Detection of Crohn ’s disease with diffusion images versus contrast-enhanced images in pediatric using MR enterography with histopathological correlation

AbstractThe purpose of this study was to determine whether MRE performed with diffusion-weighted imaging (DWI) sequences is comparable to contrast-enhanced MRE in the detection of active small-bowel inflammation in pediatric patients with Crohn ’s disease (CD). We included in our study 68 patients with diagnosis of CD between April 2015 and June 2018 that underwent MRE examination. Examination protocol includes coronal and axial FISP, T2-w half-Fourier RARE and DWI sequences, a baseline coronal T1-w fat-saturated ultrafast (GRE) sequence followed by contrast 3D T1-w GRE. All images were assessed by two radiologists who graded each of bowel segments for the presence of inflammation on a four-point confidence scale on the basis of wall thickening and wall signal on DWI and ADC maps and comparing their results with post-contrast image s. When considering all bowel segments, we found 41 true positive and 25 true negative on DWI. One false positive case corresponded to the absence of inflammatory histopathology changes at the level of the terminal ileum in a 15-year-old male, and one false negative case was in a 10-year-old female with only jejunal lesion. The corresponding sensitivity, specificity, PPV, NPV and accuracy were 97.6% (95% CI 67.7–99.7), 96.1% (95% CI 66.7–98.5), 97.6% (95% CI 70.8–98.4), 96.1% (95% CI 64.2–90.6) and 97% (95% CI 84.2–97.5), respectively. Analyzing the gadolinium-enhanced set, 35 true p ositive and 25 true negative results were found. One ...
Source: La Radiologia Medica - Category: Radiology Source Type: research