Estudo da sequência de difusão através da ressonância magnética de 3 Tesla em pacientes com doença de crohn

• Ano de defesa: 2018
• Autor(a) principal: Durayski, Evandra
• Orientador(a): Baldisserotto, Matteo
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Pontifícia Universidade Católica do Rio Grande do Sul
• Programa de Pós-Graduação: Programa de Pós-Graduação em Medicina e Ciências da Saúde
• Departamento: Escola de Medicina
• País: Brasil
• Palavras-chave em Português: Doença de Crohn; Difusão; Inflamação; Intestino Delgado; Ressonância Magnética
• Área do conhecimento CNPq: CIENCIAS DA SAUDE::MEDICINA
• Link de acesso: http://tede2.pucrs.br/tede2/handle/tede/8159

Introduction: Crohn's disease (CD) is an idiopathic inflammatory bowel disease, which mainly affects the terminal ileum A biopsy colonoscopy with regard to the gold standard in the assessment of disease and the area of education costly and with anesthetic risks. Noninvasive methods of evaluation such as magnetic resonance enterography (MRE) have been developed in the last decade. Evaluation systems such as the magnetic resonance index of activity (MaRIA) and Clermont score are used in clinical studies to quantify inflammation in patients with CD. A diffusion-weighted magnetic resonance imaging (DWI) evaluates a restitution of the water molecules in the tissues. Studies have shown a correlation between a restriction of diffusion on the wall of the intestine with inflammation. However, few studies with MRE of 3 Tesla support analysis a apparent diffusion coefficient (ADC) correlactionan in inflammatory proces in the terminal ileum. Purpose: To determine the applicability of the sequence DWI in 3 Tesla MRE in the identification of inflammatory signs in the distal ileum in patients with Crohn’s disease. Materials and Methods: We retrospectively studied 38 individuals with CD, who underwent MRE between March 2014 to september 2017 and had an anatomopathological and endoscopic evaluation in the distal ileum. The following variables were evaluated: diffusion (DWI), quantitative ADC, wall thickening, intramural edema, ulcerations, stricture, segmental mural hyperenhancement, relativo contrast enchancement (RCE), MaRIA and Clermont score. Results: The mean duration of the disease was 7 ± 5 years, 19 patients (50%) were male. Eighteen patients (47%) had active inflammatory disease and twenthy (53%) had disease in remission in the terminal ileum. Patients with active inflammatory disease in the distal ileum had a greater restriction on DWI, intramural edema, wall thickening, MaRIA and Clermont score, when compared to the group of patients without inflammation. The correlation between MaRIA and Clermont score (r = 0.975) was strong. The Kappa coefficient of interobserver agreement was excellent for the MaRIA, Clermont score and restriction DWI, moderate for ADC and weak for RCE. The best cut-off point in this study for the inflammation identified by the colonoscopy for the ADC was 2.1x103mm2/s, with sensitivity of 88.8% and specificity of 95.0%. The DWI presented accuracy of 89.4%, sensitivity of 88.9% and specificity of 90.0% in relation to inflammation identified by colonoscopy. Conclusion: The quantitative values of ADC have a good sensitivity in detecting inflammation at colonoscopy. Analysis of the diffusion sequence of good accuracy in the detection of ileum inflammmation in patients with Crohn's disease. However, when in association with intramural enhancement, edema and wall thickening it has a strong correlation with severe inflammation identified at colonoscopy.