Assessment of Crohn’s disease in the small bowel: prospective comparison of magnetic resonance enteroclysis with conventional enteroclysis

Abstract

Our objective was to assess the diagnostic value of magnetic resonance enteroclysis (MRE) compared with conventional enteroclysis (CE) in patients with Crohn's disease. A secondary objective was to evaluate the diagnostic accuracy of each different MR sequence. Sixty-six consecutive patients with known Crohn's disease underwent MRE and CE. Fast imaging employing steady-state acquisition (FIESTA), single-shot fast spin-echo (ssFSE), and contrast-enhanced T1-weighted sequences were assessed by two radiologists who reached a consensus about the following findings: visualization of wall ulcers, pseudopolyps, fistulae, mural stenosis, and mesenteric abnormalities. Standard descriptive statistics and the McNemar test were used. The sensitivity, specificity and accuracy of MRE were 90-87% and 83% for the depiction of parietal ulcers, 84%-88% and 86% for pseudopolyps, 100-94% and 96% for mural stenosis, 93-100% and 94% for fistulae. The number of detected extraluminal findings was significantly higher with MRE (P < 0.01). The accuracy of FIESTA sequence was statistically higher in the depiction of wall ulcers and fistulae than that of three-dimensional fast spoiled gradient echo (3D-FSPGR) (P < 0.01) and ssFSE (P < 0.05) sequences. Contrast-enhanced 3D-FSPGR was superior for mural stenosis visualization compared to ssFSE (P < 0.05) and FIESTA (P < 0.05). MRE correlates accurately with CE in the detection of superficial and transmural abnormalities and has the advantage of assessing the mesenteric manifestations.

Using of magnetic resonance enterography in the management of Crohn's disease of the small intestine: First year of experience

“…This correlates with the severity of the endoscopic lesions and with the presence of oedema, ulcers, size of lymph nodes and the presence of pseudopolyps (14,15). In our series, we evaluate CD activity based on wall thickening, the presence of ulcers, increase in vascularisation, mesenteric inflammation and the presence of reactive lymphadenopathies (16). The information obtained on MRE was useful in scaling medical treatment in almost 50% of patients in whom it was performed for the purpose of monitoring medical treatment.…”

Correlation of MRI-determined small bowel Crohn’s disease categories with medical response and surgical pathology

“…CTE also lacks functional information, has poor fluoroscopic control of SB filling and suboptimal soft tissue contrast [6,[10][11][12] . MRI also has high sensitivity and specificity in the evaluation of CD [13] and while it does not provide as consistently good mucosal detail as conventional enteroclysis, it has a strong correlation with pathologic findings and does not use ionising radiation [14][15][16] . MRI also demonstrates good soft tissue contrast, subtle degrees of contrast enhancement and conveys functional information, while potentially differentiating active inflammation from fibrosis in preliminary studies [16,17] .…”

“…MRI also has high sensitivity and specificity in the evaluation of CD [13] and while it does not provide as consistently good mucosal detail as conventional enteroclysis, it has a strong correlation with pathologic findings and does not use ionising radiation [14][15][16] . MRI also demonstrates good soft tissue contrast, subtle degrees of contrast enhancement and conveys functional information, while potentially differentiating active inflammation from fibrosis in preliminary studies [16,17] . A retrospective paper correlating CTE findings with surgical pathology in 36 patients accurately detected strictures, fistulas, abscesses and inflammatory masses in 94% of patients [18] .…”

Role of spectral presaturation attenuated inversion‐recovery fat‐suppressed T2‐weighted MR imaging in active inflammatory bowel disease

“…Magnetic resonance imaging (MRI) is a useful alternative due to its high soft-tissue contrast, multiplanar imaging, and avoidance of ionizing radiation (6). The potential for MRI to determine the degree of inflammatory CD activity have focused on perfusion characteristics of the bowel wall after intravenous gadolinium (Gd) administration (7).…”