School of Medicine, University of Milano-Bicocca, Milan, Italy.
Department of Diagnostic Radiology, San Gerardo Hospital H. S. Gerardo Monza, Via Pergolesi 33, 20900-Monza, MB, Italy.
Contrast Media Mol Imaging. 2019 Feb 4;2019:1767620. doi: 10.1155/2019/1767620. eCollection 2019.
To assess the feasibility of dynamic contrast-enhanced perfusion-MRI in characterization of active small-bowel inflammation and chronic mural fibrosis in patients with Crohn's disease (CD).
We analyzed a total of 37 (11 women; 23-69 years) patients with known biopsy proven CD, who underwent MR-enterography (MRE) study, performed on a 1.5 T MRI system (Achieva, Philips), using a phased array sense body multicoil, after oral administration of 1.5-2 L of PEG solution. MRE protocol included T1 weighted, SSh T2, sBTFE, and gadolinium-enhanced THRIVE sequences acquired on coronal and axial planes. A dedicated workstation was used to generate perfusion color maps, on which we drown ROI on normal bowel and on pathological segment, thus obtaining related perfusion parameters: relative arterial, venous, and late enhancement (RAE, RVE, and RLE), maximum enhancement (ME), and time to peak (TTP).
Quantitative perfusion analysis showed a good correlation with local degree of Crohn's inflammation activity. Twenty-nine out of 37 patients showed active inflammatory disease (reference standard of active disease: wall bowel thickness and layered enhancement) with following perfusion parameters: REA (%) = 116.1, RVE (%) = 125.3, RLE (%) = 127.1, ME (%) = 1054.7, TTP (sec) = 157. The same parameters calculated in patients with mural fibrosis were as follows: RAE (%): median = 56.4; RVE (%): 81.2; RLE (%): 85.4; ME (%):809.6; TTP (sec): 203.4. A significant difference ( < 0.001) between inflamed and fibrotic bowel wall vascularity, regarding all perfusion parameters evaluated, was found, with higher values in active CD localizations.
Vascular assessment of perfusion kinetics of bowel wall by dynamic contrast perfusion-MR analysis may represent a complementary diagnostic tool that enables a quantitative evaluation of local inflammation activity in CD patients.
评估动态对比增强磁共振灌注成像（DCE-MRI）在诊断克罗恩病（CD）患者活动性小肠炎症和慢性壁纤维化中的可行性。
我们分析了 37 例（11 名女性；23-69 岁）经活检证实为 CD 的患者，这些患者均在 1.5T MRI 系统（Achieva，Philips）上进行了磁共振肠道成像（MRE）检查，使用了相控阵体多线圈，在口服 1.5-2L 的 PEG 溶液后进行。MRE 方案包括冠状位和轴位的 T1 加权、SSH T2、sBTFE 和钆增强 THRIVE 序列。使用专用工作站生成灌注彩色图，在正常肠段和病理节段上画出 ROI，从而获得相关灌注参数：相对动脉、静脉和晚期增强（RAE、RVE 和 RLE）、最大增强（ME）和达峰时间（TTP）。
定量灌注分析与局部 CD 炎症活动程度具有良好的相关性。37 例患者中有 29 例（参考标准为活动性疾病：肠壁厚度和分层强化）显示出活动性炎症性疾病，其灌注参数如下：REA（%）=116.1、RVE（%）=125.3、RLE（%）=127.1、ME（%）=1054.7、TTP（sec）=157。在壁纤维化患者中计算出的相同参数如下：RAE（%）：中位数=56.4；RVE（%）：81.2；RLE（%）：85.4；ME（%）：809.6；TTP（sec）：203.4。在所有评估的灌注参数方面，活动性和纤维化肠壁血管性之间存在显著差异（<0.001），活动性 CD 病变部位的灌注参数更高。
通过动态对比增强磁共振灌注分析评估肠壁灌注动力学，可能是一种补充性诊断工具，能够对 CD 患者的局部炎症活动进行定量评估。
