Apparent diffusion coefficient (ADC) parameter in detection
of active intestine inflammation in patients with Crohn's
disease
Poster No.:
C-2240
Congress:
ECR 2015
Type:
Scientific Exhibit
Authors:
D. K. Galaska , K. Markiet , A. M. Szyma#ska-Dubowik , B.
1
1
1
2
1 1
2
Tomicka-Szymanska , E. Szurowska ; Gdansk/PL, 80-210/PL
Keywords:
Inflammation, Diagnostic procedure, MR-Diffusion/Perfusion,
Abdomen
DOI:
10.1594/ecr2015/C-2240
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Page 1 of 8
Aims and objectives
Crohn's disease (CD) is a chronic inflammatory disease of unknown origin involving
the entire gastrointestinal tract. CD can affect any part of the gastrointestinal tract from
mouth to anus, it most commonly affects the terminal ileum and the beginning of the
colon. MR imaging has been increasingly used for the diagnosis and follow-up of patients
with inflammatory bowel disease. MRI enterography (MRE) is commonly used to identify
segments of intestine affected by Crohn's disease and activity of the process. MR imaging
is recommended by European Crohn's and Colitis Organisation (ECCO).
CD may be revealed at any age, however i tis most frequently encountered in patiens
between 15-40 yo and 60-70 yo, in 15% of cases CD is diagnosed in childhood.
MRI is free of ionizing radiation and therefore especially recommendend for young
patients with Crohn disease, who may accumulate high radiation doses with repeated CT
studies over their life-time. MRI is proposed as a first choice for non-emergent follow-up of
CD patients. MRI may provide useful information in colonic CD, including wall thickening,
presence of ulcers, depth of mural penetration, oedema, loss of haustration, presence of
polyps, as well as extraluminal findings and complications (Figure 1).
Signs of active inflammatory disease include mural thickening (of more than 4 mm) avid
post-contrast enhancement of the intestine wall, homogenous or with stratified pattern,
mesenteric hypervascularity (Figure 2) and mural diffusion restriction on diffusionweighted MRI imaging (DWI). Increase in the serum C-reactive protein (CRP) blood level
is also observed.
Diffusion-weighted MRI imaging (DWI) is sensitive to changes in the local diffusion of
water and provides information regarding tissue integrity. Quantitative apparent diffusion
coefficient (ADC) maps can be derived from DWI images.
Images for this section:
Page 2 of 8
Fig. 2: Coronal dynamic post-contrast coronal fat-saturated T1-weighted 3D volumetric
interpolated breath-hold examination (VIBE) image presents, hypervascularity of the
mesentery (arrow).
Page 3 of 8
Fig. 1: Coronal dynamic post-contrast coronal fat-saturated T1-weighted 3D volumetric
interpolated breath-hold examination (VIBE) image shows, oedema and post-contrast
enhancement of intestine wall in active Crohn's disease (arrows). CRP level 55,4 mg/l.
Page 4 of 8
Methods and materials
We retrospectively analyzed MRI exams of 60 patients with Crohn's disease confirmed
with histopathological examination, 30 patients (age 33±10, 12 F and M 18) with active
and 30 patients (age 34±11, 10 F and 20 M) with non-active intestine inflammatory
changes. Patients underwent MRI enterography including dynamic contrast enhanced
and diffusion-weighted sequences.
MRI was performed using a 1.5 Tesla MR scanner (Magnetom Area Siemens, Erlangen,
Germany).
Forty minutes prior to the examination, an oral 3% mannitol solution in 1-1,5 l of water
was administered. Buscopan in dose 10 mg was given intravenously.
After the localizer scout images the following sequences were obtained: axial and
coronal T2-weighted half-Fourier single-shot turbo spin-echo (HASTE) images acquired
during a breath-hold, coronal fat-saturated T2-weighted half-Fourier single-shot turbo
spin-echo (HASTE) images, coronal T2-weighted true fast imaging with steady-state
free precession (TRUFI), dynamic post-contrast coronal fat-saturated T1-weighted 3D
volumetric interpolated breath-hold examination (VIBE).
DWI coronal images with different b- values (0, 50, 500 and 800 s/mm2) and ADC maps
were obtained.
Coronal fat-saturated T1-weighted (FL2d) multiple breath hold before- and transverse
post-contrast images. Gadolinium-based contrast agent was administered intravenously
in dose of 0,1 ml/kg.
Characteristic changes including mural thickening, mural stratification and contrast
enhancement were analyzed using dedicated workstation. The apparent diffusion
coefficient (ADC) was determined in segments of intestine affected by Crohn's disease.
The ADC values (Figure 3), using ROI of 0,2 cm2, were measured, then the mean value
was calculated for each patient. The mean value ADCs were compared within the groups
with active and non-active CD. Results are presented in Table.
The serum C-reactive protein (CRP) level was estimated in periexamination period for
each of the patients.
Images for this section:
Page 5 of 8
Fig. 3: Coronal ADC map shows the measurement of the ADC value of the thickened
intestine wall in patient with active CD (ROI 0,2 cm2).
Page 6 of 8
Results
The ADC value in the active intestine lesions was lower than in the non-active intestine
-3
2
-3
2
changes ((1.146 ± 0.136)x10 mm /s versus (2.365 ± 0.413)x10 mm /s) P<0.001).
As expected the CRP levels in patients in the active phase of Crohn's disease was
significantly higher than in non-active phase (49,5 ± 36,7 mg/l versus 3,6 ± 2,65 mg/l).
Images for this section:
Fig. 4: Results
Page 7 of 8
Conclusion
The ADC value corelates with the activity of Crohn's disease and is an useful MRI
parameter of activity besides contrast enhancement. As expected we also observed a
significant correlation with clinical disease severity and CRP level.
Results indicate that a quantitative analysis of ADC values can be used to distinguish
active from non-active intestine changes in patients with Crohn's disease.
Personal information
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