Diffusion-weighted MRI Enables to Accurately Grade Inflammatory Activity in Patients of Ileocolonic Crohn's Disease: Results from an Observational Study

Xue Hua Li, Can Hui Sun, Ren Mao, Si Yun Huang, Zhong Wei Zhang, Xu Feng Yang, Li Huang, Jin Jiang Lin, Jian Zhang, Shomron Ben-Horin, Shi Ting Feng, Min Hu Chen, Zi Ping Li*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

38 Scopus citations


Background: Diffusion-weighted imaging (DWI) is a novel technique to evaluate bowel inflammation in Crohn's disease (CD). It remains unclear whether DWI could differentiate grades of inflammation activity and add to the accuracy of conventional magnetic resonance enterography (MRE) in defining disease activity. We aimed to assess the accuracy of DWI for evaluating ileocolonic CD inflammation compared with conventional MRE, using ileocolonoscopy as reference standard. Methods: This was an observational study of CD patients who underwent both ileocolonoscopy and MRE with DWI. The conventional MRE and DWI findings of the ileocolon were scored from 0 to 3. The respective segment endoscopic disease activity was scored by simplified endoscopic score for Crohn's disease (SES-CD) and was graded as inactive (0-2), mild (3-6) or moderate-severe (≥7). Results: One hundred eighty-five bowel segments from 43 consecutive CD patients were evaluated and included inactive (n = 86), mild (n = 72), and moderate-severe (n = 27) ileo-colonic segments. The area under the receiver operating characteristics curve (AUC) of 0.973 for apparent diffusion coefficient (ADC) to differentiate active from inactive CD was significantly higher than those of conventional MRE parameters (AUC between 0.840 and 0.940). Higher accuracy of ADC (AUC = 0.919) for differentiating inactive-mild from moderate-severe CD was also shown compared with that of conventional MRE parameters (AUC between 0.868 and 0.915). ADC values demonstrated strongest correlation with SES-CD (r = -0.880) comparing to DWI SI and conventional MRE parameters (r between 0.787 and 0.867). Conclusions: DWI enables to accurately grade inflammatory activity in patients of ileocolonic CD and may be better suited than conventional MRE for monitoring the activity of CD.

Original languageEnglish
Pages (from-to)244-253
Number of pages10
JournalInflammatory Bowel Diseases
Issue number2
StatePublished - 1 Feb 2017


FundersFunder number
National Natural Science Foundation of China81571750
Natural Science Foundation of Guangdong Province2015A030313043, 2014A030311018
Science and Technology Planning Project of Guangdong Province2014A020212480


    • Crohn's disease
    • apparent diffusion coefficient
    • diffusion-weighted MR imaging


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