Quantitative Analysis of Apparent Diffusion Coefficient for Disease Assessment in Paediatric Inflammatory Bowel Disease

Objective: To establish an apparent diffusion coefficient (ADC) cut-off value to classify active and non-active lesions in inflammatory bowel disease. Methods: We reviewed 167 paediatric Magnetic Resonance Enterographies (MRE) executed for suspected inflammatory bowel disease by using a 1.5- and 3-tesla scanner. We assessed the presence and activity of the disease by using morphologic and functional parameters such as the ADC. Each patient could have more than one examinations. Quantitative assessment of disease activity in the ADC map was measured placing 3 regions of interest in the areas of highest inflammation and the mean value was calculated, patients without sign of inflammation were assessed at two standardised site. Ileocolonoscopy, esophagogastroduodenoscopy, surgery or video-capsule endoscopy were used as standards of reference. Results: We enrolled 34 patients and 35 examinations: radiological findings of disease were identified in 29 exams and 44 lesions were detected. Six patients had negative results and ADC assessment was taken at the terminal ileum and cecum. A total of 56 bowel segments were included in the study. Image analysis revealed 39 active lesions (69.6%) and their ADC values were lower compared to the ones of non-active segments. For each scanner a cut-off value was found (sensitivity: 0.91, specificity: 0.89 for 1.5T and 0.81 for 3T). Inter-rater agreement on disease activity between ADC values and MRE results and and between ADC values and the standard of reference were very good. Conclusions: ADC can provide a scanner-based quantitative measurement of disease activity. Address correspondence and reprint requests to Alessandra Scionti, MD, Division of Diagnostic and Interventional Radiology, Department of Translational Research on New Technologies in Medicine and Surgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy (e-mail: alessandra86sc@gmail.com). Received 2 August, 2018 Accepted 5 October, 2018 Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). The authors declare that they have no conflict of interest and that no funding was received for this work. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Informed consent was obtained from all individual participants included in the study. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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