The usefulness of selected sequences of magnetic resonance imaging in a diagnostic model for Crohn’s disease

Introduction
We hypothesized that, based on magnetic resonance enterography (MRE) and the apparent diffusion coefficient (ADC), measured in the affected parts of the intestine, it is possible to effectively differentiate active and chronic phases of Crohn’s disease.

Aim
To create a multidimensional diagnostic model for differentiating between the phases of Crohn’s disease.

Material and methods
This study included 125 patients – 55 women (aged 19 to 66 years) and 70 men (aged 12 to 67 years) – who underwent MRE and ADC measurement for the first time.

Results
The group of potential explanatory variables comprised 11 variables, including the thickness and length of the occupied section, number of lymph nodes, layered bowel wall enhancement, total transitions on fat tissue, and features of restricted diffusion. The final discrimination model was based on 2 variables: ADC (A) and layered bowel wall enhancement (W). Active Crohn’s disease was defined as –6.339 + 4.747 × W + 0.008 × A, while chronic Crohn’s disease was defined as –11.365 + 2.812 × W + 0.012 × A. Definitive diagnosis was based on histological examination of material collected during ileocolonoscopy in 96 patients, surgery with subsequent histopathological examination in 17 patients, and capsule endoscopy in 12 patients.

Conclusions
The predictive model described here could identify the active form of Crohn’s disease with a probability of 93.06% and the chronic form with a probability of 75.57%. The use of classic MRE layered bowel wall enhancement and a DWI-based ADC metric eliminates the main shortcomings of both approaches.