Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Diffusion-Weighted MR Enterography to Monitor Bowel Inflammation after Medical Therapy in Crohn's Disease: A Prospective Longitudinal Study

  • Huh, Jimi (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Kyung Jo (Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Park, Seong Ho (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Park, So Hyun (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Yang, Suk-Kyun (Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Ye, Byong Duk (Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Park, Sang Hyoung (Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Han, Kyunghwa (Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Kim, Ah Young (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
  • Received : 2016.04.30
  • Accepted : 2016.08.10
  • Published : 2017.01.01
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Abstract

Objective: To prospectively evaluate the performance of diffusion-weighted imaging (DWI) to monitor bowel inflammation after medical therapy for Crohn's disease (CD). Materials and Methods: Before and following 1-2 years of medical therapy, between October 2012 and May 2015, 18 randomly selected adult CD patients (male:female, 13:5; mean $age{\pm}SD$, $25.8{\pm}7.9years$ at the time of enrollment) prospectively underwent MR enterography (MRE) including DWI ($b=900s/mm^2$) and ileocolonoscopy. Thirty-seven prospectively defined index lesions (one contiguous endoscopy-confirmed inflamed area chosen from each inflamed anatomical bowel segment; 1-4 index lesions per patient; median, 2 lesions) were assessed on pre- and post-treatment MRE and endoscopy. Visual assessment of treatment responses on DWI in 4 categories including complete remission and reduced, unchanged or increased inflammation, and measurements of changes in apparent diffusion coefficient (${\Delta}ADC$), i.e., pre-treatment-post-treatment, were performed by 2 independent readers. Endoscopic findings and CD MRI activity index (CDMI) obtained using conventional MRE served as reference standards. Results: ${\Delta}ADC$ significantly differed between improved (i.e., complete remission and reduced inflammation) and unimproved (i.e., unchanged or increased inflammation) lesions: $mean{\pm}SD$ (${\times}10^{-3}mm^2/s$) of $-0.65{\pm}0.58$ vs. $0.06{\pm}0.15$ for reader 1 (p = 0.022) and $-0.68{\pm}0.56$ vs. $0.10{\pm}0.26$ for reader 2 (p = 0.025). DWI accuracy for diagnosing complete remission or improved inflammation ranged from 76% (28/37) to 84% (31/37). A significant negative correlation was noted between ${\Delta}ADC$ and ${\Delta}CDMI$ for both readers with correlation coefficients of -0.438 and -0.461, respectively (p < 0.05). Conclusion: DWI is potentially a feasible tool to monitor quantitatively and qualitatively bowel inflammation of CD after medical treatment.

Keywords

References

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