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![Crohn disease limited to the sigmoid and confirmed by endoscopy in a 12-year-old girl. a Axial T2-weighted sequence (repetition time/echo time [TR/TE] 4.2/2.1 ms) demonstrates discrete wall thickening of the moderately distended sigmoid colon (arrowhead). b Axial T1-weighted fat-saturated contrast-enhanced MR image ([TR/TE]=4.5/2.1 ms) demonstrates the lack of abnormal enhancement of the sigmoid (arrowhead). c Axial diffusion-weighted image (b=1,300) shows clear hyperintensity of the sigmoid (arrowhead). TE echo time, TR repetition time](publication/326250088/figure/fig2/AS:941388006965268@1601455799323/Crohn-disease-limited-to-the-sigmoid-and-confirmed-by-endoscopy-in-a-12-year-old-girl-a.png)
Crohn disease limited to the sigmoid and confirmed by endoscopy in a 12-year-old girl. a Axial T2-weighted sequence (repetition time/echo time [TR/TE] 4.2/2.1 ms) demonstrates discrete wall thickening of the moderately distended sigmoid colon (arrowhead). b Axial T1-weighted fat-saturated contrast-enhanced MR image ([TR/TE]=4.5/2.1 ms) demonstrates the lack of abnormal enhancement of the sigmoid (arrowhead). c Axial diffusion-weighted image (b=1,300) shows clear hyperintensity of the sigmoid (arrowhead). TE echo time, TR repetition time
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Background
Contrast-enhanced MRI is often used for diagnosis and follow-up of children with inflammatory bowel disease. Objective
To compare the accuracy of diffusion-weighted MRI (DWI) to contrast-enhanced MRI in children with known or suspected inflammatory bowel disease. Materials and methodsThis retrospective, consecutive study included 55 chil...
Similar publications
Endoscopy remains the reference standard for the diagnosis and assessment of patients with inflammatory bowel disease (IBD), but it has several important limitations. Cross-sectional imaging techniques such as magnetic resonance enterography (MRE) and intestinal ultrasound (IUS) are better tolerated and safer. Moreover, they can examine the entire...
Citations
... Diffusion-weighted imaging (DWI) is a fast functional MR technique with wide acceptance in imaging of IBD as it depends on molecular motion and can illustrate inflammatory lesions in IBD [13,14] also, DWI is fit for children, owing to quicker image acquisition [15]. ...
... Our results revealed substantial inter-observer agreement for mural diffusion restriction on DW images with higher sensitivity, specificity and accuracy than mural edema detected on MRE, that was in concordance with another study which revealed very good sensitivity, specificity, PPV, NPV and accuracy of diffusion compared to contrast-enhanced MRI as 90%, 98%, 90%, 98% and 96%, respectively [14]. Also few other studies revealed similar results with good performance of DWI compared to contrast-enhanced MRE [13,13]. ...
Background
Inflammatory bowel disease (IBD) is considered as significant cause of morbidity in children with a global rise in its pediatric onset recently. Our study aimed to assess the facility of magnetic resonance enterography (MRE) and diffusion-weighted imaging (DWI) to identify the activity of pediatric IBD in correlation with clinical and endoscopic activity scores. Twenty-four patients of IBD who underwent clinical examination, ileocolonoscopy and MRE and DWI within less than 14 days were prospectively included. For all Crohn’s cases (9/24), the simplified endoscopic activity score for Crohn’s disease (SES-CD) and magnetic resonance enterography global score (MEGS) were acquired, while for all UC (15/24) cases, MRE score and Mayo endoscopic score were calculated. Sensitivity and specificity of MRE for detection disease activity against clinical and endoscopic scores were compared. Pathological reference for disease activity was based on assessment for mucosal inflammatory changes on endoscopic biopsy in all cases.
Results
There was a perfect inter-observer agreement (kappa 0.81–1) regarding wall thickening and mural edema, with substantial agreement (kappa 0.61–0.8) for MRE severity score, mural diffusion restriction, mesenteric edema and vascular congestion, while mural enhancement and for number of active LNs revealed moderate agreement (kappa 0.41–0.6). There was a significant positive correlation between MEGS and SES-CD in Crohn’s cases as well as between Mayo endoscopic score and MRE severity in UC cases ( r = 0.970, p > 0.001 and r = 0.544, p = 0.036, respectively). MRE compared to endoscopic findings and clinical activity scores revealed high accuracy (95.8%) with 87.5%, 80%, 96% and 94.1% for sensitivity, specificity, PPV and NPV, respectively.
Conclusion
MR enterography is a noninvasive reliable imaging modality of high accuracy for the diagnosis of pediatric IBD severity compared to endoscopic activity scores and pathological severity.
... The detailed characteristics of the included studies are summarized in Table 1. All studies were conducted in single institutions, [33][34][35][36][37][38][39][40][41] and two of the nine included studies were conducted in a prospective manner. 34,37 In four studies covering 174 patients, the target population was suspected or known IBD. 34,35,39,41 Among these patients, the final diagnosis was reported for 91, with the most common IBD type being CD [n = 76; 84%], followed by UC [n = 13; 14%]. ...
... All studies were conducted in single institutions, [33][34][35][36][37][38][39][40][41] and two of the nine included studies were conducted in a prospective manner. 34,37 In four studies covering 174 patients, the target population was suspected or known IBD. 34,35,39,41 Among these patients, the final diagnosis was reported for 91, with the most common IBD type being CD [n = 76; 84%], followed by UC [n = 13; 14%]. In seven studies that provided information on the sex of the study population, 34,35,[37][38][39][40][41] the total male-to-female ratio was 1.06 [169 : 160]. ...
... 34,37 In four studies covering 174 patients, the target population was suspected or known IBD. 34,35,39,41 Among these patients, the final diagnosis was reported for 91, with the most common IBD type being CD [n = 76; 84%], followed by UC [n = 13; 14%]. In seven studies that provided information on the sex of the study population, 34,35,[37][38][39][40][41] the total male-to-female ratio was 1.06 [169 : 160]. Five studies performed per-patient analysis, 34,35,37,38,41 and in these the proportion of patients who had bowel inflammation ranged from 55to 88%, with a pooled proportion of 72% [193/268]. ...
Background and Aims
The diagnostic performance of diffusion-weighted imaging magnetic resonance enterography (DWI-MRE) has not been clearly established in a pediatric population. We systematically evaluated the diagnostic performance of DWI-MRE for the detection of bowel inflammation in pediatric patients with suspected or known inflammatory bowel disease (IBD).
Methods
MEDLINE/PubMed, EMBASE, Web of science, and the Cochrane library were searched for articles investigating the diagnostic performance of DWI-MRE for the detection of bowel inflammation in pediatric patients with suspected or known IBD up to December 31, 2020. Pooled sensitivity and specificity were calculated using a bivariate random-effects model. Pooled inter-reader agreement for the interpretation of DWI-MRE was also calculated. This study was registered as PROSPERO CRD42021228754.
Results
Nine studies covering 400 pediatric patients were included. The pooled sensitivity and specificity of DWI-MRE for the detection of bowel inflammation were 0.93 (95% CI, 0.88–0.96) and 0.96 (95% CI, 0.88–0.96), respectively. Substantial heterogeneity was noted in both sensitivity (I 2=66%; P<0.01) and specificity (I 2=94%; P<0.01). Meta-regression analysis identified that the use of spasmolytics contributed to higher specificity (0.89 to 0.99) and that quantitative assessment with an ADC cut-off value contributed to lower sensitivity (0.93 to 0.85) and specificity (0.98 to 0.72). The pooled coefficient of inter-reader agreement, including four studies using visual assessment, was 0.97 (95% CI, 0.78–1.00).
Conclusions
DWI-MRE, especially when used with spasmolytics, is accurate for the detection of bowel inflammation in pediatric patients with suspected or known IBD. Quantitative measurement of ADC is not practical for this purpose.
... Whilst there is general agreement that more inflamed loops of bowel show greater impedance of diffusion on diffusionweighted imaging [62], there are problems with measurement repeatability for quantitative apparent diffusion coefficient measurements, as well as significant overlap of threshold apparent diffusion coefficient values quoted for normal, mildly and severely inflamed bowel in the published literature [63]. Currently it remains a useful albeit subjective adjunct that is perhaps best employed as a qualitative detection tool to determine presence of disease (Fig. 10) [64]. ...
We present the case for subspecialisation in paediatric gastrointestinal and hepato-pancreatico-biliary radiology. We frame the discussion around a number of questions: What is different about the paediatric patient and paediatric gastrointestinal system? What does the radiologist need to do differently? And finally, what can be translated from these subspecialty areas into everyday practice? We cover conditions that the sub-specialist might encounter, focusing on entities such as inflammatory bowel disease and hepatic vascular anomalies. We also highlight novel imaging techniques that are a focus of research in the subspecialties, including contrast-enhanced ultrasound, MRI motility, magnetisation transfer factor, and magnetic resonance elastography.
... Diffusion-weighted imaging was reported to be competitive or even superior to contrast-enhanced magnetic resonance imaging (MRI) for detection of bowel inflammation by several researchers (Oto, 2009;Oto, 2011;Kiryu, 2009Oussalah, 2010 andFarah Khachab, 2018). This cope with our results as there was no significant difference between visibility of lesions recorded by the 3 readers in T2, DWI +ADC and post contrast images. ...
Background: diagnostic tool to detect active episode with minimum hazards. of MR enterography, quantitative and qua experiences in assessment of disease activity in children, ii to explore if diffusion weighted imaging (DWI) can substitute contrast enhanced images. of 32 patients suspected to have active chron's disease were retrospectively evaluated by 3 radiologists with different years of experience. Magnetic resonance score activity. regarding graded DWI hyperintensity (ICC)= 0.93. There was significant moderate correlation between graded DWI hyperintensity and MaRIA (r = 0.64),mMaRIA (r=0.65). DWI hyperintensity had sensitivity of 100%, specifi lesions was 1.4 specificity 62.5. There was significant moderate inverse correlation between ADC values and MaRIA, mMaRIA, mural thickness and wall edema, while there was no significant correlation between ADC and ulcers or relative contrast enhancement. The 3 readers did not find significant difference in lesion visibility between (DWI + ADC) and (post contrast with DWI is a reliable tool that accurately assessed activity of chron's disease, regardless the experience of readers. DWI is comparable to post contrast images in detection of active disease. Copyright © 2019, Dalia M. Fahmy et al. This is an open use, distribution, and reproduction in any medium, provided
Background: Crohn's disease (CD) is a chronic disorder that often starts at a young age and involves periods of remission and relapse. Prompt diagnosis of relapses through screening is crucial due to the potential morbid complications of untreated active inflammation. Magnetic resonance enterography (MRE) is a noninvasive technique to screen for active inflammation. The standard protocol involves intravenous injection of contrast agents with potential side effects. Some abbreviated non-contrast-enhanced MRE protocols are proposed as alternatives for conventional MRE to identify active inflammation. Currently, there is controversy regarding the applicability and accuracy of these protocols. This study aims to describe and compare these protocols and evaluate their accuracy in detecting active inflammation and CD complications. Methods: Results from a systematic search of three databases in August 2022 were queried and screened by abstract and full text. Eligible studies were qualitatively and quantitatively analyzed by diagnostic test accuracy meta-analysis. Results: 59 studies entered the systematic review, and 37 were eligible for meta-analysis. Diffusion-weighted imaging (DWI) and fast T2-weighted (T2w) sequences were most frequently used in abbreviated protocols and showed non-inferior accuracy compared to the full protocol in detecting active inflammation. ADC and qualitative DWI had pooled sensitivity of 90% (CI: 82−95%) and 89% (CI:82−93%) and pooled specificity of 94% (CI: 88−97%) and 89% (CI: 79−94%), respectively for detecting active inflammation. Moreover, T2w and combined T2w+DWI sequences had pooled sensitivity of 80% (CI: 64−90%) and 76% (CI: 61−86%) and pooled specificity of 90% (CI: 80−95%) and 87% (CI: 74 − 94%), respectively. Unenhanced protocols show relatively poor diagnostic accuracy in detecting penetrating complications of CD. Magnetization transfer imaging (MTI) has demonstrated excellent accuracy in detecting fibrosis. High heterogeneity was observed in all subgroups, and accuracy was reported to be highly operator dependent in most studies. Conclusion: An abbreviated protocol consisting of DWI and fast T2w imaging can potentially replace the full protocol MRE. Full protocol MRE will still have its role in identifying penetrating complications. MTI should be indicated in case of suspected fibrostenotic disease.
Background:
The Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) initiative of the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) has proposed treatment-targets in 2015 for adult IBD patients. We aimed to update the original STRIDE statements for incorporating treatment targets in both adult and pediatric IBD.
Methods:
Based on a systematic review of the literature and iterative surveys of 89 IOIBD members, recommendations were drafted and modified in two surveys and two voting rounds. Consensus was reached if ≥75% of participants scored the recommendation as 7-10 on a 10-point rating scale.
Results:
In the systematic-review, 11,278 manuscripts were screened, of which 435 were included. The first IOIBD survey (n=39 on Crohn's Disease (CD) and n=36 on ulcerative colitis (UC)) identified the following targets as most important: clinical response and remission, endoscopic healing, and normalization of C-reactive protein/erythrocyte sedimentation rate and calprotectin. Fifteen recommendations were identified, of which 13 were endorsed (n=70). STRIDE-II confirmed STRIDE-I long-term targets of clinical remission and endoscopic healing and added absence of disability, restoration of quality of life and normal growth in children. Symptomatic relief and normalization of serum and fecal markers have been determined as short-term targets. Transmural healing in CD and histological healing in UC are not formal targets but should be assessed as measures of the remission depth.
Conclusions:
STRIDE-II encompasses evidence- and consensus-based recommendations for treat-to-target strategies in adults and children with IBD. This framework should be adapted to individual patients and local resources to improve outcomes.
Purpose of review:
The purpose is to provide a review of cross-sectional imaging updates in the assessment of gastrointestinal diseases, relevant to clinical practice and research.
Recent findings:
New magnetic resonance imaging contrast agents (Eovist) are taken up by hepatocytes and excreted via the biliary tree. As such, a lesion will retain contrast only if hepatocytes are present, which aids in refining the differential diagnosis. Magnetic resonance enterography is a method for non-invasively diagnosing and following various GI conditions, predominantly inflammatory bowel disease. Contrast-enhanced ultrasound uses gas-filled microbubbles providing superb temporal resolution most notably in the arterial phase, which aids in differentiating lesions. Elastography is a new technique which assesses stiffness of liver for evaluating fibrosis. These new techniques provide more accurate diagnoses and information, often limiting ionizing radiation exposure from other modalities. While ultrasound will still remain the initial imaging modality, familiarity with these other options is valuable for appropriate pathology workup.
