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Medicina (Kaunas). 2019 Jul 21;55(7). pii: E394. doi: 10.3390/medicina55070394.

The Influence of Bowel Preparation on ADC Measurements: Comparison between Conventional DWI and DWIBS Sequences.

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Children Clinical University Hospital, LV-1004 Riga, Latvia.
Department of Diagnostic Radiology, Riga Stradin's University, LV-1038 Riga, Latvia.
Department of Diagnostic Radiology, Riga Stradin's University, LV-1038 Riga, Latvia.
Faculty of Medicine, Riga Stradin's University, LV-1007 Riga, Latvia.
Department of Internal Diseases, Riga Stradin's University, LV-1038 Riga, Latvia.


Background and objectives: The aim of the study was to assess whether there were differences between apparent diffusion coefficient (ADC) values of diffusion-weighted imaging (DWI) and diffusion-weighted imaging with background body signal suppression (DWIBS) sequences in non-prepared and prepared bowels before and after preparation with an enteric hyperosmolar agent, to assess whether ADC measurements have the potential to avoid bowel preparation and whether ADC-DWIBS has advantages over ADC-DWI. Materials and Methods: 106 adult patients without evidence of inflammatory bowel disease (IBD) underwent magnetic resonance (MR) enterography before and after bowel preparation. ADC-DWI and ADC-DWIBS values were measured in the intestinal and colonic walls demonstrating high signal intensity (SI) at DWI tracking images of b = 800 s/mm2 before and after preparation. Results: There were significant difference (p < 0.0001) in both ADC-DWI and ADC-DWIBS results between non-prepared and prepared jejunum for DWI being 1.09 × 10-3 mm2/s and 1.76 × 10-3 mm2/s, respectively, and for DWIBS being 0.91 × 10-3 mm2/s and 1.75 × 10-3 mm2/s, respectively. Both ADC-DWI and DWIBS also showed significant difference between non-prepared and prepared colon (p < 0.0001), with DWI values 1.41 × 10-3 mm2/s and 2.13 × 10-3 mm2/s, and DWIBS-1.01 × 10-3 mm2/s and 2.04 × 10-3 mm2/s, respectively. No significant difference between ADC-DWI and ADC-DWIBS was found in prepared jejunum (p = 0.84) and prepared colon (p = 0.58), whereas a significant difference was found in non-prepared jejunum and non-prepared colon (p = 0.0001 in both samples). Conclusions: ADC between DWI and DWIBS does not differ in prepared bowel walls but demonstrates a difference in non-prepared bowel. ADC in non-prepared bowel is lower than in prepared bowel and possible overlap with the ADC range of IBD is possible in non-prepared bowel. ADC-DWIBS has no advantage over ADC-DWI in regard to IBD assessment.


ADC; DWI; DWIBS; MR enterography; MRE; diffusion-weighted imaging

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