Crohn’s disease of the small bowel: evaluation of ileal inflammation by diffusion-weighted MR imaging and correlation with the Harvey-Bradshaw index

Abstract

DWI sequences may be useful in differentiating actively inflamed small bowel segments from normal small bowel in CD. Though partial, the correlation between DWI sequences and HBI confirms the utility of this technique in the study of patients with CD.

Evolving roles of cross-sectional imaging in Crohn's disease

“…This was associated with very good levels of intra-and inter-rater reliability of the technique. Notably, DWI-MR without intravenous contrast did not prove inferior to standard contrast-enhanced MR in evaluating CD-related small-bowel inflammation in a very recent prospective non-inferiority study [18], thus confirming the data deriving from a retrospective series (Table 1) [19]. The recently reported excellent agreement between DWI-MR results and the MaRIA index further supports the usefulness of this technique in the study of CD inflammatory status [20].…”

Diagnostic Performances of Diffusion-Weighted Magnetic Resonance Imaging in the Evaluation of Fibrosis and Post-Operative Endoscopic Recurrence in Crohn’s Disease

“…The acquisition of sequences in apnea and the administration of an anti-peristaltic agent (N-butyl scopolamine) during the investigation contributed to further reduce motion artifacts. The choice of a high value of b (800 s/mm²) has minimized the effect of perfusion in DWI images [12,14,29].…”

“…Several studies, all retrospective, with known or suspected Crohn's disease [11][12][13][14], have deter-mined the role of diffusionweighted sequences and ADC values in identifying intestinal inflammation. These have shown that DWI sequences can distinguish intestinal segments with active inflammation by normal loops and that ADC value of segments with active disease was significantly lower than healthy ileal loops.…”

“…Diffusion weighted images are characterized by high contrast resolution that allow to distinguish disease-active intestinal segments from normal bowel loops [14]; moreover these sequences allow quantitative measurements such as apparent diffusion coefficient (ADC) that can be used to quantify water diffusion in vivo. The basic principle of our study, leading us to examine the usefulness of DWI sequences with ADC calculation in Crohn's disease, is that the presence of the characteristic elements of inflammation implies an increase in interstitial cellularity resulting from the expansion of lymphatic canaliculi.…”

Conventional Radiology in the Evaluation of the Small Bowel

“…The surgical physical examination has been considered the "gold standard" (sensitivity 99.8 %) for the identification of perianal fistulas in CD for years [7]. Actually, MRI has an increasingly important role in the evaluation of disease activity in CD and of complicated CD and is actually considered the gold standard and recommended during the initial diagnosis of perianal CD according to the ECCO guidelines; moreover, compared to endoanal ultrasound it is comparable for the evaluation of perianal fistulas and proved to be superior for discriminating between simple and complex disease compared to clinical assessment and anal endosonography [10,[30][31][32][33][34][35].…”