Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2020; 26(39): 6057-6073
Published online Oct 21, 2020. doi: 10.3748/wjg.v26.i39.6057
Dynamic contrast-enhanced magnetic resonance imaging and diffusion-weighted imaging in the activity staging of terminal ileum Crohn's disease
Yin-Chen Wu, Ze-Bin Xiao, Xue-Hua Lin, Xian-Ying Zheng, Dai-Rong Cao, Zhong-Shuai Zhang
Yin-Chen Wu, Xue-Hua Lin, Xian-Ying Zheng, Dai-Rong Cao, Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
Ze-Bin Xiao, Department of Biomedical Sciences, University of Pennsylvania, Philadelphia, PA 19104, United States
Zhong-Shuai Zhang, Department of Diagnosis Imaging, Siemens Healthcare Ltd, Shanghai 201318, China
Author contributions: Wu YC made substantial contributions to the conception and design of the study, performing the study, acquisition of data and drafting the manuscript; Xiao ZB carried out the statistical analyses and image post-processing; Lin XH performed the scanning sequences; Zhang ZS was responsible for sequence optimization; Cao DR participated in the design and helped in drafting the manuscript; Zheng XY conceived the study idea, participated in its design, and helped in drafting the manuscript; all authors have read and approved the final manuscript.
Supported by Medical Innovation Program of Fujian Province, No. 2018-CX-30; and Startup Fund for Scientific Research of Fujian Medical University, No. 2018QH1054.
Institutional review board statement: The study was reviewed and approved by the Branch for Medical Research and Clinical Technology Application, Ethics Committee of First Affiliated Hospital of Fujian Medical University.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Xian-Ying Zheng, MD, Professor, Department of Radiology, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Fuzhou 350005, Fujian Province, China.
Received: June 19, 2020
Peer-review started: June 19, 2020
First decision: July 28, 2020
Revised: August 6, 2020
Accepted: September 12, 2020
Article in press: September 12, 2020
Published online: October 21, 2020

The activity staging of Crohn’s disease (CD) in the terminal ileum is critical in developing an accurate clinical treatment plan. The activity of terminal ileum CD is associated with the microcirculation of involved bowel walls. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) can reflect perfusion and permeability of bowel walls by providing microcirculation information. As such, we hypothesize that DCE-MRI and DWI parameters can assess terminal ileum CD, thereby providing an opportunity to stage CD activity.


To evaluate the value of DCE-MRI and DWI in assessing activity of terminal ileum CD.


Forty-eight patients with CD who underwent DCE-MRI and DWI were enrolled. The patients’ activity was graded as remission, mild and moderate-severe. The transfer constant (Ktrans), wash-out constant (Kep), and extravascular extracellular volume fraction (Ve) were calculated from DCE-MRI and the apparent diffusion coefficient (ADC) was obtained from DWI. Magnetic Resonance Index of Activity (MaRIA) was calculated from magnetic resonance enterography. Differences in these quantitative parameters were compared between normal ileal loop (NIL) and inflamed terminal ileum (ITI) and among different activity grades. The correlations between these parameters, MaRIA, the Crohn’s Disease Activity Index (CDAI), and Crohn’s Disease Endoscopic Index of Severity (CDEIS) were examined. Receiver operating characteristic curve analyses were used to determine the diagnostic performance of these parameters in differentiating between CD activity levels.


Higher Ktrans (0.07 ± 0.04 vs 0.01 ± 0.01), Kep (0.24 ± 0.11 vs 0.15 ± 0.05) and Ve (0.27 ± 0.07 vs 0.08 ± 0.03), but lower ADC (1.41 ± 0.26 vs 2.41 ± 0.30) values were found in ITI than in NIL (all P < 0.001). The Ktrans, Kep, Ve and MaRIA increased with disease activity, whereas the ADC decreased (all P < 0.001). The Ktrans, Kep, Ve and MaRIA showed positive correlations with the CDAI (r = 0.866 for Ktrans, 0.870 for Kep, 0.858 for Ve, 0.890 for MaRIA, all P < 0.001) and CDEIS (r = 0.563 for Ktrans, 0.567 for Kep, 0.571 for Ve, 0.842 for MaRIA, all P < 0.001), while the ADC showed negative correlations with the CDAI (r = -0.857, P < 0.001) and CDEIS (r = -0.536, P < 0.001). The areas under the curve (AUC) for the Ktrans, Kep, Ve, ADC and MaRIA values ranged from 0.68 to 0.91 for differentiating inactive CD (CD remission) from active CD (mild to severe CD). The AUC when combining the Ktrans, Kep and Ve was 0.80, while combining DCE-MRI parameters and ADC values yielded the highest AUC of 0.95.


DCE-MRI and DWI parameters all serve as measures to stage CD activity. When they are combined, the assessment performance is improved and better than MaRIA.

Keywords: Crohn’s disease, Ileum, Magnetic resonance imaging, Diffusion-weighted imaging, Perfusion imaging

Core Tip: Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) can reflect quantitative changes in perfusion and permeability information on the microcirculation of bowel walls due to variable degrees of inflammation. This study investigated the performances of DCE-MRI and DWI for assessing the activity of Crohn’s disease (CD). The results showed that DCE-MRI and DWI parameters were correlated with CD inflammation indices and were valuable in noninvasively staging CD activity. Furthermore, the diagnostic performance of the transfer constant (Ktrans), wash-out constant (Kep), extravascular extracellular volume fraction (Ve) and ADC was better than the Magnetic Resonance Index of Activity, which can assist clinical diagnosis and monitoring.