Faculty Opinions recommendation of Perianal Crohn disease: evaluation of dynamic contrast-enhanced MR imaging as an indicator of disease activity.

Background It is important to assess the activity of Graves' ophthalmopathy (GO) for planning optimal treatment strategy. Dynamic contrast-enhanced MR imaging (DCE-MRI) is a technique for assessment of microcirculation status. The correlation between disease activity and the microcirculation characteristics of extraocular muscles (EOMs) has been demonstrated in GO. Purpose To investigate the changes of rectus EOMs in patients with active vs. inactive GO using DCE-MRI, and to evaluate the value of DCE-MRI in assessing the activity of GO. Material and Methods Rectus EOMs of 20 healthy controls, 18 patients with active GO, and 16 patients with inactive GO were studied. The signal intensity (SI) of rectus EOMs on T2W images was evaluated. Regions of interest were placed on each rectus on DCE-MRI images. The DCE-MRI parameters including time to peak enhancement (Tpeak), enhancement ratio (ER), and wash-out ratio (WR) were calculated. Results There were significant differences in SI and Tpeak, ER and WR values among the three groups ( P = 0.000). However, there was no significant difference in SI between the active and inactive groups ( P = 0.07). Tpeak values of each rectus were significantly increased in inactive group compared with the active group ( P < 0.05). ER and WR values of the inferior rectus and WR values of the superior rectus in inactive group were significantly lower than those in active group ( P < 0.05). There was significant correlation between clinical activity score (CAS) and minimum Tpeak (minTpeak), maximum ER (maxER) and maximum WR (maxWR) ( P < 0.001). The cut-off values of minTpeak, maxER and maxWR were 156.98s, 1.31 and 13.50% respectively, giving positive predictive values of 68.00%, 88.90%, and 94.44% for the assessment of disease activity. Conclusion DCE-MRI could demonstrate the microcirculatory changes of rectus EOMs in both active and inactive GO, and this MRI method is a useful tool in differentiating active from inactive GO.

Download Full-text

Dynamic contrast-enhanced ultrasound of the bowel wall with quantitative assessment of Crohn’s disease activity in childhood

Radiology and Oncology ◽

10.1515/raon-2015-0042 ◽

2016 ◽

Vol 50 (4) ◽

pp. 347-354 ◽

Cited By ~ 10

Author(s):

Damjana Kljucevsek ◽

Dubravka Vidmar ◽

Darja Urlep ◽

Rok Dezman

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Kinetic Parameters ◽

Crohn Disease ◽

Quantitative Assessment ◽

Bowel Wall ◽

Contrast Enhanced Ultrasound ◽

Dynamic Contrast Enhanced ◽

Contrast Enhanced

Abstract Background Contrast-enhanced ultrasound (CEUS) has become an established non-invasive, patient-friendly imaging technique which improves the characterization of lesions. In addition, dynamic contrast-enhanced ultrasound (DCE-US) provides valuable information concerning perfusion of examined organs. This review addresses current applications of CEUS in children, focused on DCE-US of the bowel wall in patients with Crohn disease, which enables realtime assessment of the bowel wall vascularity with semi-quantitative and quantitative assessment of disease activity and response to medical treatment. Conclusions Crohn’s disease is a chronic inflammatory relapsing disease. Frequent imaging re-evaluation is necessary. Therefore, imaging should be as little invasive as possible, children friendly with high diagnostic accuracy. US with wide varieties of techniques, including CEUS/DCE-US, can provide an important contribution for diagnosing and monitoring a disease activity. Even if the use of US contrast agent is off-label in children, it is welcome and widely accepted for intravesical use, and a little less for intravenous use, manly in evaluation of parenchymal lesions. To our knowledge this is the first time that the use of DCE-US in the evaluation of activity of small bowel Crohn disease with quantitative assessment of kinetic parameters is being described in children. Even if the results of the value and accuracy of different quantitative kinetic parameters in published studies in adult population often contradict one another there is a great potential of DCE-US to become a part of the entire sonographic evaluation not only in adults, but also in children. Further control studies should be performed.

Download Full-text