Seçil Telli ERDOĞAN, Esin YENCİLEK, Gamze KILIÇOĞLU, Direnç Özlem AKSOY, Koray KOÇHAN, Mehmet Masum ŞİMŞEK

Crohn hastalığında aktivite tayininde dinamik kontrastlı ve difüzyon ağırlıklı incelemelerin konvansiyonel manyetik rezonans enterografiye katkısı

Amaç: Bu çal ı ş man ı n amac ı Crohn hastal ı ğ ı nda manyetik rezonans enterografide dinamik kontrastl ı ve difüzyon a ğ ı rl ı kl ı incelemelerin kullan ı lmas ı n ı n aktif inflame segmentlerin belirlenmesine katk ı sı n ı de ğ erlendirmektir. Materyal ve Metot: Kliniğ imizde manyetik rezonans enterografi ve devam ı nda gastroenteroloji kliniğ inde kolonoskopi yapı lm ı ş hastaları n görüntüleri ve dosyaları retrospektif olarak de ğ erlendirildi. Histopatolojik olarak aktif Crohn hastal ı ğ ı tan ı s ı alm ı ş 15 hastan ı n dinamik kontrastl ı görüntülerinde ba ğ ı rsak duvarı na ROIler yerle ştirilerek, zaman-intensite e ğ rileri olu ş turuldu. Maksimum enhansman de ğ eri, wash-in de ğ eri, zaman intensite e ğ risinin altı nda kalan alan ı gösteren area under curve (AUC) de ğ eri ölçüldü. Difüzyon a ğ ı rl ı kl ı kesitlerde ba ğ ı rsak duvar ı ndaki en parlak alanlara ROIler yerle ştirildi ve ADC ölçümleri yapı ld ı . Elde edilen veriler ayn ı hastadaki normal segment ölçümleri ile k ı yasland ı . Bulgular: Aktif inflame ba ğ ı rsak segmentlerinde normal ba ğ ı rsak segmentlerine göre artm ı ş perfüzyonu gösteren maksimum enhansman, wash-in ve AUC de ğ erlerinde anlaml ı yükseklik (p

Background: The aim of this study is to evaluate the benefits of using diffusion weighted and dynamic contrast enhanced series in addition to conventional magnetic resonance enterography. Materials and Methods: Retrospective evaluation of 15 patients who were clinically and histopathologically diagnosed as active Crohns disease was made. Region of interests (ROIs) were selected and time-intensity curves were gained in the inflamed segments in dynamic contrast enhanced series. Semiquantitative parameters maximum contrast enhancement, wash-in, and area under curve (AUC) were calculated. ROIs were placed to the brightest areas in diffusion weighted series and ADC values were measured. The data was compared to the healthy segment measurements of the same patient. Results: Maximum enhancement, wash-in and AUC values, which show the increased perfusion in the actively inflamed intestinal segments were significantly higher in involved segments than the healthy segments (p<0.05). The ADC values, which show restricted diffusion were significantly lower in the inflamed segments (p<0.05). Conclusions: Adding diffusion weighted and dynamic contrast enhanced series into the standard magnetic resonance enterography protocol in Crohns patients is useful in detecting active inflammation.

PDF

___

1. Peyrin-Biroulet L, Loftus EV Jr, Colombel J-F, Sandborn WJ. The natural history of adult Crohns disease in population-based cohorts. Am J Gastroenterol 2010;105:28997.

2. Dignass A, Van Assche G, Lindsay JO, et al. The second European evidence based Consensus on the diagnosis and management of Crohns disease: current management. J Crohns Colitis 2010;4:2862.

3. Fidler J. MR imaging of small bowel. Radiol Clin North Am 2007;45:317- 31.

4. Buisson A, Joubert A, Montoriol PF, et al. Diffusion-weighted magnetic resonance imaging for detecting and assessing ileal inflammation in Crohn's disease. Aliment Pharmacol Ther 2013;37:537-45.

5. Oto A, Kayhan A, Williams JT, et al. Active Crohn's disease in the small bowel: evaluation by diffusion weighted imaging and quantitative dynamic contrast enhanced MR imaging. J Magn Reson Imaging 2011;33:615-24.

6. Oto A, Fan X, Mustafi D, et al. Quantitative analysis of dynamic contrast enhanced MRI for assessment of bowel inflammation in Crohns disease pilot study. Acad Radiol 2009;16:122330.

7. Oto A, Zhu F, Kulkarni K, Karczmar GS, Turner JR, Rubin D. Evaluation of diffusion-weighted MR imaging for detection of bowel inflammation in patients with Crohn's disease. Acad Radiol 2009;16:597-603.

8. Danese S, Sans M, de la Motte C, et al. Angiogenesis as a novel component of inflammatory bowel disease pathogenesis. Gastroenterology 2006;130:206073.

9. Brahme F, Lindström C. A comparative radiographic and pathological study of intestinal vaso-architecture in Crohns disease and in ulcerative colitis. Gut 1970;11:92840.

10. Padhani AR, Hayes C, Landau S, Leach MO. Reproducibility of quantitative dynamic MRI of normal human tissues. NMR Biomed 2002; 15:14353.

11. Barrett T, Brechbiel M, Bernardo M, Choyke PL. MRI of tumor angiogenesis. J Magn Reson Imaging 2007;26:23549.

12. Kiryu S, Dodanuki K, Takao H, et al. Free-breathing diffusion-weighted imaging for the assessment of inflammatory activity in Crohn's disease. J Magn Reson Imaging 2009;29:880-6.

13. Okada Y, Ohtomo K, Kiryu S, Sasaki Y. Breath-hold T2-weighted MRI of hepatic tumors: value of echo planar imaging with diffusion-sensitizing gradient. J Comput Assist Tomogr 1998;22:36471.

14. Kiryu S, Watanabe M, Kabasawa H, Akahane M, Aoki S, Ohtomo K. Evaluation of super paramagnetic ironoxide-enhanced diffusion-weighted PROPELLER T2-fast spin echomagnetic resonance imaging: preliminary experience. J Comput Assist Tomogr 2006;30:197200.

15. Muller MF, Prasad P, Siewert B, Nissenbaum MA, Raptopoulos V, Edelman RR. Abdominal diffusion mapping with use of a whole-body echo- planar system. Radiology 1994;190:758.