Pier Paolo Mainenti1, Fabiana Castiglione2, Antonio Rispo2, Ettore Laccetti3, Salvatore Guarino3, Valeria Romeo3, Anna Testa2, Leonardo Pace4, Simone Maurea3. 1. Institute of Biostructures and Bioimaging of the National Council of Research (CNR), Naples, Italy. 2. Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine "Federico II" of Naples, Naples, Italy. 3. Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy. 4. Department of Medicine and Surgery, University of Salerno, Fisciano, Italy.
Abstract
OBJECTIVE: To investigate the association of mural parameters of MR-enterography (MRE) with one-year therapeutic management of Crohn's disease (CD) patients. METHODS: CD patients, undergone MRE with diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps between January 2017 and June 2018, were retrospectively enrolled. Extramural complications represented an exclusion criterion because of their potential influence on the intrinsic characteristic of the bowel wall. Two groups of patients were defined on the base of the therapeutic management adopted at 1-year follow-up: Medical-group and surgical-group. The following MRE parameters were evaluated: wall-thickening, longitudinal-extension, T2-fat-suppression-mural-signal, ulcers, mural-oedema, wall-enhancement-rate/pattern, DWI-scores, ADC-values, strictures. RESULTS: 70 CD patients were enrolled. 57/70 (81.4%) were included in Medical-group and 13/70 (18.6%) in Surgical-group. ADCmean and strictures resulted to be significantly (p < 0.01) different between the two groups. The ADCmean showed to be significantly associated to conservative management [p < 0.01; OR: 0.0003; 95% CI (0.00-0.13)], while the strictures to surgical management [p < 0.01; OR: 29.7; 95% CI (4.9-179.7)]. ROC curves for ADCmean showed that AUC was 0.717 [95% CI (0.607-0.810), p < 0.01] with an optimal cut-off value of 1.081 × 10-3 mm2 s-1. A negative predictive value of 90.2% was observed associating ADCmean values > 1.081 × 10-3 mm2 s-1 to conservative therapy. 13/17 (76%) strictures with an ADCmean > 1.081 × 10-3 mm2 s-1 benefited of conservative therapy. CONCLUSION: ADCmean values calculated on DWI-MRE may be associated to 1-year conservative medical therapy in patients with CD without extramural complications. ADVANCES IN KNOWLEDGE: ADC maps may be proposed to select CD patients with a lower burden of mural active inflammatory cells and/or fibrosis benefiting of 1-year conservative treatment.
OBJECTIVE: To investigate the association of mural parameters of MR-enterography (MRE) with one-year therapeutic management of Crohn's disease (CD) patients. METHODS: CD patients, undergone MRE with diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps between January 2017 and June 2018, were retrospectively enrolled. Extramural complications represented an exclusion criterion because of their potential influence on the intrinsic characteristic of the bowel wall. Two groups of patients were defined on the base of the therapeutic management adopted at 1-year follow-up: Medical-group and surgical-group. The following MRE parameters were evaluated: wall-thickening, longitudinal-extension, T2-fat-suppression-mural-signal, ulcers, mural-oedema, wall-enhancement-rate/pattern, DWI-scores, ADC-values, strictures. RESULTS: 70 CD patients were enrolled. 57/70 (81.4%) were included in Medical-group and 13/70 (18.6%) in Surgical-group. ADCmean and strictures resulted to be significantly (p < 0.01) different between the two groups. The ADCmean showed to be significantly associated to conservative management [p < 0.01; OR: 0.0003; 95% CI (0.00-0.13)], while the strictures to surgical management [p < 0.01; OR: 29.7; 95% CI (4.9-179.7)]. ROC curves for ADCmean showed that AUC was 0.717 [95% CI (0.607-0.810), p < 0.01] with an optimal cut-off value of 1.081 × 10-3 mm2 s-1. A negative predictive value of 90.2% was observed associating ADCmean values > 1.081 × 10-3 mm2 s-1 to conservative therapy. 13/17 (76%) strictures with an ADCmean > 1.081 × 10-3 mm2 s-1 benefited of conservative therapy. CONCLUSION: ADCmean values calculated on DWI-MRE may be associated to 1-year conservative medical therapy in patients with CD without extramural complications. ADVANCES IN KNOWLEDGE: ADC maps may be proposed to select CD patients with a lower burden of mural active inflammatory cells and/or fibrosis benefiting of 1-year conservative treatment.
Authors: A Dignass; G Van Assche; J O Lindsay; M Lémann; J Söderholm; J F Colombel; S Danese; A D'Hoore; M Gassull; F Gomollón; D W Hommes; P Michetti; C O'Morain; T Oresland; A Windsor; E F Stange; S P L Travis Journal: J Crohns Colitis Date: 2010-01-15 Impact factor: 9.071
Authors: Cécile Campos; Antoine Perrey; Céline Lambert; Bruno Pereira; Marion Goutte; Anne Dubois; Felix Goutorbe; Michel Dapoigny; Gilles Bommelaer; Constance Hordonneau; Anthony Buisson Journal: Dig Dis Sci Date: 2017-04-11 Impact factor: 3.199
Authors: Onofrio A Catalano; Michael S Gee; Emanuele Nicolai; Francesco Selvaggi; Gianluca Pellino; Alberto Cuocolo; Angelo Luongo; Marco Catalano; Bruce R Rosen; Debra Gervais; Mark G Vangel; Andrea Soricelli; Marco Salvatore Journal: Radiology Date: 2015-10-05 Impact factor: 11.105
Authors: A Jauregui-Amezaga; J Rimola; I Ordás; S Rodríguez; A Ramírez-Morros; M Gallego; M C Masamunt; J Llach; B González-Suárez; E Ricart; J Panés Journal: Gut Date: 2014-12-16 Impact factor: 23.059
Authors: Jeroen A W Tielbeek; Manon L W Ziech; Zhang Li; Cristina Lavini; Shandra Bipat; Willem A Bemelman; Joris J T H Roelofs; Cyriel Y Ponsioen; Frans M Vos; Jaap Stoker Journal: Eur Radiol Date: 2013-09-15 Impact factor: 5.315
Authors: C Hordonneau; A Buisson; J Scanzi; F Goutorbe; B Pereira; C Borderon; D Da Ines; P F Montoriol; J M Garcier; L Boyer; G Bommelaer; V Petitcolin Journal: Am J Gastroenterol Date: 2013-11-19 Impact factor: 10.864
Authors: D A Pendsé; J C Makanyanga; A A Plumb; G Bhatnagar; D Atkinson; Manuel Rodriguez-Justo; S Halligan; S A Taylor Journal: Abdom Radiol (NY) Date: 2017-01