Diffusion-weighted imaging in quiescent Crohn's disease: correlation with inflammatory biomarkers and video capsule endoscopy
Diffusion-weighted imaging in quiescent Crohn's disease: correlation with inflammatory biomarkers and video capsule endoscopy
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DOI：
10.1016/j.crad.2017.04.006
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发表时间：
2017-09-01
影响因子：
2.6
通讯作者：
Amitai, M. M.
中科院分区：
文献类型：
--
作者：
Klang, E.;Kopylov, U.;Amitai, M. M.
目的：探讨静止克罗恩病（CD）患者弥散受限的作用及其与炎症生物标志物和内窥镜疾病的关系。材料与方法：52例静止性CD患者前瞻性地接受了磁共振肠造影（MRE）和视频胶囊内窥镜（VCE）检查，并检测了炎症生物标志物、粪便钙保护蛋白（FCP）和c反应蛋白（CRP）。两名读者定性（有无）和定量（表观扩散系数[ADC]）评估回肠远端扩散受限情况。计算回肠远端基于vce的Lewis评分。对FCP升高（> 100mg /g）或正常（< 100mg /g）的患者进行VCE溃疡的限制性扩散敏感性和特异性评估。采用受试者工作特征（ROC）曲线评估ADC识别并发VCE溃疡和FCP升高患者的能力。结果：与FCP正常患者（reader 1: 46.2%, 61.5%; reader 2: 15.4%, 76.9%）相比，FCP升高患者对VCE溃疡患者弥散受限的敏感性和特异性更高（reader 1: 71.4%, 80%, reader 2: 76.2%, 100%）。ADC在识别并发VCE溃疡和FCP升高的患者方面具有很高的诊断准确性（阅读器1:AUC = 0.819，阅读器2:AUC = 0.832）。结论：在静止的CD患者中，弥散受限提示活动性炎症，与FCP升高相关。因此，DWI可以作为这些患者随访的临床工具，提示亚临床炎症发作。(C) 2017英国皇家放射学院。Elsevier Ltd.出版。版权所有。
AIM: To investigate the role of restricted diffusion in quiescent Crohn's disease (CD) patients and its association with inflammatory biomarkers and endoscopic disease.MATERIAL AND METHODS: Fifty-two quiescent CD patients prospectively underwent magnetic resonance enterography (MRE) and video capsule endoscopy (VCE) and were tested for the inflammatory biomarkers, faecal calprotectin (FCP) and C-reactive protein (CRP). Restricted diffusion in the distal ileum was qualitatively (absence/presence) and quantitatively (apparent diffusion coefficient [ ADC]) assessed by two readers. The VCE-based Lewis score was calculated for the distal ileum. Restricted diffusion sensitivity and specificity for VCE ulcerations were assessed for patients with elevated (> 100 mg/g) or normal (< 100 mg/g) FCP. Receiver operating characteristic (ROC) curve was used to assess the ability of ADC to identify patients with concurrent VCE ulceration and elevated FCP.RESULTS: The sensitivity and specificity of restricted diffusion for patients with VCE ulceration were higher in patients with elevated FCP (reader 1: 71.4%, 80%, reader 2: 76.2%, 100%, respectively) compared to patients with normal FCP (reader 1: 46.2%, 61.5%; reader 2: 15.4%, 76.9%, respectively). The ADC had a high diagnostic accuracy for identifying patients that had concurrent VCE ulceration and elevated FCP (reader 1: AUC = 0.819, reader 2: AUC = 0.832).CONCLUSION: In quiescent CD patients, the presence of restricted diffusion is suggestive of an active inflammation, associated with elevated FCP. Thus, DWI may serve as a clinical tool in the follow-up of these patients, implying subclinical inflammatory flares. (C) 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.