Diffusion-weighted magnetic resonance enterocolonography in assessing Crohn's disease activity

Introduction: Diffusion-weighted magnetic resonance imaging (DWI- MRI) has the potential for identifying inflamed bowel segments for patients with Crohn's disease (CD). Objectives: We aimed to determine diffusion-weighted imaging (DWI) value to predict active CD and compare apparent diffusion coefficients (ADC) with endoscopic and conventional magnetic resonance imaging (MRI) CD activity indices. Patients and Methods: Overall, 229 patients with suspected and diagnosed CD prospectively underwent magnetic resonance enterocolonography (MR-EC) with DWI sequence and ileocolonoscopy. Magnetic resonance activity index (MaRIA), Clermont index, and CD endoscopic index of severity (CDEIS) were calculated. Results: Of the 229 investigated patients, the clinical diagnosis of CD was confirmed in 100 persons. DWI score ≥2 had 96.9% sensitivity and 82.3% specificity for diagnosing CD. A threshold ADC value of 1.30 × 10–3 mm2 /s can distinguish between normal and inflamed bowel segments with a sensitivity of 73.8% and a specificity of 98%. While using MaRIA, the threshold ADC value of 1.32 × 10–3 mm2 /s with a sensitivity of 97.9% and a specificity of 97.8% was established. There were significant differences in the DWI scores and ADC values comparing patients with inactive, mild, moderate-severe disease (P < 0.01). ADC correlated with MaRIA-G (global) (r = −0.69, P = 0.001), Clermont-G (r = −0.722, P = 0.001) and CDEIS (r = −0.69, P = 0.001). Conclusions: DWI is a valuable tool that is able to identify inflamed bowel segments as accurate as a conventional MaRIA score and to discriminate between mild and moderate and severe CD activity

Lemann index for assessment of Crohn’s disease: correlation with the quality of life, endoscopic disease activity, magnetic resonance index of activity and C- reactive protein

Aim. Crohn’s disease (CD) is characterized by continuing infl ammation and progressive gut damage. Despite many scoring indices of CD, there is a lack of more global assessment tools for the evaluation of the total disease impact on the gut. Methods. Fift y-three adult patients with proven CD underwent magnetic resonance enterocolonography (MR-EC), colonoscopy, and clinical activity assessment, including CRP. Quality of life was assessed using IBDQ. MR-EC was used to evaluate the Magnetic Resonance Index of Activity (MaRIA- global (G)) and the Lemann Index (LI). The CD Endoscopic Index of Severity (CDEIS) was used to score the endoscopic activity of the disease. Results. A signifi cant correlation between the LI and IBDQ was found (r=-0.812, P<0.01). LI and MaRIA-G correlated moderately, while the LI did not correlate signifi cantly with CRP and CDEIS. For the detection of endoscopically active CD, MaRIA-G was more sensitive and specifi c (83.3%; 73.3%) compared to the LI (66.7%; 60.0%). There was a moderate correlation between CRP and MaRIA-G, as well as CRP and CDEIS (r=0.496; r=0.527,<0.01).Conclusion. A signifi cant negative correlation between the LI and quality of life, measured by IBDQ, was found in our study, suggesting that the LI could resemble more global features of the disease, besides infl ammatory activity of the gut