Diffusion and perfusion MRI quantification in ileal Crohn's disease

ObjectivesTo quantify intravoxel incoherent motion (IVIM)-DWI and dynamic contrast-enhanced (DCE)-MRI parameters in normal and abnormal ileal segments in Crohn's disease (CD) patients and to assess the association of these parameters with clinical and MRI-based measurements of CD activity.MethodsIn this prospective study, 27 CD patients (M/F 18/9, mean age 42 years) underwent MR enterography, including IVIM-DWI and DCE-MRI. IVIM-DWI and DCE-MRI parameters were quantified in normal and abnormal small bowel segments, the latter identified by the presence of inflammatory changes. MRI parameter differences between normal and abnormal bowel were tested using Wilcoxon signed-rank tests. IVIM-DWI and DCE-MRI parameters were correlated with clinical data (C-reactive protein, Harvey-Bradshaw Index), conventional MRI parameters (wall thickness, length of involvement) and MRI activity scores (MaRIA, Clermont). Diagnostic performance of (combined) parameters for differentiation between normal and abnormal bowel was determined using ROC analysis.ResultsThe DCE-MRI parameters peak concentration C-peak, upslope, area-under-the-curve at 60s (AUC60), K-trans and v(e) were significantly increased (p<0.023), while IVIM-DWI parameters perfusion fraction (PF) and ADC were significantly decreased (p<0.001) in abnormal bowel segments. None of the DCE-MRI and IVIM-DWI parameters correlated with clinical parameters (p>0.105). DCE-MRI parameters exhibited multiple significant correlations with wall thickness (C-peak, upslope, AUC60, K-trans; r range 0.431-0.664, p<0.025) and MaRIA/Clermont scores (C-peak, AUC60, K-trans; r range 0.441-0.617, p<0.021). Combined K-trans+v(e)+PF+ADC showed highest AUC (0.963) for differentiation between normal and abnormal bowel, while ADC performed best for individual parameters (AUC=0.800).ConclusionsDCE-MRI and IVIM-DWI, particularly when used in combination, are promising for non-invasive evaluation of small bowel CD.Key Points center dot IVIM-DWI and DCE-MRI parameters were significantly different between normal and abnormal bowel segments in CD patients.center dot DCE-MRI parameters showed a significant association with wall thickness and MRI activity scores.center dot Combination of IVIM-DWI and DCE-MRI parameters led to the highest diagnostic performance for differentiation between normal and abnormal bowel segments, while ADC showed the highest diagnostic performance of individual parameters.