• Xue-Hua Li, Can-Hui Sun, Ren Mao, Zhong-Wei Zhang, Xiao-Song Jiang, Margaret H Pui, Min-Hu Chen, and Zi-Ping Li.
• From the Department of Radiology, (X-HL, C-HS, X-SJ, Z-PL); Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (RM, M-HC); Department of Radiology, UT Southwestern Medical Center, Dallas, TX (Z-WZ); and Department of Radiology, Conde de S. Januario Central Hospital, Macau, China (MHP).
• Medicine (Baltimore). 2015 Oct 1; 94 (43): e1819.

AbstractTo assess the diagnostic efficacy of diffusion-weighted MR imaging (DWI) for evaluating inflammatory activity in patients with Crohn's disease (CD). A total of 47 CD patients underwent MR enterography (MRE) and DWI using 3 b values of 50, 400, and 800 s/mm. Apparent diffusion coefficients (ADCs) of inflamed and normal bowel wall were calculated. The conventional MRE findings and DWI signal intensities were qualitatively scored from 0 to 3. The correlation between Crohn disease activity index (CDAI) and both ADCs and magnetic resonance imaging scores was analyzed. Receiver-operating characteristic curve analysis was used to determine the diagnostic accuracy of CD activity. Of the 47 patients, 25 were active CD (CDAI≥150) and 22 were inactive (CDAI<150). Diffusion-weighted MR imaging and MRE + DWI scores of active CD were significantly higher than that of inactive CD (both P < 0.001). Apparent diffusion coefficients in inflamed segments of active CD were lower than that of inactive CD (P < 0.001). The DWI scores (r = 0.74, P < 0.001), ADCs (r = -0.71, P < 0.001), MRE scores (r = 0.54, P < 0.001), and MRE + DWI scores (r = 0.66, P < 0.001) were all correlated with CDAI. The areas under the receiver-operating characteristics curves for ADCs, DWI scores, MRE scores, and MRE + DWI scores ranged from 0.83 to 0.98. The threshold ADC value of 1.17 × 10 mm/s allowed differentiation of active from inactive CD with 100% sensitivity and 88% specificity. Diffusion-weighted MR imaging and ADC correlated with CD activity, and had excellent diagnostic accuracy for differentiating active from inactive CD.

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