Evaluation Activity And Motion Function In Crohn's Disease With MR Bowel Imaging

Subjective: Evaluating the bowel peristalsis function and discriminating the activity in Crohn's disease(CD)with MR bowel motility imaging.Methods: A total of 75 CD patients(42 active patients and 33 inactive patients)with 100 segments lesion and 40 control cases were enrolled in the study.After MR bowel motility exams,bowel motility color map was created through the post processing software.The average motility amplitude of each control case bowel segments(duodenum,jejuno,ileum,end of ileum,ascending colon,transverse colon,descending colon and sigmoid colon)and the average,maximum,minimum values of motility amplitude of totally intestinal tract(Tmean,Tmin and Tmax)and focal tract,including lesion segment(Lmean,Lmin,Lmax),control segment(C1mean,C1 min,C1max for patient group and C2 mean,C2min,C2 max for control group),adjacent expand segment(Emean,Emax,Emin),Lmean/C1 mean,Lmax/C1 max,Lmin/C1 min,Emean /C1 mean and Tmax-Tmin were measured.One-way ANOVA and Student t test statistical analysis were made.Results: The average motility amplitude of each volunteer bowel segments from high to low were found in end of ileum,duodenum,jejuno,ileum and colons.For each volunteer,Vmean of duodenum had no statistical difference with other bowel segments.Statistical difference of Vmean between jejuno and ileum,small bowel and colon were obvious(p<0.05).The Vmean of end of ileum was statistically different compared with other bowel segments except for duodenum(p<0.05).The Vmean of ascending colon was statistically different with other colon segments(p<0.05).Other comparison was no statistical difference(p<0.05).Tmean and Tmax in the CD active group(7.71,25.21)were higher than that in the CD inactive group(6.60,23.01)and control group(7.36,24.12).The largest motility amplitude appeared in expand segment adjacent to stenosis(Emean=29.84 in active group and 31.40 in inactive one).Lmean/C1 mean ratio was significantly different among normal(1.0),active(1.11)and inactive(0.74)groups.Emean/C1 mean ratio was significantly different between CD active group(1.26)and inactive group(0.98)(P=0.000).According to the diagnosing efficiency of inactive CD,the AUC was 0.801 with a sensitivity of 84.6% and specificity of 81.8%.According to the diagnosing efficiency of active CD,the AUC was 0.726 with a sensitivity of 68.8% and specificity of 87.8%.Conclusion: MR bowel motility imaging is valuable to evaluate bowel peristalsis function and distinguish CD activity through motion change.Objective:Crohn's disease(CD)activity is critical for making clinical diagnosis and treatment.In this study,we evaluated the feasibility of conventional and functional MR in evaluating Crohn's disease activity.Methods: A total of 104 CD cases underwent conventional and functional MR examinations.Multiple parameters including intestinal wall edema,ulcer in mucous,reactive lymph nodes,wall thickness,intestine wall enhancement pattern,intestinal morphological changes,perienteric exudation,ADC values,total enhancement rate,arterial phase enhancement rate,portal phase enhancement rate and delay phase enhancement rate were determined.All the parameters were analyzed statistically.Results: A total of 61 active and 43 CD inactive cases were included.Wall edema and perienteric exudation could be only seen in active group.Ulcer in mucosa,wall thickness(0.923±0.336 cm vs 0.675±0.249cm),wall enhancement pattern,morphology,ADC values(1.598±0.383mm2/s vs 1.949±0.431mm2/s)and enhancement rate(AP: 181.46 vs 92.63,PP: 321.9 vs 201.32,DP: 466.18 vs 271.91,TP: 92.15 vs 40.59)were significantly different between active and inactive groups.The most specific parameter for activity diagnosis was TP followed by AP,DP,wall thickness,PP and ADC value.The most sensitivity parameter was DP.Moderate relationship could be found between blood CRP,ESR level and wall thickness,ADC values,total/arterial/portal/delay phase enhancement rate.MR indexes which relative with blood CRP were TP,wall thickness,AP,PP,DP and ADC values(from high relationship to low).MR indexes which relative with blood ESR were TP,wall thickness,PP,DP,ADC values and AP(from high relationship to low).The diagnosing formula would help diagnose and differentiate the CD activity,P = 1/[1+e-(-9.162+2.528(ADC values)+4.84(edema)2-0.101(TP)+2.248(wall enhance pattern))] of sensitivity 80% and specificity 100%.Conclusion: The effective MRI parameters to assess the activity of CD include ADC value,rate of enhancement,ulcer in mucosa,intestinal wall edema,change in intestinal morphology,and intestine wall enhance pattern.The most sensitive indicator was delayed phase enhancement rate and the most specific indicator was total enhancement rate.The best correlation indicator with CRP was TP.