Molecular Oncology, Robert Bosch Hospital, Stuttgart, Germany.
Radiology, Robert Bosch Hospital, Stuttgart, Germany.
Rofo. 2022 Oct;194(10):1119-1131. doi: 10.1055/a-1826-0049. Epub 2022 Jun 15.
We compared contrast-enhanced MR enterography with diffusion-weighted sequences to evaluate the validity of diffusion-weighted sequences for activity assessment in Crohn's disease compared to endoscopy. In addition, we investigated a new color-coded image post-processing technique in comparison with standard sequences and endoscopy.
Included were 197 MR enterographies (2015-2017) performed by using standardized examination protocols. The intestine was divided into 7 segments, which were compared separately. The accuracy of the MR examinations with regard to disease activity was validated using the Seo and MaRIA score and endoscopy findings. In addition, the image data were post-processed using a color-coded evaluation method (DCE tool on OsiriX).
The comparison between contrast-enhanced and diffusion-weighted sequences showed a highly significant correlation for all bowel sections with a mean Spearman correlation coefficient of 0.876 (0.809-0.928). The color-coded image post-processing showed a sensitivity of 83.2 % and a specificity of 70.5 % in comparison with the MaRIA score. In comparison to endoscopy, a sensitivity of 81.3 % and a specificity of 70.5 %. In comparison with endoscopy, the MaRIA score showed a sensitivity of 80.2 % and a specificity of 84.0 % at a cut-off of 7. The visual score according to Seo showed a sensitivity of 85.7 % with a specificity of 77.0 % in the contrast-weighted examination and a sensitivity of 87.9 % and a specificity of 71.8 % for diffusion weighted images.
Diffusion-weighted sequences are as good as contrast-weighted sequences for assessing inflammatory activity in Crohn's disease. Contrast is often helpful for assessing complications, but this was not the purpose of this study. Visual imaging using color-coded data sets was similarly good at detecting inflammation.
· MR enterography is possible without contrast using diffusion-weighted imaging with comparable high informative value.. · Inflammatory activity in MR correlates sufficiently well with endoscopy. · The MaRIA and Seo scores are comparable in their validity.. · The colored representation of inflamed bowel sections is a promising technique..
· Jakob M, Backes M, Schaefer C et al. MR Enterography in Crohn's Disease: Comparison of Contrast Imaging with Diffusion-weighted Imaging and a special Form of Color Coding. Fortschr Röntgenstr 2022; 194: 1119 - 1131.
我们比较了对比增强磁共振肠造影术与弥散加权序列，以评估弥散加权序列在克罗恩病活动性评估中的有效性，并与内镜检查进行比较。此外，我们还研究了一种新的彩色编码图像后处理技术，并与标准序列和内镜检查进行了比较。
纳入了 197 例 2015-2017 年采用标准化检查方案进行的磁共振肠造影术。肠被分为 7 个节段，分别进行比较。采用 Seo 和 MaRIA 评分及内镜检查结果验证磁共振检查对疾病活动度的准确性。此外，还使用彩色编码评估方法（OsiriX 上的 DCE 工具）对图像数据进行后处理。
对比增强和弥散加权序列之间的比较显示，所有肠段的相关性均高度显著，平均 Spearman 相关系数为 0.876（0.809-0.928）。与 MaRIA 评分相比，彩色编码图像后处理的敏感性为 83.2%，特异性为 70.5%。与内镜检查相比，敏感性为 81.3%，特异性为 70.5%。与内镜检查相比，MaRIA 评分在截断值为 7 时的敏感性为 80.2%，特异性为 84.0%。根据 Seo 的视觉评分，在对比加权检查中，敏感性为 85.7%，特异性为 77.0%，而在弥散加权图像中，敏感性为 87.9%，特异性为 71.8%。
弥散加权序列与对比增强序列在评估克罗恩病的炎症活动度方面同样有效。对比剂通常有助于评估并发症，但这不是本研究的目的。使用彩色数据集进行的视觉成像在检测炎症方面同样有效。
磁共振肠造影术无需使用对比剂即可进行弥散加权成像，具有相当高的信息量。
磁共振成像的炎症活动与内镜检查结果具有足够的相关性。
MaRIA 和 Seo 评分在有效性方面相当。
彩色编码显示炎症肠段是一种很有前途的技术。
