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

Journal article (2018)

Authors

C. A.J. Puylaert Universiteit van Amsterdam
J. A.W. Tielbeek Universiteit van Amsterdam
Peter J. Schüffler ETH Zürich, Memorial Sloan-Kettering Cancer Center
C. Yung Nio Universiteit van Amsterdam
Karin Horsthuis Vrije Universiteit Amsterdam
Banafsche Mearadji Universiteit van Amsterdam
Cyriel Y. Ponsioen Universiteit van Amsterdam
F.M. Vos ImPhys/Quantitative Imaging , Universiteit van Amsterdam
J. Stoker Universiteit van Amsterdam
Research Group
ImPhys/Quantitative Imaging
Copyright: © 2018 Carl A.J. Puylaert, Jeroen A.W. Tielbeek, Peter J. Schüffler, C. Yung Nio, Karin Horsthuis, Banafsche Mearadji, Cyriel Y. Ponsioen, F.M. Vos, Jaap Stoker
DOI: https://doi.org/10.1007/s00261-018-1734-6
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Published Date

2018

Language

English

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Research Group

ImPhys/Quantitative Imaging

Abstract

Purpose: The purpose of the study was to compare the performance of contrast-enhanced (CE)-MRI and diffusion-weighted imaging (DW)-MRI in grading Crohn’s disease activity of the terminal ileum. Methods: Three readers evaluated CE-MRI, DW-MRI, and their combinations (CE/DW-MRI and DW/CE-MRI, depending on which protocol was used at the start of evaluation). Disease severity grading scores were correlated to the Crohn’s Disease Endoscopic Index of Severity (CDEIS). Diagnostic accuracy, severity grading, and levels of confidence were compared between imaging protocols and interobserver agreement was calculated. Results: Sixty-one patients were included (30 female, median age 36). Diagnostic accuracy for active disease for CE-MRI, DW-MRI, CE/DW-MRI, and DW/CE-MRI ranged between 0.82 and 0.85, 0.75 and 0.83, 0.79 and 0.84, and 0.74 and 0.82, respectively. Severity grading correlation to CDEIS ranged between 0.70 and 0.74, 0.66 and 0.70, 0.69 and 0.75, and 0.67 and 0.74, respectively. For each reader, CE-MRI values were consistently higher than DW-MRI, albeit not significantly. Confidence levels for all readers were significantly higher for CE-MRI compared to DW-MRI (P < 0.001). Further increased confidence was seen when using combined imaging protocols. Conclusions: There was no significant difference of CE-MRI and DW-MRI in determining disease activity, but the higher confidence levels may favor CE-MRI. DW-MRI is a good alternative in cases with relative contraindications for the use of intravenous contrast medium.