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Diffusion-weighted magnetic resonance offers reliable CD inflammation gauge without gadolinium
Physicians can successfully assess patient inflammation in colonic and ileal Crohn’s disease without gadolinium injection by using diffusion-weighted magnetic resonance imaging, a study determined.
“DWI-MREC [diffusion-weighted imaging magnetic resonance enterocolonography] is a well-tolerated, non-time-consuming, accurate and reproducible tool for detecting and assessing [inflammation],” the researchers wrote.
The single-center, observational, prospective study evaluated 848 segments (352 small bowel and 496 colon/rectum) from 130 Crohn’s disease (CD) patients who underwent MREC with gadolinium injection and DWI sequences consecutively between July 2011 and December 2012.
Sixty-four colon/rectum and 111 small bowel segments were active as defined by magnetic resonance index of activity (MaRIA)≥7 (n=175, 20.6%). Using DWI sequences, 172 segments were considered active.
Sensitivity was 93.7% overall, 91.9% in the small bowel and 96.9% in the large bowel. Specificity was 98.7% overall, 97.9% in the small bowel and 99.1% in the large bowel. And accuracy was 97.6% overall, 96% in the small bowel and 98.8% in the large bowel.
Researchers then used a ROC curve to determine an apparent diffusion coefficient (ADC) threshold that demonstrated sensitivities of 96.9% and 85.9% and specificities of 98.1% and 81.6% in differentiating active and nonactive CD for the colon/rectum and ileum, respectively.
The ADC also was found to correlate more closely with MaRIA ≥7 than contrast enhancement using injected sequences (P<.001). Clermont score also was highly correlated with MaRIA among patients with ileal CD but not those with colonic CD.
“ADC is able to accurately differentiate active from nonactive colonic CD but requires external validation in an independent cohort,” the researchers concluded. “The Clermont score completing internal and external validation is a reliable tool in assessing inflammation in ileal CD. It could be of particular interest in clinical trials dedicated to CD involving terminal ileum. DWI-MREC should be more widely used in CD assessment and would avoid gadolinium injection in daily practice.”
Disclosure: The researchers report no relevant financial disclosures.