Skip to main content
SpringerLink
Log in

Mesenteric lymph nodes in MR enterography: are they reliable followers of bowel in active Crohn’s disease?

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To demonstrate magnetic resonance enterography (MRE) features of mesenteric lymph nodes (LN) in patients with Crohn’s disease (CD) and investigate whether they follow enhancement or apparent diffusion coefficient (ADC) parameters of bowel.

Methods

This study was approved by the institutional review board. A total of 788 MREs from patients with CD were retrospectively reviewed. Eighty-eight patients, aged 16-66 years, including 59 active cases, were enrolled based on inclusion criteria. In each MRE, two segments (normal and abnormal) and two LNs (regional and non-regional) were independently suggested, consensually chosen, and analyzed by two radiologists. Signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were calculated to assess signal intensities (SI) at 30, 60 and 180 s after contrast administration, as well as slope of enhancement (SOE). Enhancement parameters and ADC values were compared.

Results

Regional LNs showed significantly higher SI30, SI60 and SI180 (CNR&SNR) and lower ADC values in active vs. inactive groups (all p<0.05) without significant difference in number or size. Strong correlations were demonstrated between abnormal segments and regional LNs in active group in terms of SI30, SI60, SI180, SOE0-30 and ADC values (r = 0.679 to 0.774, all p<0.001). SI180, SOE60-180 and ADC values were moderately correlated between abnormal segments and regional LNs in inactive group (r = 0.448 to 0.595, all p<0.05). In logistic regression analyses, SOE0-30 and ADC value of regional LNs independently predicted active CD.

Conclusion

Mesenteric LNs follow quantitative enhancement and diffusion parameters of bowel in active CD. SOE0-30 and ADC value of LN could predict disease activity.

Key Points

• Mesenteric LNs may strongly follow enhancement pattern of bowel in active CD.

• DWI parameters of LNs and bowel were strongly correlated in active CD.

• SI180 was moderately correlated between bowel and LNs in inactive CD.

• DWI parameters were moderately correlated between LNs and bowel in inactive CD.

• SOE0-30 and ADC value of mesenteric LN could predict disease activity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

ADC:

Apparent diffusion coefficient

CD:

Crohn’s disease

CNR:

Contrast-to-noise ratio

ESR:

Erythrocyte sedimentation rate

LN:

Lymph node

MRE:

Magnetic resonance enterography

SAD:

Short axis diameter

SI:

Signal intensity

SNR:

Signal-to-noise ratio

SOE:

Slope of enhancement

References

  1. Sinha R, Verma R, Verma S, Rajesh A (2011) MR enterography of Crohn disease: part 1, rationale, technique, and pitfalls. AJR Am J Roentgenol 197:76–79

    Article  Google Scholar 

  2. Li Y, Hauenstein K (2015) New Imaging Techniques in the Diagnosis of Inflammatory Bowel Diseases. Viszeralmedizin 31:227–234

    PubMed  PubMed Central  Google Scholar 

  3. Rimola J, Rodriguez S, Garcia-Bosch O et al (2009) Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn's disease. Gut 58:1113–1120

    Article  CAS  Google Scholar 

  4. von der Weid PY, Rehal S, Ferraz JG (2011) Role of the lymphatic system in the pathogenesis of Crohn's disease. Curr Opin Gastroenterol 27:335–341

    Article  Google Scholar 

  5. Gourtsoyianni S, Papanikolaou N, Amanakis E et al (2009) Crohn's disease lymphadenopathy: MR imaging findings. Eur J Radiol 69:425–428

    Article  Google Scholar 

  6. Schunk K, Kern A, Oberholzer K et al (2000) Hydro-MRI in Crohn's disease: appraisal of disease activity. Invest Radiol 35:431–437

    Article  CAS  Google Scholar 

  7. Koh DM, Miao Y, Chinn RJ et al (2001) MR imaging evaluation of the activity of Crohn's disease. AJR Am J Roentgenol 177:1325–1332

    Article  CAS  Google Scholar 

  8. Best WR, Becktel JM, Singleton JW, Kern F (1976) Development of a Crohn's disease activity index. Gastroenterology 70:439–444

    CAS  PubMed  Google Scholar 

  9. Chenevert TL, Malyarenko DI, Newitt D et al (2014) Errors in Quantitative Image Analysis due to Platform-Dependent Image Scaling. Transl Oncol 7:65–71

    Article  Google Scholar 

  10. Li Y, Zhu W, Zuo L, Shen B (2016) The Role of the Mesentery in Crohn's Disease: The Contributions of Nerves, Vessels, Lymphatics, and Fat to the Pathogenesis and Disease Course. Inflamm Bowel Dis 22:1483–1495

    Article  Google Scholar 

  11. Becker F, Yi P, Al-Kofahi M, Ganta VC, Morris J, Alexander JS (2014) Lymphatic dysregulation in intestinal inflammation: new insights into inflammatory bowel disease pathomechanisms. Lymphology 47:3–27

    CAS  PubMed  Google Scholar 

  12. Behr MA (2010) The path to Crohn's disease: is mucosal pathology a secondary event? Inflamm Bowel Dis 16:896–902

    Article  Google Scholar 

  13. Van Kruiningen HJ, Colombel JF (2008) The forgotten role of lymphangitis in Crohn's disease. Gut 57:1–4

    Article  Google Scholar 

  14. Al-Kofahi M, Yun JW, Minagar A, Alexander JS (2017) Anatomy and roles of lymphatics in inflammatory diseases. Clin Exp Neuroimmunol

  15. Kalima TV (1970) Experimental lymphatic obstruction in the ileum. Ann Chir Gynaecol Fenn 59:187–201

    CAS  PubMed  Google Scholar 

  16. Kalima TV, Saloniemi H, Rahko T (1976) Experimental regional enteritis in pigs. Scand J Gastroenterol 11:353–362

    CAS  PubMed  Google Scholar 

  17. Heatley RV, Bolton PM, Hughes LE, Owen EW (1980) Mesenteric lymphatic obstruction in Crohn's disease. Digestion 20:307–313

    Article  CAS  Google Scholar 

  18. Wu TF, Carati CJ, Macnaughton WK, von der Weid PY (2006) Contractile activity of lymphatic vessels is altered in the TNBS model of guinea pig ileitis. Am J Physiol Gastrointest Liver Physiol 291:G566–G574

    Article  CAS  Google Scholar 

  19. Jurisic G, Sundberg JP, Detmar M (2013) Blockade of VEGF receptor-3 aggravates inflammatory bowel disease and lymphatic vessel enlargement. Inflamm Bowel Dis 19:1983–1989

    PubMed  PubMed Central  Google Scholar 

  20. D'Alessio S, Correale C, Tacconi C et al (2014) VEGF-C-dependent stimulation of lymphatic function ameliorates experimental inflammatory bowel disease. J Clin Invest 124:3863–3878

    Article  CAS  Google Scholar 

  21. Coffey JC, O'Leary DP, Kiernan MG, Faul P (2016) The mesentery in Crohn's disease: friend or foe? Curr Opin Gastroenterol 32:267–273

    Article  Google Scholar 

  22. Westerland O, Griffin N (2016) Magnetic Resonance Enterography in Crohns Disease. Semin Ultrasound CT MR 37:282–291

    Article  Google Scholar 

  23. Choi SH, Kim KW, Lee JY, Kim KJ, Park SH (2016) Diffusion-weighted Magnetic Resonance Enterography for Evaluating Bowel Inflammation in Crohn's Disease: A Systematic Review and Meta-analysis. Inflamm Bowel Dis 22:669–679

    Article  Google Scholar 

  24. Oto A, Zhu F, Kulkarni K, Karczmar GS, Turner JR, Rubin D (2009) Evaluation of diffusion-weighted MR imaging for detection of bowel inflammation in patients with Crohn's disease. Acad Radiol 16:597–603

    Article  Google Scholar 

  25. Ninivaggi V, Missere M, Restaino G et al (2016) MR-enterography with diffusion weighted imaging: ADC values in normal and pathological bowel loops, a possible threshold ADC value to differentiate active from inactive Crohn's disease. Eur Rev Med Pharmacol Sci 20:4540–4546

    CAS  PubMed  Google Scholar 

  26. Spalinger J, Patriquin H, Miron MC et al (2000) Doppler US in patients with crohn disease: vessel density in the diseased bowel reflects disease activity. Radiology 217:787–791

    Article  CAS  Google Scholar 

  27. Ludwig D, Wiener S, Bruning A, Schwarting K, Jantschek G, Stange EF (1999) Mesenteric blood flow is related to disease activity and risk of relapse in Crohn's disease: a prospective follow-up study. Am J Gastroenterol 94:2942–2950

    Article  CAS  Google Scholar 

  28. Tielbeek JA, Ziech ML, Li Z et al (2014) Evaluation of conventional, dynamic contrast enhanced and diffusion weighted MRI for quantitative Crohn's disease assessment with histopathology of surgical specimens. Eur Radiol 24:619–629

    Article  Google Scholar 

  29. Rimola J, Planell N, Rodriguez S et al (2015) Characterization of inflammation and fibrosis in Crohn's disease lesions by magnetic resonance imaging. Am J Gastroenterol 110:432–440

    Article  Google Scholar 

  30. Zappa M, Stefanescu C, Cazals-Hatem D et al (2011) Which magnetic resonance imaging findings accurately evaluate inflammation in small bowel Crohn's disease? A retrospective comparison with surgical pathologic analysis. Inflamm Bowel Dis 17:984–993

    Article  Google Scholar 

  31. Gourtsoyiannis N, Papanikolaou N, Grammatikakis J, Papamastorakis G, Prassopoulos P, Roussomoustakaki M (2004) Assessment of Crohn’s disease activity in the small bowel with MR and conventional enteroclysis: preliminary results. Eur Radiol 14:1017–1024

    Article  Google Scholar 

  32. Church PC, Turner D, Feldman BM et al (2015) Systematic review with meta-analysis: magnetic resonance enterography signs for the detection of inflammation and intestinal damage in Crohn's disease. Aliment Pharmacol Ther 41:153–166

    Article  CAS  Google Scholar 

  33. de Souza HS, Fiocchi C (2016) Immunopathogenesis of IBD: current state of the art. Nat Rev Gastroenterol Hepatol 13:13–27

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank the staff of our imaging center for their effort and contribution in patient care and helping us to diagnose and manage patients with Crohn’s disease.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, North Kargar St., Tehran, 14117, Iran

    Amir Reza Radmard, Rana Eftekhar Vaghefi, Sara Naybandi Atashi, Amir Pejman Hashemi Taheri, Sepehr Haghighi & Aneseh Salehnia

  2. Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran

    Seyed Ali Montazeri & Reza Malekzadeh

  3. Department of Electrical Engineering, Central Tehran Branch, Islamic Azad University, Tehran, Iran

    Mehrdad Dadgostar

Authors
  1. Amir Reza Radmard
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rana Eftekhar Vaghefi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seyed Ali Montazeri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sara Naybandi Atashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Amir Pejman Hashemi Taheri
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sepehr Haghighi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Aneseh Salehnia
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mehrdad Dadgostar
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Reza Malekzadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amir Reza Radmard.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Reza Malekzadeh.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Informed consent was waived due to the retrospective nature of this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• cross sectional study

• performed at one institution

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Radmard, A.R., Eftekhar Vaghefi, R., Montazeri, S.A. et al. Mesenteric lymph nodes in MR enterography: are they reliable followers of bowel in active Crohn’s disease?. Eur Radiol 28, 4429–4437 (2018). https://doi.org/10.1007/s00330-018-5441-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-018-5441-z

Keywords

Search

Navigation