Diffusion-weighted imaging and apparent diffusion coefficient values for evaluating terminal ileitis in patients with Crohn’s disease

Abstract

Objective: To determine the accuracy of diffusion-weighted imaging (DWI) in identifying terminal ileitis in patients with Crohn’s disease. Materials and Methods: This was a retrospective study of 38 consecutive patients with Crohn’s disease who underwent magnetic resonance enterography with DWI in a 3.0 T scanner. The patients were divided into two groups, on the basis of colonoscopy and biopsy findings: active inflammation; and inactive disease. Apparent diffusion coefficient (ADC) values were determined, as were the magnetic resonance index of activity (MaRIA) and the Clermont score. Results: Of the 38 patients evaluated, 18 (47%) had active inflammation. The patients with active inflammation showed greater restricted diffusion, more pronounced mucosal edema, greater wall thickening, a higher MaRIA, and a higher Clermont score than did those with inactive disease. The level of interobserver agreement (intraclass correlation coefficient) was excellent for the MaRIA and the Clermont score, whereas it was substantial for the ADC values. For identifying colonoscopy-proven inflammation, the best ADC cut-off point was 2.1 × 10−3 mm2/s, which had a sensitivity of 88.8% and a specificity of 95.0%, whereas DWI presented an overall accuracy of 89.4%, with a sensitivity of 88.9% and a specificity of 90.0%. Conclusion: Visual analysis of the DWI sequence has good accuracy in detecting terminal ileitis in patients with Crohn’s disease. In addition, low ADC values have good sensitivity for detecting colonoscopy-proven inflammation.

Evaluating inflammatory activity in Crohn’s disease by cross-sectional imaging techniques

“…One recent study evaluated the use of diffusionweighted imaging in predicting the inflammatory activity of Crohn's disease in the distal ileum, showing that it presents good accuracy in the detection of an inflammatory process, in comparison with the identification of inflammation by colonoscopy, with a sensitivity and specificity of 88.8% and 95.0%, respectively, when a cut-off point of 2.1 × 10 −3 mm 2 /s for the ADC is applied (34) . Other studies have shown that diffusion-weighted imaging has the potential to substantially increase interobserver reproducibility in the evaluation of patients with Crohn's disease (35) , making it a useful tool in the monitoring of treatment responses in such patients (36,37) , as well as a good predictor of capsule retention during capsule endoscopy (38) .…”

Role of abbreviated non-contrast-enhanced MR-enterography in the evaluation of Crohn's disease activity and complications as an alternative for full protocol contrast-enhanced study: A systematic review and meta-analysis

“…SR has better sensitivity. Durayski, 2019 [44] DWI and ADC histopathology terminal ileum active inflammation adult ADC: 88.8% Sens, 95% Spec DWI: 88.9%, 90% Spec ADC and DWI can accurately identify active inflammation in CD. Soydan, 2019 [68] combined DWI and T2w (SSFE, FIESTA), ADC ileocolonoscopy ileum and colon active inflammation adult ADC: 88.5% Sens, 57.1% Spec, 72.9% AUC DWI + T2 score: 88.4% Sens, 53.5 Spec.…”

“…However, there is significant disagreement between studies regarding the optimal threshold value for ADC. The optimal ADC threshold for the maximum AUC ranged from 0.86 in one study [42] to as high as 2.1 in another study [44] . Nevertheless, the majority of studies included in our analysis proposed a threshold value of approximately 1.4, as summarized in Table 2 .…”

The Use of Diffusion Weighted Imaging and Intravoxel Incoherent Motion to Assess Edema and Perfusion in Abdominal Organs during Endotoxemia

“…Previously, only one study reported (again Lu et al) an ADC value of 1.6 on average in nonpathological intestine samples [34]. Two other studies, instead, reported values oscillating from 2 to 3 in healthy tissue [36,37]. An ADC lower than 2 was associated with inflammation in these studies and used as a cut-off to appraise inflammatory lesions.…”