Evaluation of conventional, dynamic contrast enhanced and diffusion weighted MRI for quantitative Crohn's disease assessment with histopathology of surgical specimens

Objectives To prospectively compare conventional MRI sequences, dynamic contrast enhanced (DCE) MRI and diffusion weighted imaging (DWI) with histopathology of surgical specimens in Crohn's disease. Methods 3-T MR enterography was performed in consecutive Crohn's disease patients scheduled for surgery within 4 weeks. One to four sections of interest per patient were chosen for analysis. Evaluated parameters included mural thickness, T1 ratio, T2 ratio; on DCE-MRI maximum enhancement (ME), initial slope of increase (ISI), time-to-peak (TTP); and on DWI apparent diffusion coefficient (ADC). These were compared with location-matched histopathological grading of inflammation (AIS) and fibrosis (FS) using Spearman correlation, Kruskal-Wallis and Chi-squared tests. Results Twenty patients (mean age 38 years, 12 female) were included and 50 sections (35 terminal ileum, 11 ascending colon, 2 transverse colon, 2 descending colon) were matched to AIS and FS. Mural thickness, T1 ratio, T2 ratio, ME and ISI correlated significantly with AIS, with moderate correlation (r=0.634, 0.392, 0.485, 0.509, 0.525, respectively; all P < 0.05). Mural thickness, T1 ratio, T2 ratio, ME, ISI and ADC correlated significantly with FS (all P < 0.05). Conclusions Quantitative parameters from conventional, DCE-MRI and DWI sequences correlate with histopathological scores of surgical specimens. DCE-MRI and DWI parameters provide additional information. Key points Conventional MR enterography can be used to assess Crohn's disease activity. Several MRI parameters correlate with inflammation and fibrosis scores from histopathology. Dynamic contrast enhanced imaging and diffusion weighted imaging give additional information. Quantitative MRI parameters can be used as biomarkers to evaluate Crohn's disease activity.