Soydan Levent, Demir Ali Aslan, Ozer Serhat, Ozkara Selvinaz
TC Saglik Bakanligi Haydarpasa Numune Egitim ve, Arastirma Hastanesi Istanbul, TR.
Istanbul Faculty of Medicine, Istanbul University, TR.
J Belg Soc Radiol. 2019 Jan 18;103(1):10. doi: 10.5334/jbsr.1521.
Monitoring Crohn's disease (CD) activity has a crucial importance, especially for evaluating treatment efficacy. Magnetic resonance enterography (MRE) and diffusion-weighted imaging (DWI) or their combination may represent potential non-invasive tools for this purpose. This study aimed to examine DWI and MRE for their potential to differentiate between different grades of ileocolonic CD activity.
This retrospective study included 54 adult patients with a diagnosis of CD who underwent ileocolonoscopy and MRE including the DWI sequence. The severity of CD inflammation was categorized by Simple Endoscopic Score for Crohn's Disease (SES-CD) as inactive, mild, moderate and severe. In addition, following conventional MRE and DWI parameters were examined: bowel wall thickness, mural T2 hyperintensity, contrast enhancement, DWI signal intensity, and apparent diffusion coefficient (ADC) values.
In patients with moderate to severe disease based on SES-CD, T2 hyperintensity score [1.68 ± 0.77 (1-3) vs. 2.19 ± 0.69 (1-3); p = 0.013] and mean DWI score [2.42 ± 0.58 (1-3) vs. 2.04 ± 0.69 (1-3); p = 0.037 ] were higher and mean ADC values [1.5 ± 0.4 (0.9-2.5) vs. 1.2 ± 0.3 (0.6-1.8)] were lower compared to patients with inactive to mild CD. ADC had a moderate diagnostic accuracy in predicting moderate to severe disease (AUC = 0.729, 95% CI = 0.591-0.841, p = 0.001), with a cut-off value of ≤1.47 × 10 mm/sec yielded 88.5% (23/26) sensitivity, 57.1% (16/28) specificity.
DWI, ADC and T2 signal appear to differentiate moderate to severe CD from inactive to mildly active CD, based on SES-CD evaluation and may be useful in monitoring disease activity, particularly when evaluating treatment response.
监测克罗恩病（CD）的活动具有至关重要的意义，特别是对于评估治疗效果。磁共振肠造影（MRE）和扩散加权成像（DWI）或其联合应用可能是用于此目的的潜在非侵入性工具。本研究旨在探讨DWI和MRE区分不同程度回结肠CD活动的潜力。
这项回顾性研究纳入了54例诊断为CD的成年患者，他们接受了回结肠镜检查以及包括DWI序列的MRE检查。CD炎症的严重程度根据克罗恩病简易内镜评分（SES-CD）分为非活动、轻度、中度和重度。此外，还检查了以下常规MRE和DWI参数：肠壁厚度、壁T2高信号、对比增强、DWI信号强度和表观扩散系数（ADC）值。
基于SES-CD，中度至重度疾病患者的T2高信号评分[1.68±0.77（1-3）vs. 2.19±0.69（1-3）；p = 0.013]和平均DWI评分[2.42±0.58（1-3）vs. 2.04±0.69（1-3）；p = 0.037]更高，而平均ADC值[1.5±0.4（0.9-2.5）vs. 1.2±0.3（0.6-1.8）]低于非活动至轻度CD患者。ADC在预测中度至重度疾病方面具有中等诊断准确性（AUC = 0.729，95% CI = 0.591-0.841，p = 0.001），截断值≤1.47×10 mm/sec时，敏感性为88.5%（23/26），特异性为57.1%（16/28）。
基于SES-CD评估，DWI、ADC和T2信号似乎能够区分中度至重度CD与非活动至轻度活动CD，可能有助于监测疾病活动，特别是在评估治疗反应时。
