Diagnosis of postoperative recurrence of Crohn disease with MR-enterography: Value of diffusion-weighted imaging - 19/06/21

Doi : 10.1016/j.diii.2021.06.002

Manel Djelouah ^a, Victoria Marical ^b, Lukshe Kanagaratnam ^c, Reza Kianmanesh ^d, Amélie Biron ^e, Guillaume Cadiot ^e, Christine Hoeffel ^a,⁎
^a Department of Radiology, Reims University Hospital and CRESTIC, URCA, 51092 Reims, France
^b Department of Radiology, Reims University Hospital, 51092 Reims, France
^c Department of Biostatistics, Reims University Hospital, 51092 Reims, France
^d Department of Hepatic and Gastrointestinal Surgery, Reims University Hospital, 51092 Reims, France
^e Department of Hepato-Gastroenterology and Digestive Oncology, Reims University Hospital, 51092 Reims, France

^⁎Corresponding author.

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Highlights

•	Diffusion-weighted MR-enterography has similar diagnostic capabilities than contrast-enhanced MR-enterography for the diagnosis of Crohn disease recurrence in patients with prior ileocolic resection and ileocolic anastomosis.
•	Diffusion-weighted MR-enterography may be used as a reliable alternative to intravenous administration of gadolinium chelate for the diagnosis of anastomotic recurrence of Crohn disease.
•	Adding diffusion-weighted imaging to contrast-enhanced MR-enterography does not significantly increase MR-enterography performances for the diagnosis of anastomotic recurrence of Crohn disease.

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Abstract

Purpose

To compare the diagnostic capabilities of MR enterography (MRE) using contrast-enhanced (CE) sequences with those of MRE using diffusion-weighted (DW) imaging for the diagnosis of postoperative recurrence at the neo-terminal ileum and/or anastomosis after ileocolonic resection in patients with Crohn disease (CD), and to clarify the role of additional DW imaging to CE-MRE in this context.

Material and methods

Forty patients who underwent ileal resection for CD, and both endoscopy and MRE within the first year after surgery were included. There were 21 men and 19 women, with a mean age of 38 years±12 (SD) years (range: 18–67 years). MRE examinations were blindly analyzed independently by one senior (R1) and one junior (R2) radiologist for the presence of small bowel postoperative recurrence at the anastomotic site. During a first reading session, T2-, steady-state- and DW-MRE were reviewed (DW-MRE or set 1). During a separate distant session, T2-, steady-state- and CE-MRE were reviewed (CE-MRE or set 2). Lastly, all sequences were analyzed altogether (set 3). Performances of each reader for the diagnosis of postoperative recurrence were evaluated using endoscopic findings as the standard of reference (Rutgeerts score≥i2b).

Results

Fifteen patients out of 40 (37.5%) had endoscopic postoperative recurrence at the anastomotic site. Sensitivity for the diagnosis of postoperative recurrence was 73% (95% CI: 51–96%) for R1 and 67% (95% CI: 43–91%) for R2 using set 1, and 80% (95% CI: 60–100%) for both readers using set 2. There was no significant differences in sensitivity between reading set 1 and reading set 2, for either R1 or R2 (R1, P> 0.99; R2, P=0.48). Specificity was 96% (95% CI: 88–100%) for both readers using set 1 or using set 2. Reading set 3 yielded an area under the ROC curve (AUC) of 0.93 (95% CI: 0.84–1) versus 0.89 (95% CI: 0.75–1) with set 1 (P=0.18) and versus 0.89 (95% CI: 0.78–1) with set 2 (P=0.21). No significant differences in AUC were found between set 1 or 2 and set 3 (P=0.18), nor between set 1 and 2 (P=0.76). Accuracies were 88% (95% CI: 74–95%) and 85% (95% CI: 71–93%) for DW-MRE for R1 and R2, respectively; 90% (95% CI: 77–96%) for CE-MRE for both readers; and 93% (95% CI: 80–97%) and 88% (95% CI: 74–95%) for R1 and R2 with set 3, respectively.