CD (mild to severe CD). The AUC when combining the Ktrans, Kep and Ve was 0.80, while combining DCE-MRI parameters and ADC values yielded the highest AUC of 0.95.
CONCLUSION DCE-MRI and DWI parameters all serve as measures to stage CD activity. When they are combined, the assessment performance is improved and better than MaRIA.
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Affiliation(s)
- Yin-Chen Wu
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
| | - Ze-Bin Xiao
- Department of Biomedical Sciences, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Xue-Hua Lin
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
| | - Xian-Ying Zheng
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
| | - Dai-Rong Cao
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
| | - Zhong-Shuai Zhang
- Department of Diagnosis Imaging, Siemens Healthcare Ltd, Shanghai 201318, China
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Vieujean S, Coibion C, Seidel L, Louis E, Meunier P. Magnetic resonance enterography perfusion parameters reveal complex changes in affected and unaffected segments in Crohn's disease. Scand J Gastroenterol 2020; 55:1041-1048. [PMID: 32757858 DOI: 10.1080/00365521.2020.1802773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To compare dynamic contrast-enhanced (DCE)-MRI parameters in affected and unaffected segments of CD patients with those of a control group, and to assess the correlation between DCE-MRI parameters and clinical index of activity (HBI) as well as biomarkers (CRP and faecal calprotectin). METHODS We performed a single-center prospective study of CD patients and control subjects who underwent DCE-MRI. Regions of interest were drawn in segments and the program (Olea Medical - Canon) provided values for transfer constant (Ktrans), fractional volume of extravascular-extracellular space (Ve), slope of enhancement (SoE), time to maximum enhancement (TME), maximum enhancement (ME) and enhancement ratio (ER) which were determined and compared. RESULTS Fifteen CD patients (mean age 42 years; 10 women) and 7 healthy subjects (mean age 40.4 years; 6 women) were included. Paired comparisons of affected and unaffected segments in CD showed a significant increase of all parameters in affected segments, except for ER and TME. When comparing to controls, the affected segments did not show any significant difference, while a significant decrease in most of the parameters (except for ER and TME) was observed when comparing unaffected segments of CD patients to controls. In CD, significant correlations between DCE-MRI parameters and biomarkers (CRP, faecal calprotectin) were more frequent in unaffected segments than in affected segments. CONCLUSIONS Significant differences in perfusion parameters were observed between affected and unaffected segments of CD patients and between unaffected segments and those of control subjects. This suggests complex perfusion changes in both unaffected and affected intestinal segments in CD.
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Affiliation(s)
- Sophie Vieujean
- Department of Gastroenterology, CHU Sart-Tilman, University of Liège, Liege, Belgium
| | - Caroline Coibion
- Department of Radiology, CHU Sart-Tilman, University of Liège, Liege, Belgium
| | - Laurence Seidel
- Biostatistics and medico-economic information department, CHU Sart-Tilman, University of Liège, Liege, Belgium
| | - Edouard Louis
- Department of Gastroenterology, CHU Sart-Tilman, University of Liège, Liege, Belgium
| | - Paul Meunier
- Department of Radiology, CHU Sart-Tilman, University of Liège, Liege, Belgium
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Kim DH, Chang KJ, Fowler KJ, Cash BD, Garcia EM, Kambadakone AR, Levy AD, Liu PS, Mace SE, Marin D, Moreno C, Peterson CM, Pietryga JA, Solnes LB, Weinstein S, Carucci LR. ACR Appropriateness Criteria® Crohn Disease. J Am Coll Radiol 2020; 17:S81-S99. [PMID: 32370980 DOI: 10.1016/j.jacr.2020.01.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/22/2020] [Indexed: 02/08/2023]
Abstract
Three common clinical scenarios involving use of imaging in Crohn disease are covered. These include the initial evaluation of Crohn disease when the diagnosis has not been previously established, the evaluation for anticipated exacerbation of known disease, and the evaluation of disease activity during therapy monitoring. The appropriateness of a given imaging modality for each scenario is rated as one of three categories (usually appropriate, may be appropriate, usually not appropriate) to help guide evaluation. Pediatric presentation of Crohn disease and the appropriateness of imaging are not covered in this document. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- David H Kim
- Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin.
| | | | - Kathryn J Fowler
- Panel Vice-Chair, University of California San Diego, San Diego, California
| | - Brooks D Cash
- University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | - Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | | | - Angela D Levy
- Medstar Georgetown University Hospital, Washington, District of Columbia
| | | | - Sharon E Mace
- Cleveland Clinic, Cleveland, Ohio; American College of Emergency Physicians
| | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | | | | | | | | | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Cansu A, Bekircavusoglu S, Oguz S, Bulut E, Fidan S. Can diffusion weighted imaging be used as an alternative to contrast-enhanced imaging on magnetic resonance enterography for the assessment of active inflammation in Crohn disease? Medicine (Baltimore) 2020; 99:e19202. [PMID: 32080107 PMCID: PMC7034637 DOI: 10.1097/md.0000000000019202] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The present study aimed to investigate the potential use of T2-weighted sequences with diffusion weighted imaging (DWI) in magnetic resonance (MR) enterography instead of conventional contrast-enhanced MR imaging (MRI) sequences for the evaluation of active inflammation in Crohn disease.Two-hundred thirteen intestinal segments of 43 patients, who underwent colonoscopy within 2 weeks before or after MR enterography were evaluated in this retrospective study. DWI sequences, T2-weighted sequences, and contrast-enhanced T1-weighted sequences were acquired in the MR enterography scan after cleaning of the bowel and using an oral contrast agent. First, the intestinal segments that had active inflammation in MR enterography were qualitatively evaluated in T2-weighted and contrast-enhanced T1-weighted sequences and then MR activity index (MRAI 1) and MRAI 2 were formed with and without contrast-enhanced sequences in 2 separate sessions.The correlation coefficient between contrast enhanced and DWI MR enterography scores (MRAI 1 and MRAI 2) of intestinal inflammation was 0.97 for all segments. In addition, separate correlation coefficients were calculated for terminal ileum, right colon, transverse colon, left colon, and rectum, and there was a strong correlation between the MRAI 1 and MRAI 2 scores of each segment (r = 0.86-0.97, P < .001). On the other hand, MR enterography had 88.7% sensitivity, 97.9% specificity, 95.5% positive predictive value, 94.6% negative predictive value, and 94.8% accuracy for detection of active inflammation in all intestinal segments in Crohn disease.DWI and T2-weighted sequences acquired with cleaning of the bowel can be used instead of contrast-enhanced MRI sequences for the evaluation of active inflammation in Crohn disease.
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Affiliation(s)
- Aysegul Cansu
- Karadeniz Technical University, Faculty of Medicine, Department of Radiology
| | | | - Sukru Oguz
- Karadeniz Technical University, Faculty of Medicine, Department of Radiology
| | - Eser Bulut
- Trabzon Kanuni Education and Research Hospital, Department of Radiology
| | - Sami Fidan
- Karadeniz Technical University, Faculty of Medicine, Department of Gastroenterology, Trabzon, Turkey
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Fang ZN, Li XH, Lin JJ, Huang SY, Cao QH, Chen ZH, Sun CH, Zhang ZW, Rieder F, Rimola J, Chen MH, Li ZP, Mao R, Feng ST. Magnetisation transfer imaging adds information to conventional MRIs to differentiate inflammatory from fibrotic components of small intestinal strictures in Crohn's disease. Eur Radiol 2020; 30:1938-1947. [PMID: 31900705 PMCID: PMC7760892 DOI: 10.1007/s00330-019-06594-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 11/09/2019] [Accepted: 11/14/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Identifying inflammation- or fibrosis-predominant strictures in Crohn's disease (CD) is crucial for treatment strategies. We evaluated the additive value of magnetisation transfer (MT) to conventional MRI for differentiating CD strictures using surgical histopathology as a reference standard. METHODS Twenty-eight consecutive CD patients who underwent MRI preoperatively were recruited. MRI parameters included T2-weighted imaging (T2WI) hyperintensity, bowel wall thickness, enhancement pattern changes over time, enhancement pattern and gain ratio in dynamic contrast-enhanced phases, and MT ratio. Correlation analysis was performed using Spearman's rank test. Receiver operating characteristic curve analysis and Cohen's κ were used. A model with combined MRI variables characterising intestinal strictures was proposed and validated in 14 additional CD patients. RESULTS Significant correlations with histological inflammation scores were shown for wall thickness (r = 0.361, p = 0.001) and T2WI hyperintensity (r = 0.396, p < 0.001), whereas histological fibrosis scores were significantly correlated with MT ratio (r = 0.681, p < 0.001) and wall thickness (r = 0.461, p < 0.001). T2WI hyperintensity could differentiate mild from moderate-to-severe inflammation with a sensitivity of 0.871 and a specificity of 0.800. MT ratio could discriminate mild from moderate-to-severe fibrosis with a sensitivity and a specificity of 0.913 and 0.923, respectively. Combining MT ratio and T2WI hyperintensity, the MRI classification moderately agreed with the pathological stricture classification (p < 0.01, κ = 0.549). In the validation set, the diagnostic accuracy of T2WI hyperintensity and MT ratio were 86% and 89%, with good agreement between MRI and histopathological classification (p < 0.01, κ = 0.665). CONCLUSIONS MT ratio combined with conventional MRI improves the differentiation of fibrotic from inflammatory components of small-bowel strictures in CD patients. KEY POINTS • MT ratio from magnetisation transfer imaging combined with T2WI from conventional MRI can simultaneously characterise bowel fibrosis and inflammation in adult Crohn's disease.
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Affiliation(s)
- Zhuang-Nian Fang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Xue-Hua Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Jin-Jiang Lin
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Si-Yun Huang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Qing-Hua Cao
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Zhi-Hui Chen
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Can-Hui Sun
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Zhong-Wei Zhang
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 South Kingshighway Boulevard, St. Louis, MO, 6310, USA
| | - Florian Rieder
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, USA
| | - Jordi Rimola
- Department of Radiology, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Barcelona, Spain
| | - Min-Hu Chen
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Zi-Ping Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Ren Mao
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China.
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China.
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11
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Gatti M, Allois L, Carisio A, Dianzani C, Garcia Martinez M, Ruggirello I, Varello S, Darvizeh F, Faletti R. Magnetic resonance enterography. MINERVA GASTROENTERO 2019; 65:319-334. [PMID: 31760740 DOI: 10.23736/s1121-421x.19.02639-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Crohn's disease is a condition of chronic inflammation that may involve any part of the gastrointestinal tract, although it more frequently affects the terminal ileum. Longstanding inflammation may lead to several bowel complications including obstruction, stricture, fistula and abscesses which often necessitate surgery. Cross-sectional imaging methods such as computed tomography and magnetic resonance imaging are being utilized more frequently to assess mural and extramural inflammatory bowel disease manifestations. Magnetic resonance enterography (MRE) for assessment of small bowel is optimal because of absence of ionizing radiation, better soft tissue contrast, development of motion-free sequences and high resolution images. A typical protocol includes pre and postcontrast sequences utilizing an enteric contrast agent for adequate bowel distention and an antiperistaltic agent. Overall, MRE allows the evaluation of disease activity, extraenteric complication and response to therapy with a great impact on patient management. In this review we discuss the features of MRE from patient's preparation and exam protocol to pathological findings.
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Affiliation(s)
- Marco Gatti
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy -
| | - Luca Allois
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Andrea Carisio
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Chiara Dianzani
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Maria Garcia Martinez
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Irene Ruggirello
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Sara Varello
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Fatemeh Darvizeh
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Riccardo Faletti
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
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12
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Ippolito D, Lombardi S, Talei Franzesi C, Drago SG, Querques G, Casiraghi A, Pecorelli A, Riva L, Sironi S. Dynamic Contrast-Enhanced MR with Quantitative Perfusion Analysis of Small Bowel in Vascular Assessment between Inflammatory and Fibrotic Lesions in Crohn's Disease: A Feasibility Study. CONTRAST MEDIA & MOLECULAR IMAGING 2019; 2019:1767620. [PMID: 30863218 PMCID: PMC6378774 DOI: 10.1155/2019/1767620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 09/26/2018] [Accepted: 12/10/2018] [Indexed: 02/08/2023]
Abstract
AIM To assess the feasibility of dynamic contrast-enhanced perfusion-MRI in characterization of active small-bowel inflammation and chronic mural fibrosis in patients with Crohn's disease (CD). METHODS We analyzed a total of 37 (11 women; 23-69 years) patients with known biopsy proven CD, who underwent MR-enterography (MRE) study, performed on a 1.5 T MRI system (Achieva, Philips), using a phased array sense body multicoil, after oral administration of 1.5-2 L of PEG solution. MRE protocol included T1 weighted, SSh T2, sBTFE, and gadolinium-enhanced THRIVE sequences acquired on coronal and axial planes. A dedicated workstation was used to generate perfusion color maps, on which we drown ROI on normal bowel and on pathological segment, thus obtaining related perfusion parameters: relative arterial, venous, and late enhancement (RAE, RVE, and RLE), maximum enhancement (ME), and time to peak (TTP). RESULTS Quantitative perfusion analysis showed a good correlation with local degree of Crohn's inflammation activity. Twenty-nine out of 37 patients showed active inflammatory disease (reference standard of active disease: wall bowel thickness and layered enhancement) with following perfusion parameters: REA (%) = 116.1, RVE (%) = 125.3, RLE (%) = 127.1, ME (%) = 1054.7, TTP (sec) = 157. The same parameters calculated in patients with mural fibrosis were as follows: RAE (%): median = 56.4; RVE (%): 81.2; RLE (%): 85.4; ME (%):809.6; TTP (sec): 203.4. A significant difference (p < 0.001) between inflamed and fibrotic bowel wall vascularity, regarding all perfusion parameters evaluated, was found, with higher values in active CD localizations. CONCLUSION Vascular assessment of perfusion kinetics of bowel wall by dynamic contrast perfusion-MR analysis may represent a complementary diagnostic tool that enables a quantitative evaluation of local inflammation activity in CD patients.
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Affiliation(s)
- Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Milan, Italy
- Department of Diagnostic Radiology, San Gerardo Hospital H. S. Gerardo Monza, Via Pergolesi 33, 20900-Monza, MB, Italy
| | - Sophie Lombardi
- School of Medicine, University of Milano-Bicocca, Milan, Italy
- Department of Diagnostic Radiology, San Gerardo Hospital H. S. Gerardo Monza, Via Pergolesi 33, 20900-Monza, MB, Italy
| | - Cammillo Talei Franzesi
- School of Medicine, University of Milano-Bicocca, Milan, Italy
- Department of Diagnostic Radiology, San Gerardo Hospital H. S. Gerardo Monza, Via Pergolesi 33, 20900-Monza, MB, Italy
| | - Silvia Girolama Drago
- School of Medicine, University of Milano-Bicocca, Milan, Italy
- Department of Diagnostic Radiology, San Gerardo Hospital H. S. Gerardo Monza, Via Pergolesi 33, 20900-Monza, MB, Italy
| | - Giulia Querques
- School of Medicine, University of Milano-Bicocca, Milan, Italy
- Department of Diagnostic Radiology, San Gerardo Hospital H. S. Gerardo Monza, Via Pergolesi 33, 20900-Monza, MB, Italy
| | - Alessandra Casiraghi
- School of Medicine, University of Milano-Bicocca, Milan, Italy
- Department of Diagnostic Radiology, San Gerardo Hospital H. S. Gerardo Monza, Via Pergolesi 33, 20900-Monza, MB, Italy
| | - Anna Pecorelli
- School of Medicine, University of Milano-Bicocca, Milan, Italy
- Department of Diagnostic Radiology, San Gerardo Hospital H. S. Gerardo Monza, Via Pergolesi 33, 20900-Monza, MB, Italy
| | - Luca Riva
- School of Medicine, University of Milano-Bicocca, Milan, Italy
- Department of Diagnostic Radiology, San Gerardo Hospital H. S. Gerardo Monza, Via Pergolesi 33, 20900-Monza, MB, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Milan, Italy
- Department of Diagnostic Radiology, Papa Giovanni XXIII Hospital H. Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
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13
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Zhang J, Feng L, Otazo R, Kim SG. Rapid dynamic contrast-enhanced MRI for small animals at 7T using 3D ultra-short echo time and golden-angle radial sparse parallel MRI. Magn Reson Med 2019; 81:140-152. [PMID: 30058079 PMCID: PMC6258350 DOI: 10.1002/mrm.27357] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/02/2018] [Accepted: 04/22/2018] [Indexed: 01/18/2023]
Abstract
PURPOSE To develop a rapid dynamic contrast-enhanced MRI method with high spatial and temporal resolution for small-animal imaging at 7 Tesla. METHODS An ultra-short echo time (UTE) pulse sequence using a 3D golden-angle radial sampling was implemented to achieve isotropic spatial resolution with flexible temporal resolution. Continuously acquired radial spokes were grouped into subsets for image reconstruction using a multicoil compressed sensing approach (Golden-angle RAdial Sparse Parallel; GRASP). The proposed 3D-UTE-GRASP method with high temporal and spatial resolutions was tested using 7 mice with GL261 intracranial glioma models. RESULTS Iterative reconstruction with different temporal resolutions and regularization factors λ showed that, in all cases, the cost function decreased to less than 2.5% of its starting value within 20 iterations. The difference between the time-intensity curves of 3D-UTE-GRASP and nonuniform fast Fourier transform (NUFFT) images was minimal when λ was 1% of the maximum signal intensity of the initial NUFFT images. The 3D isotropic images were used to generate pharmacokinetic parameter maps to show the detailed images of the tumor characteristics in 3D and also to show longitudinal changes during tumor growth. CONCLUSION This feasibility study demonstrated that the proposed 3D-UTE-GRASP method can be used for effective measurement of the 3D spatial heterogeneity of tumor pharmacokinetic parameters.
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Affiliation(s)
- Jin Zhang
- Center for Biomedical Imaging (CBI), Center for Advanced Imaging Innovation and Research (CAIR), Department of Radiology, New York University School of Medicine, New York, NY, United States
| | - Li Feng
- Center for Biomedical Imaging (CBI), Center for Advanced Imaging Innovation and Research (CAIR), Department of Radiology, New York University School of Medicine, New York, NY, United States
| | - Ricardo Otazo
- Center for Biomedical Imaging (CBI), Center for Advanced Imaging Innovation and Research (CAIR), Department of Radiology, New York University School of Medicine, New York, NY, United States
| | - Sungheon Gene Kim
- Center for Biomedical Imaging (CBI), Center for Advanced Imaging Innovation and Research (CAIR), Department of Radiology, New York University School of Medicine, New York, NY, United States
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14
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Hectors SJ, Gordic S, Semaan S, Bane O, Hirten R, Jia X, Colombel JF, Taouli B. Diffusion and perfusion MRI quantification in ileal Crohn's disease. Eur Radiol 2018; 29:993-1002. [PMID: 30019143 DOI: 10.1007/s00330-018-5627-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/12/2018] [Accepted: 06/21/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To quantify intravoxel incoherent motion (IVIM)-DWI and dynamic contrast-enhanced (DCE)-MRI parameters in normal and abnormal ileal segments in Crohn's disease (CD) patients and to assess the association of these parameters with clinical and MRI-based measurements of CD activity. METHODS In this prospective study, 27 CD patients (M/F 18/9, mean age 42 years) underwent MR enterography, including IVIM-DWI and DCE-MRI. IVIM-DWI and DCE-MRI parameters were quantified in normal and abnormal small bowel segments, the latter identified by the presence of inflammatory changes. MRI parameter differences between normal and abnormal bowel were tested using Wilcoxon signed-rank tests. IVIM-DWI and DCE-MRI parameters were correlated with clinical data (C-reactive protein, Harvey-Bradshaw Index), conventional MRI parameters (wall thickness, length of involvement) and MRI activity scores (MaRIA, Clermont). Diagnostic performance of (combined) parameters for differentiation between normal and abnormal bowel was determined using ROC analysis. RESULTS The DCE-MRI parameters peak concentration Cpeak, upslope, area-under-the-curve at 60s (AUC60), Ktrans and ve were significantly increased (p<0.023), while IVIM-DWI parameters perfusion fraction (PF) and ADC were significantly decreased (p<0.001) in abnormal bowel segments. None of the DCE-MRI and IVIM-DWI parameters correlated with clinical parameters (p>0.105). DCE-MRI parameters exhibited multiple significant correlations with wall thickness (Cpeak, upslope, AUC60, Ktrans; r range 0.431-0.664, p<0.025) and MaRIA/Clermont scores (Cpeak, AUC60, Ktrans; r range 0.441-0.617, p<0.021). Combined Ktrans+ve+PF+ADC showed highest AUC (0.963) for differentiation between normal and abnormal bowel, while ADC performed best for individual parameters (AUC=0.800). CONCLUSIONS DCE-MRI and IVIM-DWI, particularly when used in combination, are promising for non-invasive evaluation of small bowel CD. KEY POINTS • IVIM-DWI and DCE-MRI parameters were significantly different between normal and abnormal bowel segments in CD patients. • DCE-MRI parameters showed a significant association with wall thickness and MRI activity scores. • Combination of IVIM-DWI and DCE-MRI parameters led to the highest diagnostic performance for differentiation between normal and abnormal bowel segments, while ADC showed the highest diagnostic performance of individual parameters.
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Affiliation(s)
- Stefanie J Hectors
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sonja Gordic
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Sahar Semaan
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Octavia Bane
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Hirten
- IBD Center, Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Xiaoyu Jia
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jean-Frederic Colombel
- IBD Center, Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bachir Taouli
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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15
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Khatri G, Coleman J, Leyendecker JR. Magnetic Resonance Enterography for Inflammatory and Noninflammatory Conditions of the Small Bowel. Radiol Clin North Am 2018; 56:671-689. [PMID: 30119767 DOI: 10.1016/j.rcl.2018.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Magnetic resonance enterography (MRE) is an effective noninvasive tool for evaluation of inflammatory and noninflammatory conditions of the small bowel. MRE allows for repeated evaluation of patients with Crohn disease without exposure to ionizing radiation, and can be used to assess disease status and direct management. MRE also allows evaluation of neoplastic and other nonneoplastic conditions of the small bowel. Adequate patient preparation and acquisition techniques are required for optimal image quality.
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Affiliation(s)
- Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Jay Coleman
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - John R Leyendecker
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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16
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Lefrançois P, Zummo-Soucy M, Olivié D, Billiard JS, Gilbert G, Garel J, Visée E, Manchec P, Tang A. Diagnostic performance of intravoxel incoherent motion diffusion-weighted imaging and dynamic contrast-enhanced MRI for assessment of anal fistula activity. PLoS One 2018; 13:e0191822. [PMID: 29370278 PMCID: PMC5784995 DOI: 10.1371/journal.pone.0191822] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/11/2018] [Indexed: 12/14/2022] Open
Abstract
Objective To evaluate intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) sequences for quantitative characterization of anal fistula activity. Methods This retrospective study was approved by the institutional review board. One hundred and two patients underwent MRI for clinical suspicion of anal fistula. Forty-three patients with demonstrable anal fistulas met the inclusion criteria. Quantitative analysis included measurement of DCE and IVIM parameters. The reference standard was clinical activity based on medical records. Statistical analyses included Bayesian analysis with Markov Chain Monte Carlo, multivariable logistic regression, and receiver operating characteristic analyses. Results Brevity of enhancement, defined as the time difference between the wash-in and wash-out, was longer in active than inactive fistulas (p = 0.02). Regression coefficients of multivariable logistic regression analysis revealed that brevity of enhancement increased and normalized perfusion area under curve decreased with presence of active fistulas (p = 0.03 and p = 0.04, respectively). By cross-validation, a logistic regression model that included quantitative perfusion parameters (DCE and IVIM) performed significantly better than IVIM only (p < 0.001). Area under the curves for distinguishing patients with active from those with inactive fistulas were 0.669 (95% confidence interval [CI]: 0.500, 0.838) for a model with IVIM only, 0.860 (95% CI: 0.742, 0.977) for a model with IVIM and brevity of enhancement, and 0.921 (95% CI: 0.846, 0.997) for a model with IVIM and all DCE parameters. Conclusion The inclusion of brevity of enhancement measured by DCE-MRI improved assessment of anal fistula activity over IVIM-DWI only.
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Affiliation(s)
- Philippe Lefrançois
- Department of Radiology, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Mathieu Zummo-Soucy
- Department of Radiology, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Damien Olivié
- Department of Radiology, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Jean-Sébastien Billiard
- Department of Radiology, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Guillaume Gilbert
- Department of Radiology, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
- MR Clinical Science, Philips Healthcare Canada, Markham, Ontario, Canada
| | - Juliette Garel
- Department of Radiology, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Emmanuel Visée
- Department of Radiology, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
- Centre Hospitalier Départemental de Vendée, Les Oudairies, La Roche-Sur-Yon, France
| | - Perrine Manchec
- Department of Radiology, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
- Norimagerie, 1,3 chemin du Penthod, Caluire et Cuire, France
| | - An Tang
- Department of Radiology, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada
- * E-mail:
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17
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Wilkens R, Hagemann-Madsen RH, Peters DA, Nielsen AH, Nørager CB, Glerup H, Krogh K. Validity of Contrast-enhanced Ultrasonography and Dynamic Contrast-enhanced MR Enterography in the Assessment of Transmural Activity and Fibrosis in Crohn's Disease. J Crohns Colitis 2018; 12:48-56. [PMID: 28981627 DOI: 10.1093/ecco-jcc/jjx111] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/01/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Increased small intestinal wall thickness correlates with both inflammatory activity and fibrosis in Crohn's disease [CD]. Assessment of perfusion holds promise as an objective marker distinguishing between the two conditions. Our primary aim was to determine if relative bowel wall perfusion measurements correlate with histopathological scores for inflammation or fibrosis in CD. METHODS A total of 25 patients were investigated before elective surgery for small intestinal CD. Unenhanced ultrasonography [US] and magnetic resonance enterography [MRE] were applied to describe bowel wall thickness. Perfusion was assessed with contrast-enhanced US [CEUS] and dynamic contrast-enhanced MRE [DCE-MRE]. Histopathology was used as gold standard. RESULTS Compared with histopathology, the mean wall thickness was 0.4 mm greater on US [range -0.3 to 1.0, p = 0.24] and 1.4 mm greater on MR [0.4 to 2.3, p = 0.006]. No correlation was found between the severity of inflammation or fibrosis on histopathology, and either DCE-MRE [r = -0.13, p = 0.54 for inflammation and r = 0.41, p = 0.05 for fibrosis] or CEUS [r = 0.16, p = 0.45 for inflammation and r = -0.28, p = 0.19 for fibrosis]. Wall thickness assessed with US was correlated with both histological inflammation [r = 0.611, p = 0.0012] and fibrosis [r = 0.399, p = 0.048]. The same was not true for MR [r = 0.41, p = 0.047 for inflammation and r = 0.29, p = 0.16 for fibrosis]. CONCLUSIONS Bowel wall thickness assessed with US is a valid marker of inflammation in small intestinal CD. However, relative contrast enhancement of US or of MRE cannot distinguish between inflammatory activity and fibrosis.
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Affiliation(s)
- Rune Wilkens
- University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark.,Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke H Hagemann-Madsen
- Department of Clinical Pathology, Lillebaelt Hospital, Vejle, Denmark.,Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - David A Peters
- Department of Clinical Engineering, Aarhus University Hospital, Aarhus, Denmark
| | - Agnete H Nielsen
- University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Charlotte B Nørager
- Department of Colorectal Surgery P, Aarhus University Hospital, Aarhus, Denmark
| | - Henning Glerup
- University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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18
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19
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Anoperineal lesions in Crohn's disease: French recommendations for clinical practice. Tech Coloproctol 2017; 21:683-691. [PMID: 28929282 DOI: 10.1007/s10151-017-1684-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/13/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anoperineal lesion (APL) occurrence is a significant event in the evolution of Crohn's disease (CD). Management should involve a multidisciplinary approach combining the knowledge of the gastroenterologist, the colorectal surgeon and the radiologist who have appropriate experience in this area. Given the low level of evidence of available medical and surgical strategies, the aim of this work was to establish a French expert consensus on management of anal Crohn's disease. These recommendations were led under the aegis of the Société Nationale Française de Colo-Proctologie (SNFCP). They report a consensus on the management of perianal Crohn's disease lesions, including fistulas, ulceration and anorectal stenosis and propose an appropriate treatment strategy, as well as sphincter-preserving and multidisciplinary management. METHODOLOGY A panel of French gastroenterologists and colorectal surgeons with expertise in inflammatory bowel diseases reviewed the literature in order to provide practical management pathways for perianal CD. Analysis of the literature was made according to the recommendations of the Haute Autorité de Santé (HAS) to establish a level of proof for each publication and then to propose a rank of recommendation. When lack of factual data precluded ranking according to the HAS, proposals based on expert opinion were written. Therefore, once all the authors agreed on a consensual statement, it was then submitted to all the members of the SNFCP. As initial literature review stopped in December 2014, more recent European or international guidelines have been published since and were included in the analysis. RESULTS MRI is recommended for complex secondary lesions, particularly after failure of previous medical and/or surgical treatments. For severe anal ulceration in Crohn's disease, maximal medical treatment with anti-TNF agent is recommended. After prolonged drainage of simple anal fistula by a flexible elastic loop or loosely tied seton, and after obtaining luminal and perineal remission by immunosuppressive therapy and/or anti-TNF agents, the surgical treatment options to be discussed are simple seton removal or injection of the fistula tract with biological glue. After prolonged loose-seton drainage of the complex anal fistula in Crohn's disease, and after obtaining luminal and perineal remission with anti-TNF ± immunosuppressive therapy, surgical treatment options are simple removal of seton and rectal advancement flap. Colostomy is indicated as a last option for severe APL, possibly associated with a proctectomy if there is refractory rectal involvement after failure of other medical and surgical treatments. The evaluation of anorectal stenosis of Crohn's disease (ARSCD) requires a physical examination, sometimes under anesthesia, plus endoscopy with biopsies and MRI to describe the stenosis itself, to identify associated inflammatory, infectious or dysplastic lesions, and to search for injury or fibrosis of the sphincter. Therapeutic strategy for ARSCD requires medical-surgical cooperation.
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20
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van Kalleveen IML, Hoogendam JP, Raaijmakers AJE, Visser F, Arteaga de Castro CS, Verheijen RHM, Luijten PR, Zweemer RP, Veldhuis WB, Klomp DWJ. Boosting the SNR by adding a receive-only endorectal monopole to an external antenna array for high-resolution, T 2 -weighted imaging of early-stage cervical cancer with 7-T MRI. NMR IN BIOMEDICINE 2017; 30:e3750. [PMID: 28574604 DOI: 10.1002/nbm.3750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 06/07/2023]
Abstract
The aim of this study was to investigate the signal-to-noise ratio (SNR) gain in early-stage cervical cancer at ultrahigh-field MRI (e.g. 7 T) using a combination of multiple external antennas and a single endorectal antenna. In particular, we used an endorectal monopole antenna to increase the SNR in cervical magnetic resonance imaging (MRI). This should allow high-resolution, T2 -weighted imaging and magnetic resonance spectroscopy (MRS) for metabolic staging, which could facilitate the local tumor status assessment. In a prospective feasibility study, five healthy female volunteers and six patients with histologically proven stage IB1-IIB cervical cancer were scanned at 7 T. We used seven external fractionated dipole antennas for transmit-receive (transceive) and an endorectally placed monopole antenna for reception only. A region of interest, containing both normal cervix and tumor tissue, was selected for the SNR measurement. Separated signal and noise measurements were obtained in the region of the cervix for each element and in the near field of the monopole antenna (radius < 30 mm) to calculate the SNR gain of the endorectal antenna in each patient. We obtained high-resolution, T2 -weighted images with a voxel size of 0.7 × 0.8 × 3.0 mm3 . In four cases with optimal placement of the endorectal antenna (verified on the T2 -weighted images), a mean gain of 2.2 in SNR was obtained at the overall cervix and tumor tissue area. Within a radius of 30 mm from the monopole antenna, a mean SNR gain of 3.7 was achieved in the four optimal cases. Overlap between the two different regions of the SNR calculations was around 24%. We have demonstrated that the use of an endorectal monopole antenna substantially increases the SNR of 7-T MRI at the cervical anatomy. Combined with the intrinsically high SNR of ultrahigh-field MRI, this gain may be employed to obtain metabolic information using MRS and to enhance spatial resolutions to assess tumor invasion.
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Affiliation(s)
| | - J P Hoogendam
- Department of Gynaecological Oncology, UMC Utrecht Cancer Centre, the Netherlands
| | | | - F Visser
- Department of Radiology, UMC Utrecht, the Netherlands
| | | | - R H M Verheijen
- Department of Gynaecological Oncology, UMC Utrecht Cancer Centre, the Netherlands
| | - P R Luijten
- Department of Radiology, UMC Utrecht, the Netherlands
| | - R P Zweemer
- Department of Gynaecological Oncology, UMC Utrecht Cancer Centre, the Netherlands
| | - W B Veldhuis
- Department of Radiology, UMC Utrecht, the Netherlands
| | - D W J Klomp
- Department of Radiology, UMC Utrecht, the Netherlands
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Zhang J, Winters K, Reynaud O, Kim SG. Simultaneous measurement of T 1 /B 1 and pharmacokinetic model parameters using active contrast encoding (ACE)-MRI. NMR IN BIOMEDICINE 2017; 30:10.1002/nbm.3737. [PMID: 28544159 PMCID: PMC5557664 DOI: 10.1002/nbm.3737] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 05/06/2023]
Abstract
The aim of this study was to assess the feasibility of combining dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) with the measurement of the radiofrequency (RF) transmit field B1 and pre-contrast longitudinal relaxation time T10 . A novel approach has been proposed to simultaneously estimate B1 and T10 from a modified DCE-MRI scan that actively encodes the washout phase of the curve with different amounts of T1 and B1 weighting using multiple flip angles and repetition times, hence referred to as active contrast encoding (ACE)-MRI. ACE-MRI aims to simultaneously measure B1 and T10 , together with contrast kinetic parameters, such as the transfer constant Ktrans , interstitial space volume fraction ve and vascular space volume fraction vp . The proposed method was tested using numerical simulations and in vivo studies with mouse models of breast cancer implanted in the flank and mammary fat pad, and glioma in the brain. In the numerical simulation study with a signal-to-noise ratio of 10, both B1 and T10 were estimated accurately with errors of 5.1 ± 3.5% and 12.3 ± 8.8% and coefficients of variation (CV) of 14.9 ± 8.6% and 15.0 ± 5.0%, respectively. Using the same ACE-MRI data, the kinetic parameters Ktrans , ve and vp were also estimated with errors of 14.2 ± 8.3% (CV = 13.5 ± 4.6%), 14.7 ± 9.9% (CV = 13.3 ± 4.5%) and 14.0 ± 9.3% (CV = 14.0 ± 4.5%), respectively. For the in vivo tumor data from 11 mice, voxel-wise comparisons between ACE-MRI and DCE-MRI methods showed that the mean differences for the five parameters were as follows: ΔKtrans = 0.006 (/min), Δve = 0.016, Δvp = 0.000, ΔB1 = -0.014 and ΔT1 = -0.085 (s), which suggests a good agreement between the two methods. When compared with separately measured B1 and T10 , and DCE-MRI estimated kinetic parameters as a reference, the mean relative errors of ACE-MRI estimation were B1 = -0.3%, T10 = -8.5%, Ktrans = 11.4%, ve = 14.5% and vp = 4.5%. This proof-of-concept study demonstrates that the proposed ACE-MRI method can be used to estimate B1 and T10 , together with contrast kinetic model parameters.
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Affiliation(s)
- Jin Zhang
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, USA
| | - Kerryanne Winters
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, USA
| | - Olivier Reynaud
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, USA
| | - Sungheon Gene Kim
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, USA
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Radmard AR, Haghighi S, Hashemi Taheri AP, Mohammadinejad P, Eftekhar Vaghefi R, Naybandi Atashi S, Pak N, Aghaghazvini L, Malekzadeh R. Magnetic Resonance Enterography in 300 Known Cases of Crohn's Disease: An Initial Report from a Referral Center in Iran. Middle East J Dig Dis 2016; 8:273-281. [PMID: 27957290 PMCID: PMC5145294 DOI: 10.15171/mejdd.2016.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Magnetic resonance enterography (MRE) has become the modality of choice in assessment of patients with Crohn’s disease (CD). We aimed to present our experience on 300 patients with CD who underwent MRE during the first 30 months after setting up MRE for the first time in a referral center in Iran. METHODS Patients with a definite diagnosis of CD based on either ileocolonoscopy or histopathological studies were included in the final report and categorized into four phenotypes of inactive, active, stricturing, and penetrating disease. RESULTS This was a case series study on 300 patients with known CD out of 594 referred subjects. The most prevalent phenotype was inactive observed in 162 (54.0%) patients followed by stricturing in 44 (14.7%), active in 40 (13.3%), penetrating in 27(9%), and active on chronic in 27 (9%) cases. The number of referred patients increased from 51 cases in the first 6 months to 165 in the last 6 months. CONCLUSION This study presents the first report on the application of MRE in Iran as superb modality for management of CD. The growing number of referred patients indicates that MRE has been successful in addressing the most critical concerns of clinicians on determining the dominant disease phenotype.
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Affiliation(s)
- Amir Reza Radmard
- Department of Radiology, Shariati hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepehr Haghighi
- Department of Radiology, Shariati hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Payam Mohammadinejad
- Department of Radiology, Shariati hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Rana Eftekhar Vaghefi
- Department of Radiology, Shariati hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Naybandi Atashi
- Department of Radiology, Shariati hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Pak
- Department of Radiology, Shariati hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Aghaghazvini
- Department of Radiology, Shariati hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Malekzadeh
- Autoimmune and Motility Disorders of the Gastro-Intestinal Tract Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Rajabi S, Dupuis I, Benmassaoud A, Prucha A, Bessissow T, Reinhold C, Stein LA, Gallix B. Magnetic Resonance Enterography in the Study of Patients With Crohn's Disease: Which Findings Are More Likely to Change Patient Management? Can Assoc Radiol J 2016; 67:387-394. [PMID: 27578460 DOI: 10.1016/j.carj.2016.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 12/27/2015] [Accepted: 02/15/2016] [Indexed: 12/22/2022] Open
Affiliation(s)
- Shadi Rajabi
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
| | - Isabelle Dupuis
- Department of Diagnostic Radiology, McGill University Health Centre, Montréal, Quebec, Canada
| | - Amine Benmassaoud
- Department of Internal Medicine, McGill University Health Centre, Montréal, Quebec, Canada
| | - Alexandre Prucha
- Department of Diagnostic Radiology, McGill University Health Centre, Montréal, Quebec, Canada
| | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Centre, Montréal, Quebec, Canada
| | - Caroline Reinhold
- Department of Diagnostic Radiology, McGill University Health Centre, Montréal, Quebec, Canada
| | - Lawrence A Stein
- Department of Diagnostic Radiology, McGill University Health Centre, Montréal, Quebec, Canada
| | - Benoit Gallix
- Department of Diagnostic Radiology, McGill University Health Centre, Montréal, Quebec, Canada
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Masselli G, Mastroiacovo I, De Marco E, Francione G, Casciani E, Polettini E, Gualdi G. Current tecniques and new perpectives research of magnetic resonance enterography in pediatric Crohn's disease. World J Radiol 2016; 8:668-82. [PMID: 27551337 PMCID: PMC4965351 DOI: 10.4329/wjr.v8.i7.668] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 03/24/2016] [Accepted: 04/07/2016] [Indexed: 02/06/2023] Open
Abstract
Crohn's disease affects more than 500000 individuals in the United States, and about 25% of cases are diagnosed during the pediatric period. Imaging of the bowel has undergone dramatic changes in the past two decades. The endoscopy with biopsy is generally considered the diagnostic reference standard, this combination can evaluates only the mucosa, not inflammation or fibrosis in the mucosa. Actually, the only modalities that can visualize submucosal tissues throughout the small bowel are the computed tomography (CT) enterography (CTE) with the magnetic resonance enterography (MRE). CT generally is highly utilized, but there is growing concern over ionizing radiation and cancer risk; it is a very important aspect to keep in consideration in pediatric patients. In contrast to CTE, MRE does not subject patients to ionizing radiation and can be used to detect detailed morphologic information and functional data of bowel disease, to monitor the effects of medical therapy more accurately, to detect residual active disease even in patients showing apparent clinical resolution and to guide treatment more accurately.
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Kim DH, Carucci LR, Baker ME, Cash BD, Dillman JR, Feig BW, Fowler KJ, Gage KL, Noto RB, Smith MP, Yaghmai V, Yee J, Lalani T. ACR Appropriateness Criteria Crohn Disease. J Am Coll Radiol 2016; 12:1048-57.e4. [PMID: 26435118 DOI: 10.1016/j.jacr.2015.07.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 07/08/2015] [Indexed: 12/11/2022]
Abstract
Crohn disease is a chronic inflammatory disorder involving the gastrointestinal tract, characterized by episodic flares and times of remission. Underlying structural damage occurs progressively, with recurrent bouts of inflammation. The diagnosis and management of this disease process is dependent on several clinical, laboratory, imaging, endoscopic, and histologic factors. In recent years, with the maturation of CT enterography, and MR enterography, imaging has played an increasingly important role in relation to Crohn Disease. In addition to these specialized examination modalities, ultrasound and routine CT have potential uses. Fluoroscopy, radiography, and nuclear medicine may be less beneficial depending on the clinical scenario. The imaging modality best suited to evaluating this disease may change, depending on the target population, severity of presentation, and specific clinical situation. This document presents seven clinical scenarios (variants) in both the adult and pediatric populations and rates the appropriateness of the available imaging options. They are summarized in a consolidated table, and the underlying rationale and supporting literature are presented in the accompanying narrative. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Affiliation(s)
- David H Kim
- University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
| | - Laura R Carucci
- Virginia Commonwealth University Medical Center, Richmond, Virginia
| | | | | | | | - Barry W Feig
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Richard B Noto
- Brown University Rhode Island Hospital, Providence, Rhode Island
| | - Martin P Smith
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Judy Yee
- University of California San Francisco, San Francisco, California
| | - Tasneem Lalani
- Inland Imaging Associates and University of Washington, Seattle, Washington
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Guglielmo FF, Mitchell DG, O'Kane PL, Deshmukh SP, Roth CG, Burach I, Burns A, Dulka S, Parker L. Identifying decreased peristalsis of abnormal small bowel segments in Crohn's disease using cine MR enterography: the frozen bowel sign. ACTA ACUST UNITED AC 2016; 40:1150-6. [PMID: 25326259 DOI: 10.1007/s00261-014-0258-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of this study was to evaluate whether affected bowel in Crohn's disease patients can be identified by observing decreased peristalsis (frozen bowel sign) using cine balanced steady-state free precession (cine BSSFP) images. MATERIALS AND METHODS 5 radiologists independently reviewed cine BSSFP sequences from randomized MR Enterography (MRE) exams for 30 normal and 30 Crohn's disease patients, graded overall small bowel peristalsis from slowest to fastest, and graded peristalsis for the most abnormal small bowel segment. Sensitivity and specificity of the frozen bowel sign for diagnosing Crohn's disease were calculated. T tests of the peristalsis difference between abnormal segments and overall small bowel were conducted. RESULTS For 5 readers, the sensitivity and specificity of cine BSSFP of the frozen bowel sign for diagnosing Crohn's disease ranged from 70% to 100% and 87% to 100%, respectively. There were significant differences in peristalsis between abnormal small bowel segments and the overall small bowel for Crohn's patients, but not in the overall small bowel between normal-MRE patients and Crohn's disease patients. CONCLUSION Abnormal Crohn's small bowel segments have significantly decreased peristalsis compared to normal small bowel, which can be identified using cine BSSFP sequences as the frozen bowel sign.
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Affiliation(s)
- Flavius F Guglielmo
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA, 19107, USA,
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D'Souza N, Thaventhiran A, Beable R, Higginson A, Rud B. Magnetic resonance imaging (MRI) for diagnosis of acute appendicitis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Nigel D'Souza
- Salisbury District Hospital; Department of Colorectal Surgery; Odstock Road Salisbury UK
| | - Anthony Thaventhiran
- Southampton General Hospital, University Hospital Southampton NHS Foundation Trust; General Surgery; Tremona Road Southampton Hampshire UK SO16 6YD
| | - Richard Beable
- Queen Alexandra Hospital; Department of Radiology; Soutwick Hill Road Portsmouth Hampshire UK
| | - Antony Higginson
- Queen Alexandra Hospital; Department of Radiology; Soutwick Hill Road Portsmouth Hampshire UK
| | - Bo Rud
- Bispebjerg Hospital; Department of Surgical Gastroenterology K; 23 Bispebjerg Bakke Copenhagen NV Denmark DK 2400
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Shenoy-Bhangle AS, Nimkin K, Aranson T, Gee MS. Value of diffusion-weighted imaging when added to magnetic resonance enterographic evaluation of Crohn disease in children. Pediatr Radiol 2016; 46:34-42. [PMID: 26238966 DOI: 10.1007/s00247-015-3438-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 06/10/2015] [Accepted: 07/13/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND MR enterography is increasingly utilized for noninvasive evaluation of disease activity in young patients with Crohn disease and has great impact on clinical management. Diffusion-weighted imaging (DWI) is a rapid MR imaging technique that measures molecular diffusion of water and is sensitive to the inflammatory process; however, its value to MR enterography has not been rigorously evaluated. OBJECTIVE To determine whether the addition of DWI to MR enterography is helpful in evaluating Crohn disease activity in young patients when compared to a histological reference. MATERIALS AND METHODS In this single-institution retrospective study, we searched an imaging database for the period January 2010 to December 2012 to identify patients age 19 years and younger who had MR enterography with diffusion-weighted imaging (DWI). We used an electronic medical record search to identify those who had MR enterography and colonoscopy performed within 28 days of each other. All MR enterography scans were performed on a 1.5-T or 3-T clinical MR scanner with phased-array torso coil configuration using standard pulse sequences as well as axial DWI with b values of 50, 400 and 800. Bowel segments were evaluated for disease activity based on standard MR enterography sequences; in addition, segmental apparent diffusion coefficient (ADC) values were calculated based on DWI. Histological reference for disease activity was based on assessment for mucosal inflammatory changes on endoscopic biopsy. MR enterography and DWI evaluation were performed in a blinded fashion with respect to histological results. RESULTS We included imaging of 78 bowel segments from 27 patients (mean age 14.5 ± 3.02 years) with known Crohn disease in the study. The mean ADC for bowel segments with active disease was 1.56 ± 0.7 × 10(3) mm(2)/s compared with 2.58 ± 1.4 × 10(3) mm(2)/s for segments without active disease, a difference that was statistically significant (P < 0.01, Student's t-test). Using a threshold value of 2.0 × 10(3) mm(2)/s, DWI demonstrated lower accuracy (64.1%) but higher sensitivity (78.8%) for detecting active disease compared with standard MR enterography (69.2% and 54.6%, respectively). Combining DWI with MR enterography, using DWI as the initial screen and MR enterography afterward to reduce false negativity, led to a significant increase in accuracy (76.9%; P = 0.03, McNemar's test) compared with either imaging technique alone. CONCLUSION Although DWI does not perform as well as standard MR enterography for detection of active Crohn disease, the combination of DWI and MR enterography increases imaging accuracy for determining disease activity compared with either technique alone. These results indicate that DWI adds value to MR enterography and supports the incorporation of DWI into MR enterography protocols for evaluation of Crohn disease in young patients.
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Affiliation(s)
- Anuradha S Shenoy-Bhangle
- Division of Abdominal Imaging/Community Radiology, Shapiro Clinical Center, Beth Israel Deaconess Medical Center, 330 Brookline Ave., 4th Floor, Boston, MA, 02215, USA.
| | - Katherine Nimkin
- Division of Pediatric Imaging, Department of Radiology, Massachusetts General Hospital for Children, Boston, MA, USA
| | - Thomas Aranson
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Michael S Gee
- Division of Pediatric Imaging, Department of Radiology, Massachusetts General Hospital for Children, Boston, MA, USA.,Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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The Role of MR Enterography in Assessing Crohn's Disease Activity and Treatment Response. Gastroenterol Res Pract 2015; 2016:8168695. [PMID: 26819611 PMCID: PMC4706951 DOI: 10.1155/2016/8168695] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/23/2015] [Accepted: 08/27/2015] [Indexed: 12/17/2022] Open
Abstract
MR enterography (MRE) has become the primary imaging modality in the assessment of Crohn's disease (CD) in both children and adults at many institutions in the United States and worldwide, primarily due to its noninvasiveness, superior soft tissue contrast, and lack of ionizing radiation. MRE technique includes distention of the small bowel with oral contrast media with the acquisition of T2-weighted, balanced steady-state free precession, and multiphase T1-weighted fat suppressed gadolinium contrast-enhanced sequences. With the introduction of molecule-targeted biologic agents into the clinical setting for CD and their potential to reverse the inflammatory process, MRE is increasingly utilized to evaluate disease activity and response to therapy as an imaging complement to clinical indices or optical endoscopy. New and emerging MRE techniques, such as diffusion-weighted imaging (DWI), magnetization transfer, ultrasmall superparamagnetic iron oxide- (USPIO-) enhanced MRI, and PET-MR, offer the potential for an expanded role of MRI in detecting occult disease activity, evaluating early treatment response/resistance, and differentiating inflammatory from fibrotic strictures. Familiarity with MR enterography is essential for radiologists and gastroenterologists as the technique evolves and is further incorporated into the clinical management of CD.
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Assessment of Disease Activity in Small Bowel Crohn's Disease: Comparison between Endoscopy and Magnetic Resonance Enterography Using MRIA and Modified MRIA Score. Gastroenterol Res Pract 2015; 2015:159641. [PMID: 26759554 PMCID: PMC4670649 DOI: 10.1155/2015/159641] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/11/2015] [Accepted: 08/19/2015] [Indexed: 12/18/2022] Open
Abstract
Objectives. To retrospectively compare the results of the MRIA (magnetic resonance index of activity) with a modified MRIA (mMRIA), which was calculated excluding from MRIA formula the data of relative contrast enhancement (RCE). Materials and Methods. MR-E and corresponding endoscopic records of 100 patients were reviewed. MRIA, mMRIA, and SES endoscopic index were calculated for all the patients. Namely, MRIA was calculated as follows: (1.5 × wall thickening + 0.02 × RCE + 5 × intramural edema + 10 × ulcers), while mMRIA was calculated with the modified formula (1.5 × wall thickening + 5 × intramural edema + 10 × ulcers). Results. Mean MRIA and mMRIA values were 19.3 and 17.68, respectively (p < 0.0001). A significant correlation (p < 0.0001) was observed between MRIA and mMRIA scores and between both MR indexes and SES (p < 0.0001). Conclusions. mMRIA was comparable to MRIA in the evaluation of disease activity in Crohn's disease.
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Evaluation of Crohn’s disease activity by MR enterography: Derivation and histopathological comparison of an MR-based activity index. Eur J Radiol 2015; 84:1829-34. [DOI: 10.1016/j.ejrad.2015.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 05/31/2015] [Accepted: 06/03/2015] [Indexed: 12/22/2022]
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Bhatnagar G, Dikaios N, Prezzi D, Vega R, Halligan S, Taylor SA. Changes in dynamic contrast-enhanced pharmacokinetic and diffusion-weighted imaging parameters reflect response to anti-TNF therapy in Crohn's disease. Br J Radiol 2015; 88:20150547. [PMID: 26402217 DOI: 10.1259/bjr.20150547] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To investigate the effect of tumour necrosis factor (TNF)-α antagonists on MRI dynamic contrast-enhanced (DCE) and diffusion-weighted imaging (DWI) parameters in Crohn's disease (CD). METHODS 42 patients with CD (median age 24 years; 22 females) commencing anti-TNF-α therapy with baseline and follow-up (median 51 weeks) 1.5-T MR enterography (MRE) were retrospectively identified. MRE included DCE (n = 20) and/or multi-b-value DWI (n = 17). Slope of enhancement (SoE), maximum enhancement (ME), area under the time-intensity curve (AUC), Ktrans (transfer constant), ve (fractional volume of the extravascular-extracellular space), apparent diffusion coefficient (ADC) and ADCfast/slow were derived from the most inflamed bowel segments. A physician global assessment of disease activity (remission, mild, moderate and severe) at the time of MRE was assigned, and the cohort was divided into responders and non-responders. Data were compared using Mann-Whitney U test and analysis of variance. RESULTS Follow-up Ktrans, ME, SoE, AUC and ADCME changed significantly in clinical responders but not in non-responders, baseline {[median [interquartile range (IQR)]: 0.42 (0.38), 1.24 (0.52), 0.18 (0.17), 17.68 (4.70) and 1.56 mm(2) s(-1) (0.39 mm(2) s(-1)) vs follow-up [median (IQR): 0.15 (0.22), 0.50 (0.54), 0.07 (0.1), 14.73 (2.06) and 2.14 mm(2) s(-1) (0.62 mm(2) s(-1)), for responders, respectively, p = 0.006 to p = 0.037}. SoE was higher and ME and AUC lower for patients in remission than for those with severe activity [mean (standard deviation): 0.55 (0.46), 0.49 (0.28), 14.32 (1.32)] vs [0.32 (0.37), 2.21 (2.43) and 23.05 (13.66), respectively p = 0.017 to 0.033]. ADC was significantly higher for patients in remission [2.34 mm(2) s(-1) (0.67 mm(2) s(-1))] than for those with moderate [1.59 mm(2) s(-1) (0.26 mm(2) s(-1))] (p = 0.005) and severe disease [1.63 mm(2) s(-1) (0.21 mm(2) s(-1))] (p = 0.038). CONCLUSION DCE and DWI parameters change significantly in responders to TNF-α antagonists and are significantly different according to clinically defined disease activity status. ADVANCES IN KNOWLEDGE DCE and DWI parameters change significantly in responders to TNF-α antagonists in CD, suggesting an effect on bowel wall vascularity.
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Affiliation(s)
| | - Nikolaos Dikaios
- 1 Centre for Medical Imaging, University College London, London, UK
| | - Davide Prezzi
- 1 Centre for Medical Imaging, University College London, London, UK.,2 Department of Cancer Imaging, King's College London, UCL CMI, London, UK
| | - Roser Vega
- 3 Gastroenterology Department, University College London Hospitals, UCLH, London, UK
| | - Steve Halligan
- 1 Centre for Medical Imaging, University College London, London, UK
| | - Stuart A Taylor
- 1 Centre for Medical Imaging, University College London, London, UK
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Quaia E, Sozzi M, Gennari AG, Pontello M, Angileri R, Cova MA. Impact of gadolinium-based contrast agent in the assessment of Crohn's disease activity: Is contrast agent injection necessary? J Magn Reson Imaging 2015; 43:688-97. [DOI: 10.1002/jmri.25024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/22/2015] [Indexed: 12/15/2022] Open
Affiliation(s)
- Emilio Quaia
- Department of Radiology; Cattinara Hospital, University of Trieste; Trieste Italy
| | - Michele Sozzi
- Department of Gastroenterology; Cattinara Hospital; Trieste Italy
| | | | - Michele Pontello
- Department of Radiology; Cattinara Hospital, University of Trieste; Trieste Italy
| | - Roberta Angileri
- Department of Radiology; Cattinara Hospital, University of Trieste; Trieste Italy
| | - Maria Assunta Cova
- Department of Radiology; Cattinara Hospital, University of Trieste; Trieste Italy
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Mollard BJ, Smith EA, Dillman JR. Pediatric MR enterography: technique and approach to interpretation-how we do it. Radiology 2015; 274:29-43. [PMID: 25531478 DOI: 10.1148/radiol.14122449] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Magnetic resonance (MR) enterography is an increasingly important pediatric imaging modality that is most often used to evaluate inflammatory bowel disease ( IBD inflammatory bowel disease ), while sparing children and adolescents from potential risks of ionizing radiation exposure. MR enterography allows for evaluation of the bowel lumen and wall, adjacent mesentery and soft tissues, as well as a variety of extraintestinal abdominopelvic IBD inflammatory bowel disease manifestations. While MR enterography can be used to initially confirm the diagnosis of IBD inflammatory bowel disease , particularly small bowel Crohn disease, it has also proven useful in assessing the degree inflammatory activity over time, serving as a radiologic biomarker for response to medical therapy, and identifying a variety of disease-related complications, including strictures, fistulae, and abscesses. The purpose of this review article is to provide radiologists with a systematic approach for MR enterography review and interpretation in children and adolescents with known or suspected of having IBD inflammatory bowel disease and to illustrate both common and infrequent but important imaging findings. Additionally, the authors will present their well-established and clinically successful pediatric MR enterography protocol, up-to-date clinical indications for MR enterography, and briefly mention the role of MR enterography in assessing non- IBD inflammatory bowel disease abnormalities affecting the bowel. Online supplemental material is available for this article .
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Affiliation(s)
- Brett J Mollard
- From the Department of Radiology (B.J.M., E.A.S., J.R.D.), Section of Pediatric Radiology (E.A.S., J.R.D.), University of Michigan Health System, C.S. Mott Children's Hospital, 1540 E. Hospital Dr., SPC 4252, Ann Arbor, MI 48109-4252
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Quon JS, Quon PR, Lim CS, Abdeen N, Schieda N. Magnetic resonance enterography in post-operative inflammatory bowel disease. ACTA ACUST UNITED AC 2015; 40:1034-49. [PMID: 25776203 DOI: 10.1007/s00261-015-0392-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To describe the role of magnetic resonance enterography (MRE) in patients with inflammatory bowel disease (IBD), and to review the expected post-operative appearance, as well as, potential surgical complications in this unique patient population. CONCLUSION MRE compares favorably to CT Enterography (CTE) in terms of overall diagnostic accuracy and may provide better functional assessment of the small bowel through cine-MRI, diffusion-weighted imaging and dynamic contrast-enhancement. In the post-operative population, MRE provides critical information including: normal post-surgical anatomy, chronic strictures vs. active inflammation and disease/treatment-related complications. The post-operative IBD patient undergoes frequent repeated imaging and MRE may significantly reduce cumulative radiation dose while providing similar or improved diagnostic accuracy compared to CTE. MRE should be considered as an alternative imaging modality in this population.
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Affiliation(s)
- Jeffrey S Quon
- Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada,
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Church PC, Turner D, Feldman BM, Walters TD, Greer ML, Amitai MM, Griffiths AM. Systematic review with meta-analysis: magnetic resonance enterography signs for the detection of inflammation and intestinal damage in Crohn's disease. Aliment Pharmacol Ther 2015; 41:153-66. [PMID: 25403954 DOI: 10.1111/apt.13024] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 09/24/2014] [Accepted: 10/22/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND In the treatment of Crohn's disease (CD), mucosal healing has become a major goal, with the hope of avoiding intestinal damage from chronic inflammation. Magnetic resonance enterography (MRE) has emerged as a non-invasive means of monitoring inflammation and damage. AIMS As part of the development of MRE-based multi-item measures of inflammation and damage for paediatric studies, we carried out a systematic review and meta-analysis to identify MRE variables used to describe these two distinct concepts. METHODS 2501 studies of MRI and CD were identified. Studies written in any language reporting individual MRE signs for patients diagnosed with CD were included. Two-hundred-and-forty-four studies were fully reviewed and 62 were included (inflammation, n = 51; damage, n = 24). Sensitivity, specificity and associated confidence intervals were calculated, and hierarchical summary ROC curves were constructed for each MRE sign. RESULTS A total of 22 MRE signs were used to reflect inflammation, and 9 to reflect damage. Diagnostic accuracy of MRE signs of inflammation and damage was heterogeneous; however, wall enhancement, mucosal lesions and wall T2 hyperintensity were the most consistently useful for inflammation (most sensitivities >80% and specificities >90%), and detection of abscess and fistula were most consistently useful for damage (most sensitivities >90%, specificities >95%). CONCLUSIONS Identifying the best MRE variables to reflect inflammation and damage will maximise the utility of this rapidly emerging technique and is the first stage of constructing MRE-based indices for evaluating inflammation and intestinal damage.
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Affiliation(s)
- P C Church
- Division of Gastroenterology, Hepatology & Nutrition, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Guglielmo FF, Mitchell DG, O’Kane PL, Deshmukh SP, Roth CG, Burach I, Burns A, Dulka S, Parker L. Erratum to: Identifying decreased peristalsis of abnormal small bowel segments in Crohn’s disease using cine MR enterography: the frozen bowel sign. ACTA ACUST UNITED AC 2014; 40:1138-49. [PMID: 25445157 DOI: 10.1007/s00261-014-0293-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Magnetic resonance enterography for assessment of intestinal graft-versus-host disease after allogeneic stem cell transplantation. Eur Radiol 2014; 25:1229-37. [DOI: 10.1007/s00330-014-3503-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 11/10/2014] [Accepted: 11/13/2014] [Indexed: 10/24/2022]
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Fallis SA, Murphy P, Sinha R, Hawker P, Gladman L, Busby K, Sanders S. Magnetic resonance enterography in Crohn's disease: a comparison with the findings at surgery. Colorectal Dis 2014; 15:1273-80. [PMID: 23869486 DOI: 10.1111/codi.12361] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 04/11/2013] [Indexed: 02/08/2023]
Abstract
AIM Magnetic resonance (MR) enterography is a radiation-free small bowel investigation which identifies luminal and extra-luminal pathology in patients with Crohn's disease. Most studies have validated MR against conventional radiology. We evaluated the results of MR enterography by comparison with findings at elective surgery for patients with Crohn's disease, including complex pathology. METHOD Between January 2007 and March 2012 the results of preoperative MR enterography for Crohn's disease in consecutive patients in one unit were compared with the detailed findings at surgery. RESULTS Fifty-one patients underwent 55 laparotomies during the study period. MR enterography identified the presence of Crohn's disease in the distal ileum in 33/34 patients, in the proximal ileum in 7/12 patients, in the jejunum in 7/8 patients, in the large bowel in 10/11 patients and in the duodenum in one of two patients. MR enterography identified ileo-enteric fistula in 10/12 patients, ileosigmoid fistula in all of seven patients and other fistulae in 10/11 patients. An abscess was identified on MR enterography in eight of nine patients. Within abnormal distal ileal segments, the mean contrast enhancement ratio of acute inflammation was 2.39 ± 0.59 compared with 1.82 ± 0.63 (P < 0.05) in segments with fibrosis only. CONCLUSION Magnetic resonance enterography identifies small bowel Crohn's disease with an accuracy similar to or better than those of previously published series. Fistulation, abscess formation and large bowel disease can be reliably identified and disease activity assessed. Normal, uninvolved small bowel length can also be measured. Discrete proximal small bowel lesions may not always be detected. In our practice, MR enterography has replaced conventional radiology in the assessment of symptomatic patients with Crohn's disease.
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Affiliation(s)
- S A Fallis
- Warwick GI Unit, Department of Surgery, South Warwickshire NHS Foundation Trust, Warwick, UK
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Accuracy of abdominal ultrasound and MRI for detection of Crohn disease and ulcerative colitis in children. Pediatr Radiol 2014; 44:1370-8. [PMID: 24903659 DOI: 10.1007/s00247-014-3010-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 03/09/2014] [Accepted: 04/21/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Endoscopy is currently the primary diagnostic technique for inflammatory bowel disease (IBD) in children. OBJECTIVE To assess the accuracy of US and dynamic contrast-enhanced MRI for diagnosing inflammatory bowel disease and for distinguishing Crohn disease and ulcerative colitis in comparison to a reference standard. MATERIALS AND METHODS Consecutive children with suspected IBD underwent diagnostic workup including ileocolonoscopy and upper gastrointestinal endoscopy as the reference standard, abdominal US, and MR enterography and colonography at 3 T. The protocol included a dynamic contrast-enhanced 3-D sequence. Sensitivity, specificity and kappa values were calculated for one ultrasonographer and two MRI observers. RESULTS We included 28 children (15 boys) with mean age 14 years (range 10-17 years). The diagnosis was IBD in 23 children (72%), including 12 with Crohn disease, 10 with ulcerative colitis and 1 with indeterminate colitis. For the diagnosis of inflammatory bowel disease the sensitivity was 55% for US and 57% (both observers) for MR entero- and colonography, and the specificity was 100% for US and 100% (observer 1) and 75% (observer 2) for MR entero- and colonography. Combined MRI and US had sensitivity and specificity of 70% and 100% (observer 1) and 74% and 80% (observer 2), respectively. With the addition of a dynamic contrast-enhanced MR sequence, the sensitivity increased to 83% and 87%. US and MRI could only distinguish between Crohn disease and ulcerative colitis when terminal ileum lesions were present. CONCLUSION US and MR entero- and colonography have a high accuracy for diagnosing inflammatory bowel disease in children but cannot be used to distinguish Crohn disease and ulcerative colitis.
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Quaia E, Cabibbo B, Sozzi M, Gennari AG, Pontello M, Degrassi F, Cova MA. Biochemical markers and MR imaging findings as predictors of crohn disease activity in patients scanned by contrast-enhanced MR enterography. Acad Radiol 2014; 21:1225-32. [PMID: 24998692 DOI: 10.1016/j.acra.2014.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/14/2014] [Accepted: 05/09/2014] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVES To define the best independent predictors for active inflammation in patients with Crohn disease (CD) examined by contrast-enhanced magnetic resonance (MR) enterography. MATERIALS AND METHODS Ninety-one patients (47 men and 44 women; aged 39.58 ± 17.1 years) with a diagnosis of CD; CD activity index (CDAI) ≥ 150 (n = 19 patients) or <150 (n = 72) underwent MR enterography including T2-weighted half-Fourier acquisition single-shot turbo spin-echo, T2-weighted spectral fat presaturation with inversion recovery, T1-weighted balanced steady-state free precession, and T1-weighted breath-hold resolution isotropic high volume three-dimensional MR imaging sequences before and after administration of gadobenate dimeglumine during arterial (30 seconds), portal venous (70 seconds), and delayed phase (3 and 5 minutes from contrast injection). Two readers analyzed the MR images in consensus. Reference standard was the Crohn's Disease Endoscopic Index of Severity (CDEIS) with deep mucosal biopsy or the histologic analysis of the surgical specimen in those patients (n = 30) who underwent elective small-bowel resection. Univariate and multivariate logistic regression analyses were performed to assess CDAI, biochemical markers (C-reactive protein and fecal calprotectin levels) and MR imaging findings as potential predictors of inflammatory CD activity. RESULTS Patients revealed prevalently active (n = 47 patients) or quiescent CD with mural fibrosis (n = 44 patients). The bowel wall T2 hyperintensity (odds ratio [OR], 9.20; 95% confidence interval [CI], 2.71-31.19) and total length of disease (OR, 1.29; 95% CI, 1.11-1.49) were found as the best independent predictors of active CD. CDAI, C-reactive protein, and fecal calprotectin were not found independent predictors of active CD. CONCLUSIONS The bowel wall T2 hyperintensity and the length of the involved bowel tract were predictors of active inflammation in patients with CD examined by contrast-enhanced MR enterography.
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Lymphoid Nodular Hyperplasia of the Terminal Ileum Can Mimic Active Crohn Disease on MR Enterography. AJR Am J Roentgenol 2014; 203:W400-7. [DOI: 10.2214/ajr.13.12055] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
BACKGROUND Endoscopy and imaging objectively assess Crohn's disease (CD) activity. Magnetic resonance enterography (MRE) uses no ionizing radiation, carries no significant morbidity, and is highly sensitive in revealing soft tissues inflammation. Diffusion-weighted imaging can distinguish intestinal inflammation from a lower diffusion of water molecules giving rise to a reduced apparent diffusion coefficient. The magnetic resonance index of activity score and, more recently, the Clermont score were recently developed for staging CD activity. The aim of this study was to compare the MRE scores and the Simple Endoscopic Score for CD in identifying ileal CD activity. METHODS Fifty-five patients with ileal and ileocolonic CD were consecutively enrolled between June 2012 and June 2013. All patients underwent clinical examination, biochemical tests, MRE, and colonoscopy to assess disease activity. RESULTS MRE assessed active ileal disease in 31 patients (56.3%). The Clermont score significantly correlated with the magnetic resonance index of activity score (r = 0.91; P < 0.0001) and the Simple Endoscopic Score for CD (r = 0.76; P < 0.0001). The apparent diffusion coefficient correlated with the Simple Endoscopic Score for CD (r = -0.63; P < 0.0001) especially in unoperated patients. CONCLUSIONS The Clermont score and the apparent diffusion coefficient value can stage ileal CD, avoiding the need to use contrast agents.
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Abstract
Functional imaging techniques enable physiological information to be derived, which, combined with high-resolution anatomical imaging, has the potential to improve the management of patients with intestinal disease. Two of the common pathologies where imaging has a substantial role in depicting disease extent, in staging disease, and assessing therapeutic response and/or disease relapse are cancer and inflammatory bowel disease. In these scenarios, functional imaging may augment assessment of disease activity, therapeutic response/non-response, as well as disease relapse by indicating physiological changes as a result of tumor, inflammation, or fibrosis.
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Diagnostic imaging in Crohn's disease: what is the new gold standard? Best Pract Res Clin Gastroenterol 2014; 28:421-36. [PMID: 24913382 DOI: 10.1016/j.bpg.2014.04.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/06/2014] [Accepted: 04/13/2014] [Indexed: 01/31/2023]
Abstract
Historically Barium and isotope studies been used for imaging of inflammatory bowel disease (IBD) but carry risk of radiation exposure. Use of Barium is declining resulting in fewer radiologists that have the necessary expertise. Isotopes studies lack anatomical definition but 18F - fludeoxyglucose (FDG) positron emission tomography (PET) shows promise in accurate assessment of disease compared to endoscopy. Computerised tomography (CT) is particularly useful in assessment of complications of Crohn's disease (CD) but radiation exposure is high. CT enterography (CTE) has improved visualisation of small bowel mucosal disease and allows assessment of disease activity. Ultrasound is increasingly used for preliminary assessment of patients with potential IBD. Although widely available and economically attractive, the expertise required is not widespread. Finally magnetic resonance imaging (MRI) is proving to be the most accurate tool for assessment of disease extent and distribution. MRI of the pelvis has superseded other techniques in assessment of peri-anal fistulation.
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Jackson A, Li KL, Zhu X. Semi-quantitative parameter analysis of DCE-MRI revisited: monte-carlo simulation, clinical comparisons, and clinical validation of measurement errors in patients with type 2 neurofibromatosis. PLoS One 2014; 9:e90300. [PMID: 24594707 PMCID: PMC3942428 DOI: 10.1371/journal.pone.0090300] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 02/03/2014] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To compare semi-quantitative (SQ) and pharmacokinetic (PK) parameters for analysis of dynamic contrast enhanced MR data (DCE-MRI) and investigate error-propagation in SQ parameters. METHODS Clinical data was collected from five patients with type 2-neurofibromatosis (NF2) receiving anti-angiogenic therapy for rapidly growing vestibular schwannoma (VS). There were 7 VS and 5 meningiomas. Patients were scanned prior to therapy and at days 3 and 90 of treatment. Data was collected using a dual injection technique to permit direct comparison of SQ and PK parameters. Monte Carlo modeling was performed to assess potential measurement errors in SQ parameters in persistent, washout, and weakly enhancing tissues. The simulation predictions for five semi-quantitative parameters were tested using the clinical DCE-MRI data. RESULTS In VS, SQ parameters and Ktrans showed close correlation and demonstrated similar therapy induced reductions. In meningioma, only the denoised Signal Enhancement Ratio (Rse1/se2(DN)) showed a significant therapy induced reduction (p<0.05). Simulation demonstrated: 1) Precision of SQ metrics normalized to the pre-contrast-baseline values (MSErel and ∑MSErel) is improved by use of an averaged value from multiple baseline scans; 2) signal enhancement ratio Rmse1/mse2 shows considerable susceptibility to noise; 3) removal of outlier values to produce a new parameter, Rmse1/mse2(DN), improves precision and sensitivity to therapy induced changes. Direct comparison of in-vivo analysis with Monte Carlo simulation supported the simulation predicted error distributions of semi-quantitative metrics. CONCLUSION PK and SQ parameters showed similar sensitivity to anti-angiogenic therapy induced changes in VS. Modeling studies confirmed the benefits of averaging baseline signal from multiple images for normalized SQ metrics and demonstrated poor noise tolerance in the widely used signal enhancement ratio, which is corrected by removal of outlier values.
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Affiliation(s)
- Alan Jackson
- Wolfson Molecular Imaging Centre, The University of Manchester, Manchester, United Kingdom
| | - Ka-Loh Li
- Wolfson Molecular Imaging Centre, The University of Manchester, Manchester, United Kingdom
| | - Xiaoping Zhu
- Wolfson Molecular Imaging Centre, The University of Manchester, Manchester, United Kingdom
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Abstract
PURPOSE OF REVIEW Radiologic investigations continue to play a pivotal role in the diagnosis of pathologic conditions of the small intestine despite enhancement of capsule endoscopy and double-balloon endoscopy. Imaging techniques continue to evolve and new techniques in MRI in particular, are being developed. RECENT FINDINGS Continued advances in computed tomography (CT) and MRI techniques have reinforced the importance of these imaging modalities in small bowel assessment. The more invasive enteroclysis technique yields better small bowel distension for both CT and MRI when compared with peroral enterography, but no clinically significant difference is seen in terms of diagnostic accuracy. Recent concern regarding radiation exposure means that MRI is gaining in popularity. Fluoroscopic studies such as barium follow through and small bowel enteroclysis are being replaced by the cross-sectional alternatives. Contrast-enhanced ultrasound is showing results comparable with CT and MRI, but concern remains regarding reproducibility, especially outside centres that specialize in advanced sonographic techniques. SUMMARY CT and MRI enterography are comparable first-line modalities for patients with suspected small bowel disease, but magnetic resonance enterography is favoured given the absence of ionizing radiation. Capsule endoscopy is a reasonable alternative investigation in exploration of chronic gastrointestinal blood loss, but is best kept as a second-line test in patients with other symptoms.
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Spinelli A, Fiorino G, Bazzi P, Sacchi M, Bonifacio C, De Bastiani S, Malesci A, Balzarini L, Peyrin-Biroulet L, Montorsi M, Danese S. Preoperative magnetic resonance enterography in predicting findings and optimizing surgical approach in Crohn's disease. J Gastrointest Surg 2014; 18:83-90; discussion 90-1. [PMID: 24254837 DOI: 10.1007/s11605-013-2404-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 10/22/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many Crohn's disease patients require surgery. Intraoperative detection of new lesions may lead to change in planned surgery. This study aimed to determine whether magnetic resonance enterography can optimize surgical planning and guide decision making in Crohn's disease. METHODS Seventy-five patients with complicated Crohn's disease were enrolled and underwent preoperative magnetic resonance enterography. Analysis included imaging accuracy and change in surgical strategy due to discordance with imaging findings. RESULTS Surgery was performed laparoscopically in 39/75 patients (52 %), with conversion to open surgery required in six (15 %). Concordance between observers was excellent (kappa value >0.8). Magnetic resonance enterography accuracy for stenosis, abscess, and fistula were all above 85 % in per-patient analysis. In 68/75 cases (90.7 %) surgery was correctly predicted. Conversely, in 7/75 cases (three false-positives and four false-negatives) surgical strategy (type of resection or strictureplasty, n = 5) and/or surgical approach (conversion from laparoscopy to open surgery, n = 2) changed due to discordance with magnetic resonance enterography findings. CONCLUSION Surgical strategy and approach are correctly predicted by magnetic resonance enterography in the majority of patients with complicated Crohn's disease.
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Affiliation(s)
- Antonino Spinelli
- Department of Surgery-IBD Surgery Unit, Humanitas Clinical and Research Center, via Manzoni 56, Rozzano (MI), 20089, Italy,
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Current and future role of MR enterography in the management of Crohn disease. AJR Am J Roentgenol 2013; 201:56-64. [PMID: 23789658 DOI: 10.2214/ajr.12.10406] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of this article is to explore the future role of MRI in assessing the global disease burden of Crohn disease and monitoring treatment response. CONCLUSION MR enterography is increasingly used to evaluate disease activity in Crohn disease, and scoring methods have been validated. Current MRI protocols may be extended to allow the assessment of inflammation and fibrosis.
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Tielbeek JAW, Ziech MLW, Li Z, Lavini C, Bipat S, Bemelman WA, Roelofs JJTH, Ponsioen CY, Vos FM, Stoker J. Evaluation of conventional, dynamic contrast enhanced and diffusion weighted MRI for quantitative Crohn's disease assessment with histopathology of surgical specimens. Eur Radiol 2013; 24:619-29. [PMID: 24037299 DOI: 10.1007/s00330-013-3015-7] [Citation(s) in RCA: 158] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 08/25/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To prospectively compare conventional MRI sequences, dynamic contrast enhanced (DCE) MRI and diffusion weighted imaging (DWI) with histopathology of surgical specimens in Crohn's disease. METHODS 3-T MR enterography was performed in consecutive Crohn's disease patients scheduled for surgery within 4 weeks. One to four sections of interest per patient were chosen for analysis. Evaluated parameters included mural thickness, T1 ratio, T2 ratio; on DCE-MRI maximum enhancement (ME), initial slope of increase (ISI), time-to-peak (TTP); and on DWI apparent diffusion coefficient (ADC). These were compared with location-matched histopathological grading of inflammation (AIS) and fibrosis (FS) using Spearman correlation, Kruskal-Wallis and Chi-squared tests. RESULTS Twenty patients (mean age 38 years, 12 female) were included and 50 sections (35 terminal ileum, 11 ascending colon, 2 transverse colon, 2 descending colon) were matched to AIS and FS. Mural thickness, T1 ratio, T2 ratio, ME and ISI correlated significantly with AIS, with moderate correlation (r = 0.634, 0.392, 0.485, 0.509, 0.525, respectively; all P < 0.05). Mural thickness, T1 ratio, T2 ratio, ME, ISI and ADC correlated significantly with FS (all P < 0.05). CONCLUSIONS Quantitative parameters from conventional, DCE-MRI and DWI sequences correlate with histopathological scores of surgical specimens. DCE-MRI and DWI parameters provide additional information. KEY POINTS • Conventional MR enterography can be used to assess Crohn's disease activity. • Several MRI parameters correlate with inflammation and fibrosis scores from histopathology. • Dynamic contrast enhanced imaging and diffusion weighted imaging give additional information. • Quantitative MRI parameters can be used as biomarkers to evaluate Crohn's disease activity.
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Affiliation(s)
- Jeroen A W Tielbeek
- Academic Medical Center, Department of Radiology, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands,
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