Celiac Disease: Evaluation with Dynamic Contrast-enhanced MR Imaging

• Published in: Radiology Vol. 256; no. 3; pp. 783 - 790
• Main Authors: Masselli, Gabriele, Picarelli, Antonio, Di Tola, Marco, Libanori, Valerio, Donato, Giuseppe, Polettini, Elisabetta, Piermattei, Alessandra, Palumbo, Piergaspare, Pittalis, Angelo, Saponara, Annarita, Gualdi, Gianfranco
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL Radiological Society of North America 01.09.2010
• Subjects: Adolescent; Adult; Analysis of Variance; Biological and medical sciences; Biopsy; Celiac Disease - diet therapy; Celiac Disease - pathology; Contrast Media; Diet, Gluten-Free; Electrolytes; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Image Enhancement - methods; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Magnetic Resonance Imaging - methods; Male; Medical sciences; Meglumine; Middle Aged; Organometallic Compounds; Other diseases. Semiology; Polyethylene Glycols; Prospective Studies; Reproducibility of Results; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Immunopathology; Intestinal malabsorption; Medical imagery; Digestive diseases; Intestinal disease; Coeliac disease; Nuclear magnetic resonance imaging
• ISSN: 0033-8419; 1527-1315; 1527-1315
• DOI: 10.1148/radiol.10092160

To prospectively determine mural perfusion dynamics in patients with untreated celiac disease by using dynamic contrast material-enhanced magnetic resonance (MR) imaging and to compare these dynamics with those in a control population and in patients with celiac disease treated with a gluten-free diet. Institutional review board approval and informed consent from all participants were obtained. Sixty consecutive patients with untreated celiac disease, 45 patients with celiac disease treated with a gluten-free diet for at least 1 year, and 30 control subjects were enrolled in this study. Dynamic contrast-enhanced MR imaging was performed by using a 1.5-T MR unit. For each MR imaging examination, maximum enhancement, slope of enhancement, and time-signal intensity curves were calculated at the level of the descending duodenal wall. Duodenal wall thickness was also evaluated. Statistical evaluation was performed by using one-way analysis of variance, and the results were confirmed by using the Bartlett test for equal variances and complemented by using Bonferroni multiple comparison, linear correlation, and the Student t test for paired data. Mean maximum enhancement of the duodenal wall was significantly higher in patients with untreated celiac disease (229.1 +/- 46.4 [standard deviation]) than in patients with treated celiac disease (109.8 +/- 27.8) and control subjects (94.7 +/- 17.9) (P < .001 for each comparison). All 60 untreated patients showed a curve characterized by fast enhancement and washout (type 4), while all 45 treated patients and the 30 control subjects showed a curve characterized by slow constant enhancement (type 2). Mean duodenal wall thickness was not significantly different between untreated patients (2.2 mm +/- 0.4), treated patients (2.0 mm +/- 0.3), and control subjects (2.0 mm +/- 0.4) (one-way analysis of variance, P = .4177; Bartlett test, P = .6951). The results of this study suggest that dynamic evaluation of the bowel wall by using contrast-enhanced MR imaging can be an effective and reproducible way to show the inflammation state in celiac disease.