EVALUATION OF DYNAMIC MRI WITH T1-MAPS CORRELATED WITH HISTOPATHOLOGY IN PATIENTS WITH CROHN'S DISEASE.

Rationale:

Crohn’s disease (CD) is a transmural inflammatory bowel disease. Grading of severity of disease is important to be able to optimally determine treatment strategy and response to treatment. Abdominal MR-imaging using luminal and intravenous contrast medium combines transmural and extra-intestinal evaluation and can accurately show presence of disease. Moreover, MRI can discriminate between active and fibrotic disease as MRI studies undertaken to determine CD activity in the small and large bowel have indicated that a pathological increase in bowel wall enhancement after intravenous contrast administration of Gadolinium is a useful discriminatory sign of active disease.

Earlier studies have shown that dynamic contrast enhancement curves shown a correlation with active disease in patients with Crohn's disease related perianal fistulas. We expect this also to be the case in luminal Crohn's disease.


Objective:
To determine the correlation between enhancement curves at DCE-MRI and the level of histopathological activity in patients with active luminal CD.


Study design:
Prospective observational study. Patients will undergo a venapuncture and MRI scan as part of clinical routine before surgery. For this study, a dynamic sequence (DCE-MRI) sequence will be made during the MRI scan; therefore the scanning time will be prolonged for 15 minutes. Total scanning time will be 50 minutes. Also, patients have to fill in 1 questionnaire, the CDAI (duration less than 5 minutes). After surgery the resected bowel will be scanned in the MRI for anatomical reference. The inclusion period of the study will be 2 years.


Study population:
Twenty adult patients with proven Crohn’s disease who are scheduled to undergo small-bowel surgery for active M. Crohn will be included after informed consent.

To determine the correlation between enhancement curves at DCE-MRI with T1-map and the level of histopathological activity.

Before surgery, the patient will undergo an abominal MRI.

Preoperative MRI with extra dynamic sequence.