Diffusion‐weighted magnetic resonance imaging is effective to detect ileocolonic ulcerations in Crohn's disease. Issue 4 (18th June 2015)

• Record Type: Journal Article
• Authors: Buisson, A.; Hordonneau, C.; Goutte, M.; Boyer, L.; Pereira, B.; Bommelaer, G.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 42:Issue 4(2015)
• Page Start: 452
• Page End: 460
• Publication Date: 2015-06-18
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.13287
• Languages: English
• ISSNs: 0269-2813

Abstract

<abstract abstract-type="main" id="apt13287-abs-0001"> <title>Summary</title> <sec id="apt13287-sec-0001" sec-type="section"> <title>Background</title> <p>Magnetic resonance entero‐colonography enables accurate assessment of ileocolonic Crohn's disease, but the need for bowel cleansing and rectal enema limits considerably its use in daily practice.</p> </sec> <sec id="apt13287-sec-0002" sec-type="section"> <title>Aim</title> <p>We evaluated the accuracy of diffusion‐weighted magnetic resonance entero‐colonography with neither bowel cleansing nor rectal enema to assess endoscopic activity.</p> </sec> <sec id="apt13287-sec-0003" sec-type="section"> <title>Methods</title> <p>Forty‐four Crohn's disease patients underwent prospectively and consecutively diffusion‐weighted magnetic resonance entero‐colonography [with apparent diffusion coefficient (ADC) and Clermont score calculation] and ileocolonoscopy [with Crohn's Disease Endoscopic Index of Severity (CDEIS) and Simplified Endoscopic score for Crohn's Disease (SES‐CD) calculation].</p> </sec> <sec id="apt13287-sec-0004" sec-type="section"> <title>Results</title> <p>Mean ADC was inversely correlated with total CDEIS (ρ = −0.40; <italic>P</italic> = 0.0067) and total SES‐CD (ρ = −0.33; <italic>P</italic> = 0.032). Considering the 194 segments, ADC was inversely correlated with segmental CDEIS (−0.48; <italic>P</italic> < 0.001) and segmental SES‐CD (−0.44; <italic>P</italic> < 0.001). ADC values were lower in segments with deep ulcers (1.30 ± 0.23) or superficial ulcerations (1.75 ± 0.64) than in non‐ulcerated segments (2.15 ± 0.5) (<italic>P</italic> = 0.001). Using a receiver operating curve, we determined that segmental ADC <1.42 detected endoscopic deep ulcerations with sensitivity = 0.91 and specificity = 0.83 (Area under the curve = 0.84; <italic>P</italic> < 0.001). Segmental ADC <1.88 detected endoscopic superficial ulcerations with sensitivity = 0.64 and specificity = 0.75. The segmental ADC values decreased when the ulcerations size increased (<italic>P</italic> = 0.0001). Clermont score correlated with ileal CDEIS (0.63; <italic>P</italic> < 0.05) and ileal SES‐CD (0.58; <italic>P</italic> < 0.05). Clermont score was higher in ulcerated segments (23.3 ± 8.4) than in non‐ulcerated segments (12.4 ± 10.0) (<italic>P</italic> = 0.006) and increased with ulcers size (<italic>P</italic> = 0.012). Clermont score >18.9 detected ulcerations with sensitivity = 0.79 and specificity = 0.73.</p> </sec> <sec id="apt13287-sec-0005" sec-type="section"> <title>Conclusion</title> <p>Diffusion‐weighted magnetic resonance entero‐colonography using apparent diffusion coefficient and Clermont score was effective to indirectly detect endoscopic ulcerations in ileocolonic Crohn's disease.</p> </sec> </abstract>