Skip to main content
Erschienen in: Pediatric Radiology 1/2013

01.01.2013 | Original Article

Small-bowel MRI in children and young adults with Crohn disease: retrospective head-to-head comparison of contrast-enhanced and diffusion-weighted MRI

verfasst von: Henning Neubauer, Thomas Pabst, Anke Dick, Wolfram Machann, Laura Evangelista, Clemens Wirth, Herbert Köstler, Dietbert Hahn, Meinrad Beer

Erschienen in: Pediatric Radiology | Ausgabe 1/2013

Einloggen, um Zugang zu erhalten

Abstract

Background

Small-bowel MRI based on contrast-enhanced T1-weighted sequences has been challenged by diffusion-weighted imaging (DWI) for detection of inflammatory bowel lesions and complications in patients with Crohn disease.

Objective

To evaluate free-breathing DWI, as compared to contrast-enhanced MRI, in children, adolescents and young adults with Crohn disease.

Materials and methods

This retrospective study included 33 children and young adults with Crohn disease ages 17 ± 3 years (mean ± standard deviation) and 27 matched controls who underwent small-bowel MRI with contrast-enhanced T1-weighted sequences and DWI at 1.5 T. The detectability of Crohn manifestations was determined. Concurrent colonoscopy as reference was available in two-thirds of the children with Crohn disease.

Results

DWI and contrast-enhanced MRI correctly identified 32 and 31 patients, respectively. All 22 small-bowel lesions and all Crohn complications were detected. False-positive findings (two on DWI, one on contrast-enhanced MRI), compared to colonoscopy, were a result of large-bowel lumen collapse. Inflammatory wall thickening was comparable on DWI and contrast-enhanced MRI. DWI was superior to contrast-enhanced MRI for detection of lesions in 27% of the assessed bowel segments and equal to contrast-enhanced MRI in 71% of segments.

Conclusion

DWI facilitates fast, accurate and comprehensive workup in Crohn disease without the need for intravenous administration of contrast medium. Contrast-enhanced MRI is superior in terms of spatial resolution and multiplanar acquisition.
Literatur
2.
Zurück zum Zitat Loftus EV (2004) Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences. Gastroenterology 126:1504–1517PubMedCrossRef Loftus EV (2004) Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences. Gastroenterology 126:1504–1517PubMedCrossRef
3.
Zurück zum Zitat Diefenbach KA, Breuer CK (2006) Pediatric inflammatory bowel disease. World J Gastroenterol 12:3204–3212PubMed Diefenbach KA, Breuer CK (2006) Pediatric inflammatory bowel disease. World J Gastroenterol 12:3204–3212PubMed
4.
Zurück zum Zitat Desmond AN, O’Regan K, Curran C et al (2008) Crohn’s disease: factors associated with exposure to high levels of diagnostic radiation. Gut 57:1524–1529PubMedCrossRef Desmond AN, O’Regan K, Curran C et al (2008) Crohn’s disease: factors associated with exposure to high levels of diagnostic radiation. Gut 57:1524–1529PubMedCrossRef
5.
Zurück zum Zitat Peloquin JM, Pardi DS, Sandborn WJ et al (2008) Diagnostic ionizing radiation exposure in a population-based cohort of patients with inflammatory bowel disease. Am J Gastroenterol 103:2015–2022PubMedCrossRef Peloquin JM, Pardi DS, Sandborn WJ et al (2008) Diagnostic ionizing radiation exposure in a population-based cohort of patients with inflammatory bowel disease. Am J Gastroenterol 103:2015–2022PubMedCrossRef
6.
Zurück zum Zitat Alison M, Kheniche A, Azoulay R et al (2007) Ultrasonography of Crohn disease in children. Pediatr Radiol 37:1071–1082PubMedCrossRef Alison M, Kheniche A, Azoulay R et al (2007) Ultrasonography of Crohn disease in children. Pediatr Radiol 37:1071–1082PubMedCrossRef
7.
Zurück zum Zitat Semelka RC, Shoenut JP, Silverman R et al (1991) Bowel disease: prospective comparison of CT and 1.5-T pre- and postcontrast imaging with T1-weighted fat-suppressed and breath-hold FLASH sequences. J Magn Reson Imaging 1:625–632PubMedCrossRef Semelka RC, Shoenut JP, Silverman R et al (1991) Bowel disease: prospective comparison of CT and 1.5-T pre- and postcontrast imaging with T1-weighted fat-suppressed and breath-hold FLASH sequences. J Magn Reson Imaging 1:625–632PubMedCrossRef
8.
Zurück zum Zitat Shoenut JP, Semelka RC, Magro CM et al (1994) Comparison of magnetic resonance imaging and endoscopy in distinguishing the type and severity of inflammatory bowel disease. J Clin Gastroenterol 19:31–35PubMedCrossRef Shoenut JP, Semelka RC, Magro CM et al (1994) Comparison of magnetic resonance imaging and endoscopy in distinguishing the type and severity of inflammatory bowel disease. J Clin Gastroenterol 19:31–35PubMedCrossRef
9.
Zurück zum Zitat Siddiki H, Fidler J (2009) MR imaging of the small bowel in Crohn’s disease. Eur J Radiol 69:409–417PubMedCrossRef Siddiki H, Fidler J (2009) MR imaging of the small bowel in Crohn’s disease. Eur J Radiol 69:409–417PubMedCrossRef
10.
Zurück zum Zitat Kettritz U, Isaacs K, Warshauer DM et al (1995) Crohn’s disease. Pilot study comparing MRI of the abdomen with clinical evaluation. J Clin Gastroenterol 21:249–253PubMedCrossRef Kettritz U, Isaacs K, Warshauer DM et al (1995) Crohn’s disease. Pilot study comparing MRI of the abdomen with clinical evaluation. J Clin Gastroenterol 21:249–253PubMedCrossRef
11.
Zurück zum Zitat Horsthuis K, Bipat S, Stokkers PCF et al (2009) Magnetic resonance imaging for evaluation of disease activity in Crohn’s disease: a systematic review. Eur Radiol 19:1450–1460PubMedCrossRef Horsthuis K, Bipat S, Stokkers PCF et al (2009) Magnetic resonance imaging for evaluation of disease activity in Crohn’s disease: a systematic review. Eur Radiol 19:1450–1460PubMedCrossRef
12.
Zurück zum Zitat Horsthuis K, Lavini C, Stoker J (2005) MRI in Crohn’s disease. J Magn Reson Imaging 22:1–12PubMedCrossRef Horsthuis K, Lavini C, Stoker J (2005) MRI in Crohn’s disease. J Magn Reson Imaging 22:1–12PubMedCrossRef
13.
Zurück zum Zitat Gee MS, Nimkin K, Hsu M et al (2011) Prospective evaluation of MR enterography as the primary imaging modality for pediatric Crohn disease assessment. AJR 197:224–231PubMedCrossRef Gee MS, Nimkin K, Hsu M et al (2011) Prospective evaluation of MR enterography as the primary imaging modality for pediatric Crohn disease assessment. AJR 197:224–231PubMedCrossRef
14.
Zurück zum Zitat Punwani S, Rodriguez-Justo M, Bainbridge A et al (2009) Mural inflammation in Crohn disease: location-matched histologic validation of MR imaging features. Radiology 252:712–720PubMedCrossRef Punwani S, Rodriguez-Justo M, Bainbridge A et al (2009) Mural inflammation in Crohn disease: location-matched histologic validation of MR imaging features. Radiology 252:712–720PubMedCrossRef
15.
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 29:880–886PubMedCrossRef 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 29:880–886PubMedCrossRef
16.
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 16:597–603PubMedCrossRef 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 16:597–603PubMedCrossRef
17.
Zurück zum Zitat Oto A, Kayhan A, Williams JT et al (2011) Active Crohn’s disease in the small bowel: evaluation by diffusion weighted imaging and quantitative dynamic contrast enhanced MR imaging. J Magn Reson Imaging 33:615–624PubMedCrossRef Oto A, Kayhan A, Williams JT et al (2011) Active Crohn’s disease in the small bowel: evaluation by diffusion weighted imaging and quantitative dynamic contrast enhanced MR imaging. J Magn Reson Imaging 33:615–624PubMedCrossRef
18.
Zurück zum Zitat Laghi A, Borrelli O, Paolantonio P et al (2003) Contrast enhanced magnetic resonance imaging of the terminal ileum in children with Crohn’s disease. Gut 52:393–397PubMedCrossRef Laghi A, Borrelli O, Paolantonio P et al (2003) Contrast enhanced magnetic resonance imaging of the terminal ileum in children with Crohn’s disease. Gut 52:393–397PubMedCrossRef
19.
Zurück zum Zitat Toma P, Granata C, Magnano G et al (2007) CT and MRI of paediatric Crohn disease. Pediatr Radiol 37:1083–1092PubMedCrossRef Toma P, Granata C, Magnano G et al (2007) CT and MRI of paediatric Crohn disease. Pediatr Radiol 37:1083–1092PubMedCrossRef
20.
Zurück zum Zitat Alexopoulou E, Roma E, Loggitsi D et al (2009) Magnetic resonance imaging of the small bowel in children with idiopathic inflammatory bowel disease: evaluation of disease activity. Pediatr Radiol 39:791–797PubMedCrossRef Alexopoulou E, Roma E, Loggitsi D et al (2009) Magnetic resonance imaging of the small bowel in children with idiopathic inflammatory bowel disease: evaluation of disease activity. Pediatr Radiol 39:791–797PubMedCrossRef
21.
Zurück zum Zitat Sauer CG, Kugathasan S, Martin DR et al (2011) Medical radiation exposure in children with inflammatory bowel disease estimates high cumulative doses. Inflamm Bowel Dis 17:2326–2332PubMedCrossRef Sauer CG, Kugathasan S, Martin DR et al (2011) Medical radiation exposure in children with inflammatory bowel disease estimates high cumulative doses. Inflamm Bowel Dis 17:2326–2332PubMedCrossRef
22.
Zurück zum Zitat Wiarda BM, Kuipers EJ, Houdijk LP et al (2005) MR enteroclysis: imaging technique of choice in diagnosis of small bowel diseases. Dig Dis Sci 50:1036–1040PubMedCrossRef Wiarda BM, Kuipers EJ, Houdijk LP et al (2005) MR enteroclysis: imaging technique of choice in diagnosis of small bowel diseases. Dig Dis Sci 50:1036–1040PubMedCrossRef
23.
Zurück zum Zitat Oussalah A, Laurent V, Bruot O et al (2010) Diffusion-weighted magnetic resonance without bowel preparation for detecting colonic inflammation in inflammatory bowel disease. Gut 59:1056–1065PubMedCrossRef Oussalah A, Laurent V, Bruot O et al (2010) Diffusion-weighted magnetic resonance without bowel preparation for detecting colonic inflammation in inflammatory bowel disease. Gut 59:1056–1065PubMedCrossRef
24.
Zurück zum Zitat Gahr N, Darge K, Hahn G et al (2011) Diffusion-weighted MRI for differentiation of neuroblastoma and ganglioneuroblastoma/ganglioneuroma. Eur J Radiol 79:443–446PubMedCrossRef Gahr N, Darge K, Hahn G et al (2011) Diffusion-weighted MRI for differentiation of neuroblastoma and ganglioneuroblastoma/ganglioneuroma. Eur J Radiol 79:443–446PubMedCrossRef
25.
Zurück zum Zitat Low RN, Francis IR (1997) MR imaging of the gastrointestinal tract with i.v., gadolinium and diluted barium oral contrast media compared with unenhanced MR imaging and CT. AJR 169:1051–1059PubMed Low RN, Francis IR (1997) MR imaging of the gastrointestinal tract with i.v., gadolinium and diluted barium oral contrast media compared with unenhanced MR imaging and CT. AJR 169:1051–1059PubMed
26.
Zurück zum Zitat Del Vescovo R, Sansoni I, Caviglia R et al (2008) Dynamic contrast enhanced magnetic resonance imaging of the terminal ileum: differentiation of activity of Crohn’s disease. Abdom Imaging 33:417–424PubMedCrossRef Del Vescovo R, Sansoni I, Caviglia R et al (2008) Dynamic contrast enhanced magnetic resonance imaging of the terminal ileum: differentiation of activity of Crohn’s disease. Abdom Imaging 33:417–424PubMedCrossRef
27.
Zurück zum Zitat Florie J, Wasser MN, Arts-Cieslik K et al (2006) Dynamic contrast-enhanced MRI of the bowel wall for assessment of disease activity in Crohn’s disease. AJR 186:1384–1392PubMedCrossRef Florie J, Wasser MN, Arts-Cieslik K et al (2006) Dynamic contrast-enhanced MRI of the bowel wall for assessment of disease activity in Crohn’s disease. AJR 186:1384–1392PubMedCrossRef
28.
Zurück zum Zitat Pauls S, Kratzer W, Rieber A et al (2003) [Quantifying the inflammatory activity in Crohn’s disease using CE dynamic MRI] (in German). Rofo 175:1093–1099 Pauls S, Kratzer W, Rieber A et al (2003) [Quantifying the inflammatory activity in Crohn’s disease using CE dynamic MRI] (in German). Rofo 175:1093–1099
29.
Zurück zum Zitat Umschaden HW, Szolar D, Gasser J et al (2000) Small-bowel disease: comparison of MR enteroclysis images with conventional enteroclysis and surgical findings. Radiology 215:717–725PubMed Umschaden HW, Szolar D, Gasser J et al (2000) Small-bowel disease: comparison of MR enteroclysis images with conventional enteroclysis and surgical findings. Radiology 215:717–725PubMed
30.
Zurück zum Zitat Martinez MJ, Ripolles T, Paredes JM et al (2009) Assessment of the extension and the inflammatory activity in Crohn’s disease: comparison of ultrasound and MRI. Abdom Imaging 34:141–148PubMedCrossRef Martinez MJ, Ripolles T, Paredes JM et al (2009) Assessment of the extension and the inflammatory activity in Crohn’s disease: comparison of ultrasound and MRI. Abdom Imaging 34:141–148PubMedCrossRef
31.
Zurück zum Zitat Dillman JR, Ladino-Torres MF, Adler J et al (2011) Comparison of MR enterography and histopathology in the evaluation of pediatric Crohn disease. Pediatr Radiol 41:1552–1558PubMedCrossRef Dillman JR, Ladino-Torres MF, Adler J et al (2011) Comparison of MR enterography and histopathology in the evaluation of pediatric Crohn disease. Pediatr Radiol 41:1552–1558PubMedCrossRef
32.
Zurück zum Zitat Bilgili MY (2012) Reproductibility of apparent diffusion coefficients measurements in diffusion-weighted MRI of the abdomen with different b values. Eur J Radiol 81:2066–2068PubMedCrossRef Bilgili MY (2012) Reproductibility of apparent diffusion coefficients measurements in diffusion-weighted MRI of the abdomen with different b values. Eur J Radiol 81:2066–2068PubMedCrossRef
Metadaten
Titel
Small-bowel MRI in children and young adults with Crohn disease: retrospective head-to-head comparison of contrast-enhanced and diffusion-weighted MRI
verfasst von
Henning Neubauer
Thomas Pabst
Anke Dick
Wolfram Machann
Laura Evangelista
Clemens Wirth
Herbert Köstler
Dietbert Hahn
Meinrad Beer
Publikationsdatum
01.01.2013
Verlag
Springer-Verlag
Erschienen in
Pediatric Radiology / Ausgabe 1/2013
Print ISSN: 0301-0449
Elektronische ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-012-2492-1

Weitere Artikel der Ausgabe 1/2013

Pediatric Radiology 1/2013 Zur Ausgabe

Update Radiologie

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