ISBE-AstraZeneca Strategic Alliance Project 26

Evaluation of Crohn’s disease using T1-weighted dynamic contrast-

enhanced MRI (DCE-MRI)

Karl Embleton

Project objectives

• develop an M. R. based imaging technique to provide dynamic contrast enhanced images for investigation of inflammatory bowel disease

• derive disease volume measurements from contrast enhanced images of inflammatory bowel disease

• assess the application of endothelial permeability measurements to inflammatory bowel disease

• assess reproducibility of these measurements and the ability to identify treatment effects

• Five patients scanned at present

• 3 with small regions of inflammation• 1 with large region, fistula present• 1 with previous ileostomy

• Each patient scanned once only

Current recruitment

512x512x50 axial sense breathold

512x512x25 coronal sense

512x512x128 2mm axial post-contrast WAVE

MRI protocol

256x256x25 morphologicalpost-contrast

256x256x25 morphological fat-satpost-contrast

WAVE SENSE image showing inflamed and normal tissue

Enhancement curves

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Patient 3 Patient 4

time-point

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subcutaneous_ fat

inflamed bowel

artery

non-inflamed small bowel

mesentery

Permeability analysis

Standard Toft’s

Enhanced Toft’s with automated AIF

First-pass leakage profile

A model based on that of St Laurence and Lee allowing direct estimation of local tissue blood flow will also be applied

Parameter map overlays, patient 4

Kfp WAVE SENSE First pass VP

Ktrans Ve Vp

Volume renderings patient 4

Ktrans Ve Vp

Kfp First Pass Vp

Volume renderings patient 3

Ktrans Ve Vp

Kfp First Pass Vp

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Ktrans CrohnKtrans non

Mean parameter measurement for whole ROI

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Ve CrohnVe non

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Vp CrohnVp non

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Kfp CrohnKfp non

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fp Vp Crohnfp Vp non

Enhanced Toft’s with Ve abd auto AIF

First Pass

Cumulative frequency histograms, patient 4, enhanced Toft’s

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Crohn's non-inflamed

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Crohn's non-inflamed

Cumulative frequency histograms, patient 4, first pass

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0.01 0.11 0.21 0.31

Kfp

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Crohn's non-inflamed

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first pass Vp

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cyCrohn's non-inflamed

Multi-parameter segmentation

Recruitment increased to a second hospital

Reproducibility and measurement of treatment effects is required for next patients:

2 scans within 1 week prior to anti-inflammatory1 scan after 2 weeks treatment

Further work

Future possibilites could include:

Bowel motility measurements using ultra-fast SENSE imaging with contrast enhancement

CT perfusion and permeability