Diffusion‐weighted MRI: Role in detecting abdominopelvic internal fistulas and sinus tracts

Abstract

Purpose: To retrospectively determine the incremental value of diffusion-weighted MR-imaging (DW-MRI) to T2-weighted (T2w) images in diagnosis of internal fistulas (IFs) and sinus tracts (STs). Materials and Methods:Fourteen patients with 25 IFs and STs arising from the small bowel (20), colon (4) and biliary tract (1) were included. Two independent observers reviewed T2w images, T2wþDW-MRI images and T2wþcontrast enhanced T1-weighted (CE T1w) images at three sessions to detect IF/ST based on a confidence scale of five. Sensitivity and confidence score of each session was compared.Results: 10/25 (40%) and 9/25 (36%) IFs and STs were detected on T2w images by observer 1 and 2, respectively. Both observers detected 19/25 (76%) and 24/25(96%) IFs and STs on T2wþDW-MRI and T2wþCE T1w images, respectively. Detection rate and confidence score improved significantly by combining T2w images with DW-MRI or CE T1w images (reader 1 þ 2: P 0.01). There was no significant difference between the IF/ST detection rate of T2wþDW-MRI and T2wþCE T1 image combinations. Confidence scores with T2wþCE T1w images were significantly greater than DW-MRIþT2w images (reader 1:P ¼ 0.01; reader 2: P ¼ 0.03).Conclusion: DW-MRI showed additional value to T2w imaging for diagnosis of IF and ST. DW-MRI can be a useful adjunct, especially for patients with renal failure.

Comparison of contrast-enhanced and diffusion-weighted MRI in assessment of the terminal ileum in Crohn’s disease patients

“…Our results are similar to that of a previous study by Seo et al, which found no significant difference in terms of correlation to CDEIS between CE-MRI (r = 0.71) and DW-MRI (r = 0.61), although a similar discrepancy for detection of penetrating complications was reported in favor of CE-MRI [11]. In two studies by Schmid-Tannwald et al, CE-MRI showed no significant differences to DW-MRI for sensitivity for the diagnosis of active inflammation (0.80 vs. 0.67) and detection of fistulas and sinus tracts (0.96 vs. 0.76) [12,26]. Although these studies, and our own, found no significant differences between CE-MRI and DW-MRI, the consistency of numerical differences in favor of CE-MRI raises concern whether these are not based on random variance and might indicate a clinically relevant difference in diagnosis and grading.…”

“…A study by Schmid-Tannwald et al included 14 patients with internal fistulas and sinus tracts of different etiologies. They found no significant difference in the detection rate of fistulas and sinus tracts between CE-MRI (96%) and DW-MRI (76%) [12].…”

Use of a Balloon Rectal Catheter in Magnetic Resonance Imaging of Complex Anal Fistula to Improve Detection of Internal Openings

“…11,[14][15][16][17][18][19][20][21][22][23][24][25][26] Although van Beers et al 5 studied the patients with complicated anal fistulas, they did not report the findings of the internal openings. 11,[14][15][16][17][18][19][20][21][22][23][24][25][26] Although van Beers et al 5 studied the patients with complicated anal fistulas, they did not report the findings of the internal openings.…”

Current tecniques and new perpectives research of magnetic resonance enterography in pediatric Crohn’s disease

“…They also reported high interobserver agreement. A recent study [80] involved 31 CD patients with ileal involvement, compared DWI with conventional MRE in estimating inflammation in small bowel CD; DWI hyperintensity was highly correlated with disease activity evaluated using conventional MRE. Koh et al [76] reported that a segmental magnetic resonance score (MR-score-S) based on DWI values and on other MRI parameters, detected endoscopic inflammation with a sensitivity and specificity of 58.33% and 84.48% in CD.…”