Benign Brenner tumour of the ovary: CT and MRI features

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Diffusion-weighted magnetic resonance imaging is effective to detect ileocolonic ulcerations in Crohn's disease

International audienceBackgroundMagnetic resonance entero-colonography enables accurate assessment of ileocolonic Crohn's disease, but the need for bowel cleansing and rectal enema limits considerably its use in daily practice. AimWe evaluated the accuracy of diffusion-weighted magnetic resonance entero-colonography with neither bowel cleansing nor rectal enema to assess endoscopic activity. MethodsForty-four Crohn's disease patients underwent prospectively and consecutively diffusion-weighted magnetic resonance entero-colonography [with apparent diffusion coefficient (ADC) and Clermont score calculation] and ileocolonoscopy [with Crohn's Disease Endoscopic Index of Severity (CDEIS) and Simplified Endoscopic score for Crohn's Disease (SES-CD) calculation]. ResultsMean ADC was inversely correlated with total CDEIS (=-0.40; P=0.0067) and total SES-CD (=-0.33; P=0.032). Considering the 194 segments, ADC was inversely correlated with segmental CDEIS (-0.48; P18.9 detected ulcerations with sensitivity=0.79 and specificity=0.73. ConclusionDiffusion-weighted magnetic resonance entero-colonography using apparent diffusion coefficient and Clermont score was effective to indirectly detect endoscopic ulcerations in ileocolonic Crohn's disease

La cicatrisation transmurale évaluée en IRM est associée à une meilleure évolution de la maladie et représente une nouvelle cible thérapeutique potentielle chez les patients atteints de maladie de Crohn

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MRI remission after therapeutic intervention is associated with more time spent in clinical corticosteroids-free remission and decreased risk of surgery in Crohn's disease

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Faecal calprotectin as surrogate marker of transmural healing assessed using MRI in patients with Crohn's disease

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Diffusion-weighted magnetic resonance imaging for detecting and assessing ileal inflammation in Crohn's disease

International audienceBackground Whether diffusion-weighted imaging (DWI)-MRI is of value in detecting and assessing inflammation of ileal Crohn's disease (CD) remains poorly investigated. Aim To compare DWI-MR enterography (MRE) with conventional MRE in estimating inflammation in small bowel CD, to determine an apparent diffusion coefficient (ADC) threshold to differentiate active from non-active lesions and to assess inter-observer agreement. Methods Thirty-one CD patients from the Clermont-Ferrand IBD unit with ileal involvement were consecutively and prospectively included between April and June 2011. All patients underwent DWI-MRI to detect the digestive segment with the most severe lesions, which was then used to calculate the ADC. Qualitative and quantitative results were compared with conventional MRE including MaRIA (Magnetic Resonance Index of Activity) score calculation and independent activity predictors (wall thickening, oedema, ulcers). Each examination was interpreted independently by two radiologists blinded for clinical assessment. Results Seventeen patients (54.8%) had active CD as defined by the MaRIA score 7. DWI hyperintensity was highly correlated with disease activity evaluated using conventional MRE (P=0.001). Qualitative analysis of DW sequences determined sensitivity, specificity, positive predictive value and negative predictive value as 100%, 92.9%, 94.4% and 100% respectively. Quantitative analysis using a cut-off of 1.6x103 mm2/s for ADC yielded sensitivity and specificity values of, respectively, 82.4% and 100%. Inter-observer agreement was high with regard to DWI hyperintensity (=0.69, accuracy rate=85.7%) and ADC (correlation=0.74, P<0.001, and concordance=0.71, P<0.001). Conclusion DWI-MR enterography is a well-tolerated, non-time-consuming and accurate tool for detecting and assessing inflammation in small bowel Crohn's disease

Definition of therapeutic response criteria using MRI in Crohn's disease patients treated with anti-TNF therapy: a multicenter prospective study (the IRMA study)

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Diffusion-weighted magnetic resonance imaging in ileocolonic Crohn's disease: Validation of quantitative index of activity

International audienceOBJECTIVES : Magnetic resonance imaging (MRI) allows accurate assessment of Crohn's disease (CD), but requires gadolinium injection. Diffusion-weighted (DW)-MRI yields comparable performances in small bowel CD. We compared the accuracy of DW-MR enterocolonography (MREC) and the magnetic resonance index of activity (MaRIA), and performed an external validation of the Clermont score in assessing inflammation in CD. METHODS : This was an observational prospective study of a single-center cohort. A total of 130 CD patients underwent consecutively MREC with gadolinium injection and DWI sequences between July 2011 and December 2012. RESULTS : Of the 848 evaluated segments (small bowel = 352, colon/rectum = 496), 175 (20.6%) were active (small bowel = 111, colon/rectum = 64) defined as MaRIA >= 7. Using a receiver operating characteristic (ROC) curve, we determined an apparent coefficient of diffusion (ADC) threshold of 1.9x10(-3) mm(2)/s that yielded a sensitivity and a specificity in discriminating active from nonactive CD of 96.9% and 98.1%, respectively, for the colon/rectum, and 85.9% and 81.6%, respectively, for the ileum. ADC was better correlated to MaRIA >= 7 than related contrast enhancement obtained with injected sequences (P 0.9, P 0.9, P < 0001). CONCLUSIONS : DW-MREC is a reliable tool to assess inflammation in colonic (ADC) and ileal (Clermont score) CD and its use in daily practice would avoid gadolinium injection

Early Transmural Response Assessed Using Magnetic Resonance Imaging Could Predict Sustained Clinical Remission and Prevent Bowel Damage in Patients with Crohn's Disease Treated with Anti-Tumour Necrosis Factor Therapy

International audienceBackground - Magnetic resonance imaging [MRI] is a promising tool to evaluate therapeutic efficacy in ileocolonic Crohn's disease [CD]. Aims - We aimed to assess the feasibility of early MRI evaluation (week 12 [W12]) to predict corticosteroid-free remission [CFREM] at W52 and prevent long-term bowel damage. Methods - All patients with active CD needing anti-tumour necrosis factor [anti-TNF] therapy were consecutively enrolled in this multicentre prospective study. MRI was performed before starting therapy, at W12 and W52. CFREM was defined as Crohn's Disease Activity Index  +10% or ΔRCE [relative contrast enhancement] > -30% was associated with a likelihood of CFREM at W52 of 84.6% vs 37.5% in patients without transmural response [p < 0.001]. Early transmural response could prevent bowel damage progression over time using Clermont score (hazard ratio = 0.21 [0.0-0.9]; p = 0.037). Conclusion - Evaluation of early transmural response by MRI is feasible and is a promising end point to monitor therapeutic efficacy in patients with CD