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Multiparametric MRI for Staging of Bowel Inflammatory Activity in Crohn's Disease with IVIM and DCE-MRI: A Preliminary Study1Radiology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China, 2MR Research China, GE Healthcare, Beijing, China
Synopsis
Keywords: Digestive, Diffusion/other diffusion imaging techniques
In summary, our findings suggested that the combination of IVIM and DCE-MRI can be used to accurately stage CD lesions activity. However, we must acknowledge that further investigation area is warranted to validate this preliminary finding.Background:
In Crohn's disease (CD) clinical practice, an accurate staging of inflammatory activity is more importantant than detecting lesions, as clinical management decision and efficacy evaluation are dependent on activity stage.Purpose:
To investigate if the combination of intravoxel incoherent motion (IVIM) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is feasible for staging CD activity.Study Type:
Retrospective.Population:
A total of 65 CD patients (45 men and 20 women; age range 18~65 years, median age 29.78 years) were enrolled and analyzed.Field Strength/Sequence:
A 3.0-T, T1-weighted, T2-weighted, IVIM (multiplexed sensitivity encoding, MUSE), DCE images.Assessment:
The simplified endoscopic score for Crohn’s Disease (SES-CD) and magnetic resonance index of activity (MaRIA) were used as the reference. The severity and extent of bowel lesions were evaluated by a gastroenterologist using standard colonoscopy. A senior radiologist scored the ileocolic lesions using the MaRIA scoring system. The IVIM and DCE-MRI data were processed by two junior radiologists, who were blinded to the SES-CD and MaRIA scores. Finally, three IVIM parameters: fast apparent diffusion coefficient (ADCfast), slow apparent diffusion coefficient (ADCslow), and the fractional perfusion (Fraction of ADCfast), as well as four DCE-MRI parameters: volume transfer constant (Ktrans), rate constant (Kep), extravascular extracellular volume fraction (Ve) and plasma volume fraction (Vp) were generated.Statistical Tests:
Intra-class correlation coefficient (ICC), non-parametric test (Kruskal-Wallis H and Mann-Whitney U), logistic regression, receiver operating characteristic (ROC) analysis, Delong test, and Spearman's correlation test were performed.Results:
According to SES-CD, 116 ileocolonic segments with CD lesions were indentified as: inactive (n = 38), mild (n = 46), and moderate to severe (n = 32). Inter-reader agreement has been validated with high ICC coefficients > 0.9 for all IVIM and DCE-MRI parameters. Relative to the two active groups, MaRIA (6, p < 0.001), ADCfast (8.68 ×10-3 mm2/s, p < 0.001), Ktrans (0.95 min-1, p < 0.001), Kep (1.14 min-1, p < 0.001) and Ve (0.79, p < 0.001) all showed lower values in inactive group. Fraction of ADCfast (38.8%, p < 0.001) was higher in inactive than the other two groups. With multivariable logistic regression analysis, ADCfast (p < 0.001), Fraction of ADCfast (p = 0.005), Ktrans (p < 0.001) and Kep (p = 0.003) were identified as significant factors for differentiating among the three groups. Significantly different parameters were revealed between inactive and active groups, including MaRIA score (6 vs. 12.5, p < 0.001), ADCfast (8.68×10-3 mm2/s vs. 11.89×10-3 mm2/s, p < 0.001), Fraction of ADCfast (38.80% vs. 25.63%, p < 0.001), Ktrans (0.95 min-1 vs. 1.82 min-1, p < 0.001), Kep (1.14 min-1 vs. 1.64 min-1, p < 0.001) and Ve (0.79 vs. 0.87, p = 0.011). Binary logistic analyses identified ADCfast (Odds Ratio = 2.009, p = 0.001), Ktrans (Odds Ratio = 54.771, p = 0.014) and Kep (Odds Ratio = 6.105, p = 0.029) as independent predictors for the active status. The combination of ADCfast, Ktrans and Kep performed better than MaRIA score (p = 0.028), for differentiating inactive and active status. MaRIA score was positively correlated with ADCfast (r = 0.594, p < 0.001), Ktrans (r = 0.581, p < 0.001), Kep (r = 0.443, p < 0.001) and Ve (r = 0.294, p = 0.001), however, negatively correlated with Fraction of ADCfast (r = -0.394, p < 0.001).Data Conclusion:
The combination of IVIM and DCE-MRI can be used to accurately stage inflammatory activity in CD.Acknowledgements
The research project was supported by the “Six One Projects” Top-notch Talent Research Project for High-level Health Talents in Jiangsu Province, China (Grant No. LGY2018072).References
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