Comparison of MRI Activity Scoring Systems and Features for the Terminal Ileum in Patients With Crohn Disease.

OBJECTIVE: The purpose of this study was to evaluate four previously validated MRI activity scoring systems for diagnosis and grading of Crohn disease (CD) in the terminal ileum against an endoscopic and histopathologic reference standard. SUBJECTS AND METHODS: Ethics approval and written informed consent were obtained. Subjects with known or suspected CD were prospectively recruited between December 2011 and August 2014. Each patient underwent MRI and ileocolonoscopy with terminal ileum biopsies. Four MRI scoring systems (Magnetic Resonance Index of Activity [MaRIA], Clermont score, London score, and Crohn disease MRI Index) and component features were applied by two observers and correlated to the Crohn disease endoscopic index of severity (CDEIS, 0-44) and histopathologic endoscopic acute inflammation score (0-6). Interobserver agreement (weighted kappa and intraclass correlation coefficient [ICC]) and diagnostic accuracy for active and ulcerating endoscopic or histopathologic disease were evaluated. RESULTS: Ninety-eight patients (median age, 32 years old; 55 women, 43 men) were included. All four scoring systems showed good interobserver agreement (ICC = 0.70-0.78), moderate-to-strong correlation to CDEIS (r = 0.57-0.67) and weak-to-moderate correlation to endoscopic acute inflammation score (r = 0.38-0.49). Scoring systems' diagnostic accuracy for active and ulcerating endoscopic disease ranged from 73% to 78% and 71% to 76%, respectively, whereas for active histopathologic disease accuracy ranged from 65% to 72%. Between the scoring systems, no significant differences were found for both observers regarding interobserver agreement, correlation coefficients, and diagnostic accuracy. CONCLUSION: All scoring systems were comparable in terms of interobserver agreement, correlation to the endoscopic and histopathologic reference standard, and diagnostic accuracy. The London score, MaRIA, and Clermont score have the additional benefit of having validated cutoff values for both active and ulcerating endoscopic disease.

Effect of Fecal Microbiota Transplantation on 8-Week Remission in Patients With Ulcerative Colitis: A Randomized Clinical Trial.

Importance: High-intensity, aerobically prepared fecal microbiota transplantation (FMT) has demonstrated efficacy in treating active ulcerative colitis (UC). FMT protocols involving anaerobic stool processing methods may enhance microbial viability and allow efficacy with a lower treatment intensity. Objective: To assess the efficacy of a short duration of FMT therapy to induce remission in UC using anaerobically prepared stool. Design, Setting, and Participants: A total of 73 adults with mild to moderately active UC were enrolled in a multicenter, randomized, double-blind clinical trial in 3 Australian tertiary referral centers between June 2013 and June 2016, with 12-month follow-up until June 2017. Interventions: Patients were randomized to receive either anaerobically prepared pooled donor FMT (n = 38) or autologous FMT (n = 35) via colonoscopy followed by 2 enemas over 7 days. Open-label therapy was offered to autologous FMT participants at 8 weeks and they were followed up for 12 months. Main Outcomes and Measures: The primary outcome was steroid-free remission of UC, defined as a total Mayo score of ≤2 with an endoscopic Mayo score of 1 or less at week 8. Total Mayo score ranges from 0 to 12 (0 = no disease and 12 = most severe disease). Steroid-free remission of UC was reassessed at 12 months. Secondary clinical outcomes included adverse events. Results: Among 73 patients who were randomized (mean age, 39 years; women, 33 [45%]), 69 (95%) completed the trial. The primary outcome was achieved in 12 of the 38 participants (32%) receiving pooled donor FMT compared with 3 of the 35 (9%) receiving autologous FMT (difference, 23% [95% CI, 4%-42%]; odds ratio, 5.0 [95% CI, 1.2-20.1]; P = .03). Five of the 12 participants (42%) who achieved the primary end point at week 8 following donor FMT maintained remission at 12 months. There were 3 serious adverse events in the donor FMT group and 2 in the autologous FMT group. Conclusions and Relevance: In this preliminary study of adults with mild to moderate UC, 1-week treatment with anaerobically prepared donor FMT compared with autologous FMT resulted in a higher likelihood of remission at 8 weeks. Further research is needed to assess longer-term maintenance of remission and safety. Trial Registration: anzctr.org.au Identifier: ACTRN12613000236796.

Quantified Terminal Ileal Motility during MR Enterography as a Biomarker of Crohn Disease Activity: Prospective Multi-Institution Study.

Purpose To evaluate the accuracy of MRI-quantified small bowel motility for Crohn disease activity against endoscopic and histopathologic reference standards. Materials and Methods For this prospective study, 82 participants (median age, 31 years; range, 16 to 70 years; 42 males [median age, 31 years; range, 17 to 70 years] and 40 females [median age, 31 years; range, 16 to 63 years) underwent colonoscopy and MR enterography within 14 days (from October 2011 to March 2014) at two centers. The Crohn disease endoscopic index of severity (CDEIS), histopathologic activity score (endoscopic biopsy acute histologic inflammatory score [EAIS]), and MR index of activity (MaRIA) were scored in the terminal ileum. Terminal ileal motility was quantified by using an image registration based-motility assessment algorithm (hereafter, Motility). Sensitivity and specificity of Motility (˂0.3 arbitrary units) and MaRIA (≥7 and ≥11) for disease activity (CDEIS ≥4 or EAIS ≥1) were compared by using the McNemar test. Receiver operating characteristic curves were constructed and areas under the curve were compared. Motility was correlated with reference standards by using Spearman rank estimates. Results Terminal ileal Motility was negatively correlated with EAIS (r =-0.61; 95% confidence interval [CI]: 0.7, -0.5) and CDEIS (r = -0.59; 95% CI: 0.7, -0.4). With CDEIS as the standard of reference, Motility had higher sensitivity than did MaRIA (≥11) (93% vs 78%, respectively; P = .03), but lower specificity (61% vs 81%, respectively; P = .04). With EAIS as the standard of reference, Motility had higher sensitivity than did MaRIA (≥7) (92% vs 75%, respectively; P = .03) but similar specificity (71% vs 74%, respectively; P >.99). The area under the receiver operating characteristic curve for Motility was 0.86 and 0.87 with CDEIS and EAIS as the standard of reference, respectively. Conclusion The terminal ileal Motility score showed good agreement with endoscopic and histopathologic activity in Crohn disease. © RSNA, 2018 Online supplemental material is available for this article.

MRI texture analysis (MRTA) of T2-weighted images in Crohn's disease may provide information on histological and MRI disease activity in patients undergoing ileal resection.

OBJECTIVES: To associate MRI textural analysis (MRTA) with MRI and histological Crohn's disease (CD) activity. METHODS: Sixteen patients (mean age 39.5 years, 9 male) undergoing MR enterography before ileal resection were retrospectively analysed. Thirty-six small (≤3 mm) ROIs were placed on T2-weighted images and location-matched histological acute inflammatory scores (AIS) measured. MRI activity (mural thickness, T2 signal, T1 enhancement) (CDA) was scored in large ROIs. MRTA features (mean, standard deviation, mean of positive pixels (MPP), entropy, kurtosis, skewness) were extracted using a filtration histogram technique. Spatial scale filtration (SSF) ranged from 2 to 5 mm. Regression (linear/logistic) tested associations between MRTA and AIS (small ROIs), and CDA/constituent parameters (large ROIs). RESULTS: Skewness (SSF = 2 mm) was associated with AIS [regression coefficient (rc) 4.27, p = 0.02]. Of 120 large ROI analyses (for each MRI, MRTA feature and SSF), 15 were significant. Entropy (SSF = 2, 3 mm) and kurtosis (SSF = 3 mm) were associated with CDA (rc 0.9, 1.0, -0.45, p = 0.006-0.01). Entropy and mean (SSF = 2-4 mm) were associated with T2 signal [odds ratio (OR) 2.32-3.16, p = 0.02-0.004], [OR 1.22-1.28, p = 0.03-0.04]. MPP (SSF = 2 mm) was associated with mural thickness (OR 0.91, p = 0.04). Kurtosis (SSF = 3 mm), standard deviation (SSF = 5 mm) were associated with decreased T1 enhancement (OR 0.59, 0.42, p = 0.004, 0.007). CONCLUSIONS: MRTA features may be associated with CD activity. KEY POINTS: • MR texture analysis features may be associated with Crohn's disease histological activity. • Texture analysis features may correlate with MR-dependent Crohn's disease activity scores. • The utility of MR texture analysis in Crohn's disease merits further investigation.

Monitoring Crohn's disease during anti-TNF-α therapy: validation of the magnetic resonance enterography global score (MEGS) against a combined clinical reference standard.

OBJECTIVES: To assess the ability of magnetic resonance enterography global score (MEGS) to characterise Crohn's disease (CD) response to anti-TNF-α therapy. METHODS: Thirty-six CD patients (median age 26 years, 20 males) commencing anti-TNF-α therapy with concomitant baseline MRI enterography (MRE) were identified retrospectively. Patients' clinical course was followed and correlated with subsequent MREs. Scan order was randomised and MEGS (a global activity score) was applied by two blinded radiologists. A physician's global assessment of the disease activity (remission, mild, moderate or severe) at the time of MRE was assigned. The cohort was divided into clinical responders and non-responders and MEGS compared according to activity status and treatment response. Interobserver agreement was assessed. RESULTS: Median MEGS decreased significantly between baseline and first follow-up in responders (28 versus 6, P < 0.001) but was unchanged in non-responders (26 versus 18, P = 0.28). The median MEGS was significantly lower in clinical remission (9) than in moderate (14) or severe (29) activity (P < 0.001). MEGS correlated significantly with clinical activity (r = 0.53; P < 0.001). Interobserver Bland-Altman limits of agreement (BA LoA) were -19.7 to 18.5. CONCLUSIONS: MEGS decreases significantly in clinical responders to anti-TNF-α therapy but not in non-responders, demonstrates good interobserver agreement and moderate correlation with clinical disease activity. KEY POINTS: • MRI scores of Crohn's activity are used increasingly in clinical practice and therapeutic trials. • Such scores have been advocated as biomarkers of therapeutic response. • MEGS reflects clinical response to anti-TNF-α therapy and the clinical classification of disease activity. • MEGS demonstrates good interobserver agreement.

Evaluation of Crohn's disease activity: initial validation of a magnetic resonance enterography global score (MEGS) against faecal calprotectin.

OBJECTIVES: To develop an MRI enterography global score (MEGS) of Crohn's disease (CD) activity compared with a reference standard of faecal calprotectin (fC), C-reactive protein (CRP) and Harvey-Bradshaw index (HBI). METHODS: Calprotectin, CRP and HBI were prospectively recorded for 71 patients (median age 33, male 35) with known/suspected CD undergoing MRI enterography. Two observers in consensus scored activity for nine bowel segments, grading mural thickness, T2 signal, mesenteric oedema, T1 enhancement and pattern, and haustral loss. Segmental scores were multiplied according to disease length. Five points each were added for lymphadenopathy, comb sign, fistulae and abscesses to derive the MEGS. A previously validated MRI CD activity score (CDAS) was also calculated. MRI scores were correlated with clinical references using Spearman's rank. A logistic regression diagnostic model was built to discriminate active (fC > 100 µg/g) from inactive disease. RESULTS: MEGS and CDAS were significantly correlated with fC (r = 0.46, P < 0.001) and (r = 0.39, P = 0.001) respectively. MEGS correlated with CRP (r = 0.39, P = 0.002). The model for discriminating active from inactive disease achieved an area under the receiver-operating curve of 0.75 and 0.66 after leave-one-out analysis. CONCLUSION: A magnetic resonance enterography global score (MEGS) of CD activity correlated significantly with fC levels. KEY POINTS: • Magnetic resonance imaging is now widely used to assess Crohn's disease. • Existing MRI activity scores depend on local segmental endoscopic/histological reference standards. • Scores including assessment of disease extent/complications better demonstrate full disease burden. • This new global Crohn's disease burden score correlates with calprotectin and CRP. • The MRI enterography score of disease activity can complement existing clinical markers.

Current and future role of MR enterography in the management of Crohn disease.

OBJECTIVE: The purpose of this article is to explore the future role of MRI in assessing the global disease burden of Crohn disease and monitoring treatment response. CONCLUSION: MR enterography is increasingly used to evaluate disease activity in Crohn disease, and scoring methods have been validated. Current MRI protocols may be extended to allow the assessment of inflammation and fibrosis.

Grading Crohn disease activity with MRI: interobserver variability of MRI features, MRI scoring of severity, and correlation with Crohn disease endoscopic index of severity.

OBJECTIVE: The purpose of this article is to assess the interobserver variability for scoring MRI features of Crohn disease activity and to correlate two MRI scoring systems to the Crohn disease endoscopic index of severity (CDEIS). MATERIALS AND METHODS: Thirty-three consecutive patients with Crohn disease undergoing 3-T MRI examinations (T1-weighted with IV contrast medium administration and T2-weighted sequences) and ileocolonoscopy within 1 month were independently evaluated by four readers. Seventeen MRI features were recorded in 143 bowel segments and were used to calculate the MR index of activity and the Crohn disease MRI index (CDMI) score. Multirater analysis was performed for all features and scoring systems using intraclass correlation coefficient (icc) and kappa statistic. Scoring systems were compared with ileocolonoscopy with CDEIS using Spearman rank correlation. RESULTS: Thirty patients (median age, 32 years; 21 women and nine men) were included. MRI features showed fair-to-good interobserver variability (intraclass correlation coefficient or kappa varied from 0.30 to 0.69). Wall thickness in millimeters, presence of edema, enhancement pattern, and length of the disease in each segment showed a good interobserver variability between all readers (icc = 0.69, κ = 0.66, κ = 0.62, and κ = 0.62, respectively). The MR index of activity and CDMI scores showed good reproducibility (icc = 0.74 and icc = 0.78, respectively) and moderate CDEIS correlation (r = 0.51 and r = 0.59, respectively). CONCLUSION: The reproducibility of individual MRI features overall is fair to good, with good reproducibility for the most commonly used features. When combined into the MR index of activity and CDMI score, overall reproducibility is good. Both scores show moderate agreement with CDEIS.

Assessment of wall inflammation and fibrosis in Crohn's disease: value of T1-weighted gadolinium-enhanced MR imaging.

MRI is increasingly advocated as a robust method for quantifying disease activity in Crohn's disease. In particular, T1-weighted gadolinium-enhanced imaging shows considerable promise as a marker of inflammatory activity. However, interpretation of the literature must be made with an understanding of (i) the technical limitations of T1-weighted acquisition protocols and enhancement measurements; (ii) differences in standards of reference for disease activity employed between published studies; and (iii) important underlying macro and micro vascular changes in Crohn's disease. This review will focus specifically on the value of T1-weighted gadolinium-enhanced imaging in the assessment of wall inflammation and fibrosis.

Relationship between MRI quantified small bowel motility and abdominal symptoms in Crohn's disease patients-a validation study.

OBJECTIVE: Previous single-centre MRI data suggests an inverse correlation between normal small bowel motility variance and abdominal symptoms in Crohn's disease (CD) patients. The current work prospectively assesses this observation in a larger, two-centre study. METHODS: MR enterography datasets were analysed from 82 patients (38 male, aged 16-68), who completed a contemporaneous Harvey-Bradshaw index (HBI) questionnaire. Dynamic "cine motility" breath-hold balanced steady-state free precession sequences were acquired through the whole small bowel (SB) volume. Regions of interest (ROIs) were manually applied to encompass all morphologically normal SB (i.e. excluding Crohn's affected bowel) and a validated registration technique used to produce motility maps. Mean and variance motility metrics were correlated with HBI and symptom components (well-being, pain and diarrhoea) using Spearman's correlation statistics. RESULTS: Overall, motility variance was non-significantly negatively correlated with the total HBI score, (r = -0.17, p = 0.12), but for subjects with a HBI score over 10, the negative correlation was significant (r = -0.633, p = 0.027). Motility variance was negatively correlated with diarrhoea (r = -0.29, p < 0.01). No significant correlation was found between mean motility and HBI (r = -0.02, p = 0.84). CONCLUSION: An inverse association between morphologically normal small bowel motility variance and patient symptoms has been prospectively confirmed in patients with HBI scores above 10. This association is particularly apparent for the symptom of diarrhoea. Advances in knowledge: This study builds on preliminary work by confirming in a large, well-controlled prospective multicentre study a relationship between normal bowel motility variance and patient reported symptoms which may have implications for drug development and clinical management.

Semiautomatic Assessment of the Terminal Ileum and Colon in Patients with Crohn Disease Using MRI (the VIGOR++ Project).

RATIONALE AND OBJECTIVES: The objective of this study was to develop and validate a predictive magnetic resonance imaging (MRI) activity score for ileocolonic Crohn disease activity based on both subjective and semiautomatic MRI features. MATERIALS AND METHODS: An MRI activity score (the "virtual gastrointestinal tract [VIGOR]" score) was developed from 27 validated magnetic resonance enterography datasets, including subjective radiologist observation of mural T2 signal and semiautomatic measurements of bowel wall thickness, excess volume, and dynamic contrast enhancement (initial slope of increase). A second subjective score was developed based on only radiologist observations. For validation, two observers applied both scores and three existing scores to a prospective dataset of 106 patients (59 women, median age 33) with known Crohn disease, using the endoscopic Crohn's Disease Endoscopic Index of Severity (CDEIS) as a reference standard. RESULTS: The VIGOR score (17.1 × initial slope of increase + 0.2 × excess volume + 2.3 × mural T2) and other activity scores all had comparable correlation to the CDEIS scores (observer 1: r = 0.58 and 0.59, and observer 2: r = 0.34-0.40 and 0.43-0.51, respectively). The VIGOR score, however, improved interobserver agreement compared to the other activity scores (intraclass correlation coefficient = 0.81 vs 0.44-0.59). A diagnostic accuracy of 80%-81% was seen for the VIGOR score, similar to the other scores. CONCLUSIONS: The VIGOR score achieves comparable accuracy to conventional MRI activity scores, but with significantly improved reproducibility, favoring its use for disease monitoring and therapy evaluation.

Semi-automatic bowel wall thickness measurements on MR enterography in patients with Crohn's disease.

OBJECTIVE: To evaluate a semi-automatic method for delineation of the bowel wall and measurement of the wall thickness in patients with Crohn's disease. METHODS: 53 patients with suspected or proven Crohn's disease were selected. Two radiologists independently supervised the delineation of regions with active Crohn's disease on MRI, yielding manual annotations (Ano1, Ano2). Three observers manually measured the maximal bowel wall thickness of each annotated segment. An active contour segmentation approach semi-automatically delineated the bowel wall. For each active region, two segmentations (Seg1, Seg2) were obtained by independent observers, in which the maximum wall thickness was automatically determined. The overlap between (Seg1, Seg2) was compared with the overlap of (Ano1, Ano2) using Wilcoxon's signed rank test. The corresponding variances were compared using the Brown-Forsythe test. The variance of the semi-automatic thickness measurements was compared with the overall variance of manual measurements through an F-test. Furthermore, the intraclass correlation coefficient (ICC) of semi-automatic thickness measurements was compared with the ICC of manual measurements through a likelihood-ratio test. RESULTS: Patient demographics: median age, 30 years; interquartile range, 25-38 years; 33 females. The median overlap of the semi-automatic segmentations (Seg1 vs Seg2: 0.89) was significantly larger than the median overlap of the manual annotations (Ano1 vs Ano2: 0.72); p = 1.4 × 10-5. The variance in overlap of the semi-automatic segmentations was significantly smaller than the variance in overlap of the manual annotations (p = 1.1 × 10-9). The variance of the semi-automated measurements (0.46 mm2) was significantly smaller than the variance of the manual measurements (2.90 mm2, p = 1.1 × 10-7). The ICC of semi-automatic measurement (0.88) was significantly higher than the ICC of manual measurement (0.45); p = 0.005. CONCLUSION: The semi-automatic technique facilitates reproducible delineation of regions with active Crohn's disease. The semi-automatic thickness measurement sustains significantly improved interobserver agreement. Advances in knowledge: Automation of bowel wall thickness measurements strongly increases reproducibility of these measurements, which are commonly used in MRI scoring systems of Crohn's disease activity.

Aberrant Motility in Unaffected Small Bowel is Linked to Inflammatory Burden and Patient Symptoms in Crohn's Disease.

BACKGROUND: Inflammation-related enteric dysmotility has been postulated as a cause for abdominal symptoms in Crohn's disease (CD). We investigated the relationship between magnetic resonance imaging-quantified small bowel (SB) motility, inflammatory activity, and patient symptom burden. METHODS: The Harvey-Bradshaw index (HBI) and fecal calprotectin were prospectively measured in 53 patients with CD (median age, 35; range, 18-78 years) the day before magnetic resonance enterography, which included a dynamic (cine), breath-hold motility sequence, repeated to encompass the whole SB volume. A validated registration-based motility quantitation technique produced motility maps, and regions of interest were drawn to include all morphologically normal SB (i.e., excluding diseased bowel). Global SB motility was correlated with calprotectin, HBI, and symptom components (well-being, pain, and diarrhea). Adjustment for age, sex, smoking, and surgical history was made using multivariate linear regression. RESULTS: Median calprotectin was 336 (range, 0-1280). Median HBI, motility mean, and motility variance were 3 (range, 0-16), 0.33 (0.18-0.51), and 0.01 (0.0014-0.034), respectively. Motility variance was significantly negatively correlated with calprotectin (rho = -0.33, P = 0.015), total HBI (rho = -0.45, P < 0.001), well-being (rho = -0.4, P = 0.003), pain (rho = -0.27, P = 0.05), and diarrhea (rho = -0.4, P = 0.0025). The associations remained highly significant after adjusting for covariates. There was no association between mean motility and calprotectin or HBI (P > 0.05). CONCLUSIONS: Reduced motility variance in morphologically normal SB is associated with patient symptoms and fecal calprotectin levels, supporting the hypothesis that inflammation-related enteric dysmotility may explain refractory abdominal symptoms in CD.

MRI texture analysis parameters of contrast-enhanced T1-weighted images of Crohn's disease differ according to the presence or absence of histological markers of hypoxia and angiogenesis.

PURPOSE: To investigate if texture analysis parameters of contrast-enhanced MRI differ according to the presence of histological markers of hypoxia and angiogenesis in Crohn's disease (CD). METHODS: Seven CD patients (mean age 38 (19-75), 3 male)) undergoing ileal resection underwent 3T MR enterography including axial ultrafast spoiled gradient-echo T1 post IV gadolinium chelate. Regions of interest were placed in bowel destined for resection and registered to trans-mural histological sections (n = 28 across 7 bowel sections) via MRI of the resected specimen. Microvessel density (MVD) and staining for markers of hypoxia (HIF 1α) and angiogenesis (VEGF) were performed. Texture analysis features were derived utilizing an image filtration-histogram technique at spatial scaling factor (SSF) 0-6 mm, including mean, standard deviation, mean of positive pixels, entropy, kurtosis and skewness and compared according to the presence or absence of histological markers of hypoxia/angiogenesis using Mann-Whitney U/Kruskal-Wallis tests and with the log of MVD using simple linear regression. RESULTS: Mean, standard deviation and mean of positive pixels were significantly lower in sections expressing VEGF. For example at SSF 6 mm, median (inter-quartile range) of mean, standard deviation and mean of positive pixels in those with VEGF expression were 150.1 (134.7), 132.4 (49.2) and 184.0 (91.4) vs. 362.5 (150.2), 216.3 (100.1) and 416.6 (80.0) in those without (p = 0.001, p = 0.004 and p = 0.001), respectively. There was a significant association between skewness and MVD (ratio 1.97 (1.15-3.41)) at SSF = 2 mm. CONCLUSIONS: Contrast-enhanced MRI texture analysis features significantly differ according to the presence or absence of histological markers of hypoxia and angiogenesis in CD.

Incidence and Severity of Prepouch Ileitis: A Distinct Disease Entity or a Manifestation of Refractory Pouchitis?

BACKGROUND: Restorative proctocolectomy with ileal pouch-anal anastomosis is the operation of choice for patients with treatment-refractory ulcerative colitis. However, after this intervention, up to 50% of patients develop pouchitis. Moreover, a subgroup will also develop inflammation in the afferent ileum proximal to the pouch, a condition named prepouch ileitis (PI). METHODS: Data on 546 patients who underwent ileal pouch-anal anastomosis for ulcerative colitis were retrospectively collected from 3 tertiary inflammatory bowel disease referral centers in the Netherlands, Belgium, and England. PI was considered present if there was endoscopic and histological inflammation in the afferent limb proximal to the pouch. Crohn's disease was excluded by reviewing the histology of colectomy resection specimens. RESULTS: PI was present in 33/546 (6%) patients and all of these had concurrent pouchitis. One hundred forty-four (26%) patients had pouchitis without PI and 369 (68%) patients did not have inflammatory pouch disease. Of the 33 patients with PI, 6 (18%) received no specific treatment, 9 (27%) responded to antibiotics, and 18 (54%) required escalation in therapy to steroids/immunomodulators or anti-tumor necrosis factor agents. Potent immunosuppressive treatment was required more frequently in patients with PI than those with pouchitis alone. CONCLUSIONS: PI is less common and more treatment refractory than pouchitis alone. Once PI is diagnosed, clinicians should be aware that response to antibiotic therapy is less likely than in pouchitis alone. Immunomodulatory therapy and escalation to anti-tumor necrosis factor agents should be considered early in cases of nonresponse. The suggestion that PI represents misdiagnosed Crohn's disease could not be substantiated in our cohort.

Respiratory motion correction in dynamic MRI using robust data decomposition registration - application to DCE-MRI.

Motion correction in Dynamic Contrast Enhanced (DCE-) MRI is challenging because rapid intensity changes can compromise common (intensity based) registration algorithms. In this study we introduce a novel registration technique based on robust principal component analysis (RPCA) to decompose a given time-series into a low rank and a sparse component. This allows robust separation of motion components that can be registered, from intensity variations that are left unchanged. This Robust Data Decomposition Registration (RDDR) is demonstrated on both simulated and a wide range of clinical data. Robustness to different types of motion and breathing choices during acquisition is demonstrated for a variety of imaged organs including liver, small bowel and prostate. The analysis of clinically relevant regions of interest showed both a decrease of error (15-62% reduction following registration) in tissue time-intensity curves and improved areas under the curve (AUC60) at early enhancement.

Automatic Detection and Segmentation of Crohn's Disease Tissues From Abdominal MRI.

We propose an information processing pipeline for segmenting parts of the bowel in abdominal magnetic resonance images that are affected with Crohn's disease. Given a magnetic resonance imaging test volume, it is first oversegmented into supervoxels and each supervoxel is analyzed to detect presence of Crohn's disease using random forest (RF) classifiers. The supervoxels identified as containing diseased tissues define the volume of interest (VOI). All voxels within the VOI are further investigated to segment the diseased region. Probability maps are generated for each voxel using a second set of RF classifiers which give the probabilities of each voxel being diseased, normal or background. The negative log-likelihood of these maps are used as penalty costs in a graph cut segmentation framework. Low level features like intensity statistics, texture anisotropy and curvature asymmetry, and high level context features are used at different stages. Smoothness constraints are imposed based on semantic information (importance of each feature to the classification task) derived from the second set of learned RF classifiers. Experimental results show that our method achieves high segmentation accuracy with Dice metric values of 0.90 ± 0.04 and Hausdorff distance of 7.3 ± 0.8 mm. Semantic information and context features are an integral part of our method and are robust to different levels of added noise.