Dynamic contrast-enhanced magnetic resonance imaging and diffusion-weighted imaging in the activity staging of terminal ileum Crohn's disease

BACKGROUND The activity staging of Crohn's disease (CD) in the terminal ileum is critical in developing an accurate clinical treatment plan. The activity of terminal ileum CD is associated with the microcirculation of involved bowel walls. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) can reflect perfusion and permeability of bowel walls by providing microcirculation information. As such, we hypothesize that DCE-MRI and DWI parameters can assess terminal ileum CD, thereby providing an opportunity to stage CD activity. AIM To evaluate the value of DCE-MRI and DWI in assessing activity of terminal ileum CD. METHODS Forty-eight patients with CD who underwent DCE-MRI and DWI were enrolled. The patients' activity was graded as remission, mild and moderate-severe. The transfer constant (K-trans), wash-out constant (K-ep), and extravascular extracellular volume fraction (V-e) were calculated from DCE-MRI and the apparent diffusion coefficient (ADC) was obtained from DWI. Magnetic Resonance Index of Activity (MaRIA) was calculated from magnetic resonance enterography. Differences in these quantitative parameters were compared between normal ileal loop (NIL) and inflamed terminal ileum (ITI) and among different activity grades. The correlations between these parameters, MaRIA, the Crohn's Disease Activity Index (CDAI), and Crohn's Disease Endoscopic Index of Severity (CDEIS) were examined. Receiver operating characteristic curve analyses were used to determine the diagnostic performance of these parameters in differentiating between CD activity levels. RESULTS Higher K-trans (0.07 0.04 vs 0.01 +/- 0.01), K-ep (0.24 +/- 0.11 vs 0.15 +/- 0.05) and V-e (0.27 +/- 0.07 vs 0.08 +/- 0.03), but lower ADC (1.41 +/- 0.26 vs 2.41 +/- 0.30) values were found in ITI than in NIL (all P < 0.001). The K-trans, K-ep, V-e and MaRIA increased with disease activity, whereas the ADC decreased (all P < 0.001). The K-trans, K-ep, V(e )and MaRIA showed positive correlations with the CDAI (r = 0.866 for K-trans, 0.870 for K-ep, 0.858 for V-e, 0.890 for MaRIA, all P < 0.001) and CDEIS (r = 0.563 for K-trans, 0.567 for K-ep, 0.571 for V-e, 0.842 for MaRIA, all P < 0.001), while the ADC showed negative correlations with the CDAI (r = -0.857, P < 0.001) and CDEIS (r = -0.536, P < 0.001). The areas under the curve (AUC) for the K-trans, K-ep, V-e, ADC and MaRIA values ranged from 0.68 to 0.91 for differentiating inactive CD (CD remission) from active CD (mild to severe CD). The AUC when combining the K-trans, K(ep )and V(e )was 0.80, while combining DCE-MRI parameters and ADC values yielded the highest AUC of 0.95. CONCLUSION DCE-MRI and DWI parameters all serve as measures to stage CD activity. When they are combined, the assessment performance is improved and better than MaRIA.