Diffusion-weighted magnetic resonance imaging for detecting and assessing ileal inflammation in Crohn's disease
Diffusion-weighted magnetic resonance imaging for detecting and assessing ileal inflammation in Crohn's disease
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DOI：
10.1111/apt.12201
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发表时间：
2013-03-01
影响因子：
7.6
通讯作者：
Petitcolin, V.
中科院分区：
文献类型：
--
作者：
Buisson, A.;Joubert, A.;Petitcolin, V.
背景弥散加权成像(DWI)-MRI在检测和评估回肠克罗恩病（CD）炎症方面是否有价值尚不清楚。目的比较DWI-MR肠造影（MRE）与常规MRE对小肠CD炎症的评估，确定表观扩散系数（ADC）阈值，以区分活动性和非活动性病变，并评估观察者间的一致性。方法对2011年4 - 6月在克莱蒙费朗IBD病房就诊的31例累及回肠的CD患者进行连续和前瞻性分析。所有患者均行DWI-MRI检查病变最严重的消化段，然后计算ADC。定性和定量结果与常规MRE进行比较，包括MaRIA（磁共振活动指数）评分计算和独立活动预测指标（壁增厚、水肿、溃疡）。每个检查由两名盲法临床评估的放射科医生独立解释。结果17例（54.8%）患者有活动性CD （MaRIA评分7分）。DWI高强度与常规MRE评估的疾病活动性高度相关（P=0.001）。定性分析DW序列的敏感性为100%，特异性为92.9%，阳性预测值为94.4%，阴性预测值为100%。采用1.6x103 mm2/s的截止值对ADC进行定量分析，灵敏度和特异性分别为82.4%和100%。观察者间对于DWI高强度（=0.69，准确率=85.7%）和ADC(相关性=0.74，P
Background Whether diffusion-weighted imaging (DWI)-MRI is of value in detecting and assessing inflammation of ileal Crohn's disease (CD) remains poorly investigated. Aim To compare DWI-MR enterography (MRE) with conventional MRE in estimating inflammation in small bowel CD, to determine an apparent diffusion coefficient (ADC) threshold to differentiate active from non-active lesions and to assess inter-observer agreement. Methods Thirty-one CD patients from the Clermont-Ferrand IBD unit with ileal involvement were consecutively and prospectively included between April and June 2011. All patients underwent DWI-MRI to detect the digestive segment with the most severe lesions, which was then used to calculate the ADC. Qualitative and quantitative results were compared with conventional MRE including MaRIA (Magnetic Resonance Index of Activity) score calculation and independent activity predictors (wall thickening, oedema, ulcers). Each examination was interpreted independently by two radiologists blinded for clinical assessment. Results Seventeen patients (54.8%) had active CD as defined by the MaRIA score 7. DWI hyperintensity was highly correlated with disease activity evaluated using conventional MRE (P=0.001). Qualitative analysis of DW sequences determined sensitivity, specificity, positive predictive value and negative predictive value as 100%, 92.9%, 94.4% and 100% respectively. Quantitative analysis using a cut-off of 1.6x103 mm2/s for ADC yielded sensitivity and specificity values of, respectively, 82.4% and 100%. Inter-observer agreement was high with regard to DWI hyperintensity (=0.69, accuracy rate=85.7%) and ADC (correlation=0.74, P