Intravoxel incoherent motion MRI in evaluating inflammatory activity in ulcerative colitis: a pilot study

Abstract

Background: A non-invasive tool for the assessment of ulcerative colitis (UC) activity is needed for treatment control.

Purpose: To determine the efficacy of intravoxel incoherent motion (IVIM) in assessing inflammatory activity in UC.

Material and methods: In this prospective study, 20 adult patients underwent 3.0-T magnetic resonance imaging (MRI) IVIM diffusion-weighted imaging (DWI) with 10 b-values (0-900 s/mm²) 0-6 days after biopsies entailing colonoscopy. The inflammatory activity of large bowel segments was graded on endoscopy with Mayo score and on pathology with a six‑grade classification system. IVIM‑derived parameters (f, D, and D*) calculated from regions of interest placed within the bowel wall were correlated with both scores (56 and 34 bowel segments, respectively). Radiologists were blinded to endoscopy and pathology results. A T-test and Wilcoxon rank sum test was used in comparisons and receiver operating characteristic curve analysis was performed.

Results: Statistically significant differences were found between histopathologically inactive or mild activity and moderate to severe activity in f (respectively: mean = 0.19 and mean = 0.28, P = 0.024; area under the curve [AUC] = 0.723, sensitivity 0.82, specificity 0.59, accuracy 0.67 for a 0.185 cut-off value) and D (mean = 1.34 × 10^-3mm²/s and mean = 1.07 × 10^-3mm²/s, P = 0.0083; AUC = 0.735, sensitivity 0.91, specificity 0.54, accuracy 0.66 for cut-off value 1.24 × 10^-3mm²/s). No significant difference in D* was noted. No significant correlation between Mayo endoscopic subscore, and f, D, nor D* was found.

Conclusion: IVIM perfusion fraction correlates with UC activity and might represent emerging tool in assessment of inflammatory activity.

Keywords: Diffusion magnetic resonance imaging; inflammation; intravoxel incoherent motion; ulcerative colitis.