Assessment of patency capsule retention using MR diffusion-weighted imaging

Eyal Klang, Uri Kopylov, Shomron Ben-Horin, Adi Lahat, Doron Yablecovitch, Noa Rozendorn, Rami Eliakim, Michal Marianne Amitai

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: Evaluate the ability of MR diffusion-weighted imaging (DWI) to predict patency capsule retention in Crohn’s disease (CD). Methods: Clinical and imaging data were prospectively reviewed for 80 CD patients following patency capsule administration and MR-DWI under institutional review board (IRB) approval with informed consent. Two radiologists separately assessed the presence/absence of restricted diffusion in the distal ileum. Apparent diffusion coefficients (ADC) from three regions of interest on the ileal wall were averaged. The association between restricted diffusion and retention, and sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Ability of ADC to predict retention was assessed with receiver operating characteristic (ROC) curve analysis. Results: Restricted diffusion in the distal ileum was associated with capsule retention (p = 0.001, p < 0.0001). Sensitivity, specificity, PPV and NPV of restricted diffusion for capsule retention were 100.0%, 46.2%, 30.0%, 100% and 100.0%, 56.9%, 34.9%, 100%, respectively, for two radiologists. Accuracy of ADC to predict retention was high (area under the curve = 0.851, p < 0.0001). An ADC of 1.47 mm2/s showed 90.0% sensitivity and 50.0% specificity for retention. Conclusions: Sensitivity and NPV of restricted diffusion for patency capsule retention were 100%, suggesting that DWI may predict gastrointestinal tract capability to pass video camera endoscopy. Key Points: • Capsule endoscopy enables assessment of the gastrointestinal mucosa in Crohn’s disease • Prior patency capsule administration is recommended to evaluate gastrointestinal tract patency • MR diffusion-weighted imaging may detect pathological constriction of the ileum • Restricted diffusion in the distal ileum was associated with capsule retention • MR-DWI may predict gastrointestinal tract capability to pass capsule endoscopy.

Original languageEnglish
Pages (from-to)4979-4985
Number of pages7
JournalEuropean Radiology
Volume27
Issue number12
DOIs
StatePublished - 1 Dec 2017

Keywords

  • Capsule endoscopy
  • Constriction, pathologic
  • Crohn disease
  • Diffusion-weighted magnetic resonance imaging
  • Magnetic resonance imaging

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