Skip to main content
Erschienen in: Die Radiologie 2/2023

21.08.2023 | Review

Diffusion-weighted imaging in Crohn’s disease

verfasst von: Maria Ingenerf, Dr. med., PD Dr. med. Christine Schmid-Tannwald

Erschienen in: Die Radiologie | Sonderheft 2/2023

Einloggen, um Zugang zu erhalten

Abstract

Background

Diffusion-weighted MRI (DWI) is routinely used in abdominal imaging. In addition to neoplastic diseases, inflammatory changes can be delineated and diagnosed based on diffusion restriction in DWI. DWI is also increasingly used in the context of MRI of the small and large intestine.

Objective

This article focuses on the technical aspects of DWI and its role in the diagnosis of Crohn’s disease (CD) as well as in the grading of disease severity and in treatment monitoring.

Materials and methods

Guidelines, basic research papers, and review articles were analyzed.

Results

Diffusion-weighted MRI is a specialized MRI technique that visualizes the diffusion of water molecules in biological tissues. In the context of MRI of the small and large intestine, DWI facilitates the diagnosis of inflammatory bowel disease and assessment of treatment response. DWI enables detection of not only intra- and transmural changes, but also extramural pathologies and complications. However, DWI also has its limitations and challenges.

Conclusion

This article provides a comprehensive overview of the use of DWI for diagnostic evaluation of bowel wall changes and extramural complications in the setting of CD. It also summarizes the relevant evidence available in the literature.
Literatur
1.
Zurück zum Zitat Bae H, Seo N, Kang EA et al (2023) Validation of the simplified magnetic resonance index of activity by using DWI without gadolinium enhancement to evaluate bowel inflammation in Crohn’s disease. Eur Radiol 33:3266–3275CrossRefPubMed Bae H, Seo N, Kang EA et al (2023) Validation of the simplified magnetic resonance index of activity by using DWI without gadolinium enhancement to evaluate bowel inflammation in Crohn’s disease. Eur Radiol 33:3266–3275CrossRefPubMed
3.
Zurück zum Zitat Barat M, Hoeffel C, Bouquot M et al (2019) Preoperative evaluation of small bowel complications in Crohn’s disease: comparison of diffusion-weighted and contrast-enhanced MR imaging. Eur Radiol 29:2034–2044CrossRefPubMed Barat M, Hoeffel C, Bouquot M et al (2019) Preoperative evaluation of small bowel complications in Crohn’s disease: comparison of diffusion-weighted and contrast-enhanced MR imaging. Eur Radiol 29:2034–2044CrossRefPubMed
4.
Zurück zum Zitat Bhatnagar G, Dikaios N, Prezzi D et al (2015) Changes in dynamic contrast-enhanced pharmacokinetic and diffusion-weighted imaging parameters reflect response to anti-TNF therapy in Crohn’s disease. BJR 88:20150547CrossRefPubMedPubMedCentral Bhatnagar G, Dikaios N, Prezzi D et al (2015) Changes in dynamic contrast-enhanced pharmacokinetic and diffusion-weighted imaging parameters reflect response to anti-TNF therapy in Crohn’s disease. BJR 88:20150547CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Buisson A, Hordonneau C, Goutte M et al (2015) Diffusion-weighted magnetic resonance imaging is effective to detect ileocolonic ulcerations in Crohn’s disease. Aliment Pharmacol Ther 42:452–460CrossRefPubMed Buisson A, Hordonneau C, Goutte M et al (2015) Diffusion-weighted magnetic resonance imaging is effective to detect ileocolonic ulcerations in Crohn’s disease. Aliment Pharmacol Ther 42:452–460CrossRefPubMed
6.
Zurück zum Zitat Buisson A, Joubert A, Montoriol PF et al (2013) Diffusion-weighted magnetic resonance imaging for detecting and assessing ileal inflammation in Crohn’s disease. Aliment Pharmacol Ther 37:537–545CrossRefPubMed Buisson A, Joubert A, Montoriol PF et al (2013) Diffusion-weighted magnetic resonance imaging for detecting and assessing ileal inflammation in Crohn’s disease. Aliment Pharmacol Ther 37:537–545CrossRefPubMed
7.
Zurück zum Zitat Caruso A, D’incà R, Scarpa M et al (2014) Diffusion-weighted magnetic resonance for assessing ileal Crohn’s disease activity. Inflamm Bowel Dis 20:1575–1583CrossRefPubMed Caruso A, D’incà R, Scarpa M et al (2014) Diffusion-weighted magnetic resonance for assessing ileal Crohn’s disease activity. Inflamm Bowel Dis 20:1575–1583CrossRefPubMed
8.
Zurück zum Zitat Catalano OA, Gee MS, Nicolai E et al (2016) Evaluation of quantitative PET/MR enterography biomarkers for discrimination of inflammatory strictures from fibrotic strictures in Crohn disease. Radiology 278:792–800CrossRefPubMed Catalano OA, Gee MS, Nicolai E et al (2016) Evaluation of quantitative PET/MR enterography biomarkers for discrimination of inflammatory strictures from fibrotic strictures in Crohn disease. Radiology 278:792–800CrossRefPubMed
9.
Zurück zum Zitat Cavusoglu M, Duran S, Sözmen Cılız D et al (2017) Added value of diffusion-weighted magnetic resonance imaging for the diagnosis of perianal fistula. Diagn Interv Imaging 98:401–408CrossRefPubMed Cavusoglu M, Duran S, Sözmen Cılız D et al (2017) Added value of diffusion-weighted magnetic resonance imaging for the diagnosis of perianal fistula. Diagn Interv Imaging 98:401–408CrossRefPubMed
10.
Zurück zum Zitat Chatterji M, Fidler JL, Taylor SA et al (2021) State of the art MR enterography technique. Top Magn Reson Imaging 30:3–11CrossRefPubMed Chatterji M, Fidler JL, Taylor SA et al (2021) State of the art MR enterography technique. Top Magn Reson Imaging 30:3–11CrossRefPubMed
11.
Zurück zum Zitat Choi SH, Kim KW, Lee JY et al (2016) Diffusion-weighted magnetic resonance enterography for evaluating bowel inflammation in Crohn’s disease: a systematic review and meta-analysis. Inflamm Bowel Dis 22:669–679CrossRefPubMed Choi SH, Kim KW, Lee JY et al (2016) Diffusion-weighted magnetic resonance enterography for evaluating bowel inflammation in Crohn’s disease: a systematic review and meta-analysis. Inflamm Bowel Dis 22:669–679CrossRefPubMed
12.
Zurück zum Zitat Costa-Silva L, Brandão AC (2013) MR enterography for the assessment of small bowel diseases. Magn Reson Imaging Clin N Am 21:365–383CrossRefPubMed Costa-Silva L, Brandão AC (2013) MR enterography for the assessment of small bowel diseases. Magn Reson Imaging Clin N Am 21:365–383CrossRefPubMed
13.
Zurück zum Zitat Dogan I, Tastekin D, Karabulut S et al (2022) Capecitabine and temozolomide (CAPTEM) is effective in metastatic well-differentiated gastrointestinal neuroendocrine tumors. J Dig Dis 23:493–499CrossRefPubMed Dogan I, Tastekin D, Karabulut S et al (2022) Capecitabine and temozolomide (CAPTEM) is effective in metastatic well-differentiated gastrointestinal neuroendocrine tumors. J Dig Dis 23:493–499CrossRefPubMed
15.
Zurück zum Zitat Fiorino G, Bonifacio C, Padrenostro M et al (2013) Comparison between 1.5 and 3.0 Tesla magnetic resonance enterography for the assessment of disease activity and complications in ileo-colonic Crohn’s disease. Dig Dis Sci 58:3246–3255CrossRefPubMed Fiorino G, Bonifacio C, Padrenostro M et al (2013) Comparison between 1.5 and 3.0 Tesla magnetic resonance enterography for the assessment of disease activity and complications in ileo-colonic Crohn’s disease. Dig Dis Sci 58:3246–3255CrossRefPubMed
16.
Zurück zum Zitat Hordonneau C, Buisson A, Scanzi J et al (2014) Diffusion-weighted magnetic resonance imaging in ileocolonic Crohn’s disease: validation of quantitative index of activity. Am J Gastroenterol 109:89–98CrossRefPubMed Hordonneau C, Buisson A, Scanzi J et al (2014) Diffusion-weighted magnetic resonance imaging in ileocolonic Crohn’s disease: validation of quantitative index of activity. Am J Gastroenterol 109:89–98CrossRefPubMed
17.
Zurück zum Zitat Ingenerf M, Schmid-Tannwald C (2023) Magnetic resonance enterography/enteroclysis : Technical aspects and indications. Radiol (heidelb) 63:429–434 Ingenerf M, Schmid-Tannwald C (2023) Magnetic resonance enterography/enteroclysis : Technical aspects and indications. Radiol (heidelb) 63:429–434
18.
Zurück zum Zitat Jesuratnam-Nielsen K, Løgager VB, Rezanavaz-Gheshlagh B et al (2015) Plain magnetic resonance imaging as an alternative in evaluating inflammation and bowel damage in inflammatory bowel disease—a prospective comparison with conventional magnetic resonance follow-through. Scand J Gastroenterol 50:519–527CrossRefPubMed Jesuratnam-Nielsen K, Løgager VB, Rezanavaz-Gheshlagh B et al (2015) Plain magnetic resonance imaging as an alternative in evaluating inflammation and bowel damage in inflammatory bowel disease—a prospective comparison with conventional magnetic resonance follow-through. Scand J Gastroenterol 50:519–527CrossRefPubMed
19.
Zurück zum Zitat Kim KJ, Lee Y, Park SH et al (2015) Diffusion-weighted MR enterography for evaluating Crohn’s disease: how does it add diagnostically to conventional MR enterography? Inflamm Bowel Dis 21:101–109CrossRefPubMed Kim KJ, Lee Y, Park SH et al (2015) Diffusion-weighted MR enterography for evaluating Crohn’s disease: how does it add diagnostically to conventional MR enterography? Inflamm Bowel Dis 21:101–109CrossRefPubMed
20.
Zurück zum Zitat Kinner S, Blex S, Maderwald S et al (2014) Addition of diffusion-weighted imaging can improve diagnostic confidence in bowel MRI. Clin Radiol 69:372–377CrossRefPubMed Kinner S, Blex S, Maderwald S et al (2014) Addition of diffusion-weighted imaging can improve diagnostic confidence in bowel MRI. Clin Radiol 69:372–377CrossRefPubMed
21.
Zurück zum Zitat Kiryu S, Dodanuki K, Takao H et al (2009) Free-breathing diffusion-weighted imaging for the assessment of inflammatory activity in Crohn’s disease. J Magn Reson Imaging 29:880–886CrossRefPubMed Kiryu S, Dodanuki K, Takao H et al (2009) Free-breathing diffusion-weighted imaging for the assessment of inflammatory activity in Crohn’s disease. J Magn Reson Imaging 29:880–886CrossRefPubMed
22.
Zurück zum Zitat Kovanlikaya A, Beneck D, Rose M et al (2015) Quantitative apparent diffusion coefficient (ADC) values as an imaging biomarker for fibrosis in pediatric Crohn’s disease: preliminary experience. Abdom Imaging 40:1068–1074CrossRefPubMed Kovanlikaya A, Beneck D, Rose M et al (2015) Quantitative apparent diffusion coefficient (ADC) values as an imaging biomarker for fibrosis in pediatric Crohn’s disease: preliminary experience. Abdom Imaging 40:1068–1074CrossRefPubMed
23.
Zurück zum Zitat Maaser C, Sturm A, Vavricka SR et al (2019) ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: Initial diagnosis, monitoring of known IBD, detection of complications. J Crohns Colitis 13:144–164CrossRefPubMed Maaser C, Sturm A, Vavricka SR et al (2019) ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: Initial diagnosis, monitoring of known IBD, detection of complications. J Crohns Colitis 13:144–164CrossRefPubMed
24.
Zurück zum Zitat Neubauer H, Pabst T, Dick A et al (2013) Small-bowel MRI in children and young adults with Crohn disease: retrospective head-to-head comparison of contrast-enhanced and diffusion-weighted MRI. Pediatr Radiol 43:103–114CrossRefPubMed Neubauer H, Pabst T, Dick A et al (2013) Small-bowel MRI in children and young adults with Crohn disease: retrospective head-to-head comparison of contrast-enhanced and diffusion-weighted MRI. Pediatr Radiol 43:103–114CrossRefPubMed
25.
Zurück zum Zitat Ninivaggi V, Missere M, Restaino G et al (2016) MR-enterography with diffusion weighted imaging: ADC values in normal and pathological bowel loops, a possible threshold ADC value to differentiate active from inactive Crohn’s disease. Eur Rev Med Pharmacol Sci 20:4540–4546PubMed Ninivaggi V, Missere M, Restaino G et al (2016) MR-enterography with diffusion weighted imaging: ADC values in normal and pathological bowel loops, a possible threshold ADC value to differentiate active from inactive Crohn’s disease. Eur Rev Med Pharmacol Sci 20:4540–4546PubMed
26.
Zurück zum Zitat Oto A, Schmid-Tannwald C, Agrawal G et al (2011) Diffusion-weighted MR imaging of abdominopelvic abscesses. Emerg Radiol 18:515–524CrossRefPubMed Oto A, Schmid-Tannwald C, Agrawal G et al (2011) Diffusion-weighted MR imaging of abdominopelvic abscesses. Emerg Radiol 18:515–524CrossRefPubMed
27.
Zurück zum Zitat Oto A, Zhu F, Kulkarni K et al (2009) Evaluation of diffusion-weighted MR imaging for detection of bowel inflammation in patients with Crohn’s disease. Acad Radiol 16:597–603CrossRefPubMedPubMedCentral Oto A, Zhu F, Kulkarni K et al (2009) Evaluation of diffusion-weighted MR imaging for detection of bowel inflammation in patients with Crohn’s disease. Acad Radiol 16:597–603CrossRefPubMedPubMedCentral
28.
Zurück zum Zitat Park SH (2016) DWI at MR Enterography for Evaluating Bowel Inflammation in Crohn Disease. Ajr Am J Roentgenol 207:40–48CrossRefPubMed Park SH (2016) DWI at MR Enterography for Evaluating Bowel Inflammation in Crohn Disease. Ajr Am J Roentgenol 207:40–48CrossRefPubMed
29.
Zurück zum Zitat Park SH, Huh J, Park SH et al (2017) Diffusion-weighted MR enterography for evaluating Crohn’s disease: Effect of anti-peristaltic agent on the diagnosis of bowel inflammation. Eur Radiol 27:2554–2562CrossRefPubMed Park SH, Huh J, Park SH et al (2017) Diffusion-weighted MR enterography for evaluating Crohn’s disease: Effect of anti-peristaltic agent on the diagnosis of bowel inflammation. Eur Radiol 27:2554–2562CrossRefPubMed
30.
Zurück zum Zitat Qi F, Jun S, Qi QY et al (2015) Utility of the diffusion-weighted imaging for activity evaluation in Crohn’s disease patients underwent magnetic resonance enterography. BMC Gastroenterol 15:12CrossRefPubMedPubMedCentral Qi F, Jun S, Qi QY et al (2015) Utility of the diffusion-weighted imaging for activity evaluation in Crohn’s disease patients underwent magnetic resonance enterography. BMC Gastroenterol 15:12CrossRefPubMedPubMedCentral
31.
Zurück zum Zitat Rimola J, Rodriguez S, García-Bosch O et al (2009) Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn’s disease. Gut 58:1113–1120CrossRefPubMed Rimola J, Rodriguez S, García-Bosch O et al (2009) Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn’s disease. Gut 58:1113–1120CrossRefPubMed
32.
Zurück zum Zitat Rozendorn N, Amitai MM, Eliakim RA et al (2018) A review of magnetic resonance enterography-based indices for quantification of Crohn’s disease inflammation. Therap Adv Gastroenterol 11:1756284818765956CrossRefPubMedPubMedCentral Rozendorn N, Amitai MM, Eliakim RA et al (2018) A review of magnetic resonance enterography-based indices for quantification of Crohn’s disease inflammation. Therap Adv Gastroenterol 11:1756284818765956CrossRefPubMedPubMedCentral
33.
Zurück zum Zitat Schmid-Tannwald C, Agrawal G, Dahi F et al (2012) Diffusion-weighted MRI: role in detecting abdominopelvic internal fistulas and sinus tracts. J Magn Reson Imaging 35:125–131CrossRefPubMed Schmid-Tannwald C, Agrawal G, Dahi F et al (2012) Diffusion-weighted MRI: role in detecting abdominopelvic internal fistulas and sinus tracts. J Magn Reson Imaging 35:125–131CrossRefPubMed
34.
Zurück zum Zitat Seo N, Park SH, Kim KJ et al (2016) MR Enterography for the evaluation of small-bowel inflammation in Crohn disease by using diffusion-weighted imaging without intravenous contrast material: a prospective Noninferiority study. Radiology 278:762–772CrossRefPubMed Seo N, Park SH, Kim KJ et al (2016) MR Enterography for the evaluation of small-bowel inflammation in Crohn disease by using diffusion-weighted imaging without intravenous contrast material: a prospective Noninferiority study. Radiology 278:762–772CrossRefPubMed
35.
Zurück zum Zitat Shenoy-Bhangle AS, Nimkin K, Aranson T et al (2016) Value of diffusion-weighted imaging when added to magnetic resonance enterographic evaluation of Crohn disease in children. Pediatr Radiol 46:34–42CrossRefPubMed Shenoy-Bhangle AS, Nimkin K, Aranson T et al (2016) Value of diffusion-weighted imaging when added to magnetic resonance enterographic evaluation of Crohn disease in children. Pediatr Radiol 46:34–42CrossRefPubMed
36.
Zurück zum Zitat Sturm A, Atreya R, Bettenworth D et al (2022) Aktualisierte S3-Leitlinie „Diagnostik und Therapie des Morbus Crohn“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – August 2021 – AWMF-Registernummer: 021-004. Z Gastroenterol 60:332–418CrossRefPubMed Sturm A, Atreya R, Bettenworth D et al (2022) Aktualisierte S3-Leitlinie „Diagnostik und Therapie des Morbus Crohn“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – August 2021 – AWMF-Registernummer: 021-004. Z Gastroenterol 60:332–418CrossRefPubMed
37.
Zurück zum Zitat Taylor SA, Avni F, Cronin CG et al (2017) The first joint ESGAR/ESPR consensus statement on the technical performance of cross-sectional small bowel and colonic imaging. Eur Radiol 27:2570–2582CrossRefPubMed Taylor SA, Avni F, Cronin CG et al (2017) The first joint ESGAR/ESPR consensus statement on the technical performance of cross-sectional small bowel and colonic imaging. Eur Radiol 27:2570–2582CrossRefPubMed
Metadaten
Titel
Diffusion-weighted imaging in Crohn’s disease
verfasst von
Maria Ingenerf, Dr. med.
PD Dr. med. Christine Schmid-Tannwald
Publikationsdatum
21.08.2023
Verlag
Springer Medizin
Erschienen in
Die Radiologie / Ausgabe Sonderheft 2/2023
Print ISSN: 2731-7048
Elektronische ISSN: 2731-7056
DOI
https://doi.org/10.1007/s00117-023-01191-y

Weitere Artikel der Sonderheft 2/2023

Die Radiologie 2/2023 Zur Ausgabe

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Klinik aktuell Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Endlich: Zi zeigt, mit welchen PVS Praxen zufrieden sind

IT für Ärzte Nachrichten

Darauf haben viele Praxen gewartet: Das Zi hat eine Liste von Praxisverwaltungssystemen veröffentlicht, die von Nutzern positiv bewertet werden. Eine gute Grundlage für wechselwillige Ärztinnen und Psychotherapeuten.

Akuter Schwindel: Wann lohnt sich eine MRT?

28.04.2024 Schwindel Nachrichten

Akuter Schwindel stellt oft eine diagnostische Herausforderung dar. Wie nützlich dabei eine MRT ist, hat eine Studie aus Finnland untersucht. Immerhin einer von sechs Patienten wurde mit akutem ischämischem Schlaganfall diagnostiziert.

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.