Crohn's disease evaluation: Comparison of contrast-enhanced MR imaging and single-phase helical CT scanning

Low, Russell N.; Francis, Isaac R.; Politoske, Douglas; Bennett, Michael T.

doi:10.1002/(sici)1522-2586(200002)11:2<127::aid-jmri8>3.0.co;2-g

Cited by 162 publications

(70 citation statements)

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“…Our results may differ from previous studies, where Gd-enhancement showed a higher accuracy than T2W sequences in assessing disease activity (25,26). However, we used a potentially more optimized SPAIR FS technique, specifically in consideration of the challenges facing images acquired of gas-filled and peristaltic bowel.…”

Section: Discussionmentioning

confidence: 85%

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

Udayasankar

Martín

Lauenstein

et al. 2008

Magnetic Resonance Imaging

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Purpose:To retrospectively evaluate the efficacy of spectral presaturation attenuated inversion-recovery (SPAIR) fatsuppressed (FS) partial Fourier single shot (SSH) T2-weighted (T2W) and gadolinium-enhanced (Gd) FS 3D-gradient echo (3DGRE) T1-weighted (T1W) delayed phase MRI to differentiate active bowel inflammation from fibrotic disease in patients with Crohn's disease (CD). Materials and Methods:MRI studies of 81 patients (mean age, 43 years; range, 22-77 years; M:F ratio 33:48) had T2W and T1W imaging including SPAIR-SSH and delayed Gd-3DGRE. The ability to assess disease activity in bowel segments affected were retrospectively evaluated by a grading scheme based on subjective analysis of signal intensities. These results were compared against the standard clinical parameters of disease activity.Results: SPAIR-SSH images correlated better (r ϭ 0.74, P Ͻ 0.0001) with activity than delayed Gd-3DGRE (r ϭ 0.39, P ϭ 0.0003), with a significant difference between the two techniques (P Ͻ 0.0001). SPAIR-SSH images showed higher specificity in detection of severely active disease in per patient (98%) and segmental (98%) analysis compared to Gd-3DGRE (57%, 70%). Gd-3DGRE technique showed significantly higher sensitivity (P ϭ 0.01) in identifying active disease in per patient (83%) and segmental (85%) analysis compared to SPAIR-SSH (70%, 64%).Conclusion: SPAIR-SSH detects actively diseased CD bowel segments with a high level of specificity. Noninflammatory bowel fibrosis corresponds to abnormal uptake on delayed phase Gd-3DGRE images but without associated elevated abnormal signal on SPAIR-SSH.

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Section: Discussionmentioning

confidence: 85%

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

Udayasankar

Martín

Lauenstein

et al. 2008

Magnetic Resonance Imaging

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“…In addition to lack of ionizing radiation exposure, MR has the advantage of evaluation of stenotic lesions with MR fluoroscopy technique and conspicuity of abnormal bowel wall signal (6,42,43). However, the benefits of CT over MR include greater availability and robustness, shorter exam times, and higher spatial resolution.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Ionizing Radiation Exposure in a Population-Based Cohort of Patients with Inflammatory Bowel Disease

Peloquin¹,

Pardi²,

Sandborn³

et al. 2008

The American Journal of Gastroenterology

180

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Objective-For diagnosis, assessing disease activity, complications and extraintestinal manifestations, and monitoring response to therapy, patients with inflammatory bowel disease undergo many radiological studies employing ionizing radiation. However, the extent of radiation exposure in these patients is unknown.Methods-A population-based inception cohort of 215 patients with inflammatory bowel disease from Olmsted County, Minnesota, diagnosed between 1990 and 2001, was identified. The total effective dose of diagnostic ionizing radiation was estimated for each patient. Linear regression was used to assess the median total effective dose since symptom onset.Results-The number of patients with Crohn's disease and ulcerative colitis was 103 and 112, with a mean age at diagnosis of 38.6 and 39.4 yr, respectively. Mean follow-up was 8.9 yr for Crohn's disease and 9.0 yr for ulcerative colitis. Median total effective dose for Crohn's disease was 26.6 millisieverts (mSv) (range, 0-279) versus 10.5 mSv (range, 0-251) for ulcerative colitis (P < 0.001). Computed tomography accounted for 51% and 40% of total effective dose, respectively. Patients with Crohn's disease had 2.46 times higher total effective dose than ulcerative colitis patients (P = 0.001), adjusting for duration of disease.Conclusions-Annualizing our data, the radiation exposure in the inflammatory bowel disease population was equivalent to the average annual background radiation dose from naturally occurring sources in the U.S. (3.0 mSv). However, a subset of patients had substantially higher doses. The development of imaging management guidelines to minimize radiation dose, dosereduction techniques in computed tomography, and faster, more robust magnetic resonance techniques are warranted.

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“…True FISP sequence was picked up due to its short acquisition time, 1.5 s per slice, significantly reducing motion artifacts. Utilizing the true FISP sequence, image quality is unaffected by bowel motion and the use of antiperistaltic drugs can be avoided giving a major advantage in true FISP compared with other sequences, including 3D FLASH, which require pharmaceutical reduction of bowel motion [9,10,11,12]. The major difference between true FISP and the other steady-state sequences is that rephasing gradients are applied in all three directions, thus making the sequence velocity compensated in all three directions.…”

Section: Discussionmentioning

confidence: 99%

MR enteroclysis protocol optimization: comparison between 3D FLASH with fat saturation after intravenous gadolinium injection and true FISP sequences

et al. 2001

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The aim of this study was to introduce the true fast imaging with steady-state precession (FISP) sequence for MR enteroclysis and compare it with the already used T1-weighted fast low-angle shot (FLASH) sequence. Twenty-one patients underwent both MR and conventional enteroclysis. The MR enteroclysis examination was performed after administration of an iso-osmotic water solution through a nasojejunal catheter and the following sequences were included: (a) true FISP; and (b) 3D FLASH with fat saturation after intravenous injection of 20 mg Buscopan or 1 mg glucagon and 0.1 mmol/kg gadolinium chelates. The true FISP sequence provided images with significantly fewer motion artifacts, whereas 3D FLASH was less sensitive to susceptibility and chemical shift artifacts. The homogeneity of endoluminal opacification, wall conspicuity, and distention of the small bowel were very good to excellent and the two sequences presented no statistically significant differences here. True FISP provided significantly better overall image quality than did 3D FLASH. The true FISP sequence can provide good anatomic demonstration of the small bowel on T2-like images and could be combined with T1-weighted FLASH images for an integrated protocol of MR enteroclysis.

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Crohn's disease evaluation: Comparison of contrast-enhanced MR imaging and single-phase helical CT scanning

Cited by 162 publications

References 20 publications

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

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

Diagnostic Ionizing Radiation Exposure in a Population-Based Cohort of Patients with Inflammatory Bowel Disease

MR enteroclysis protocol optimization: comparison between 3D FLASH with fat saturation after intravenous gadolinium injection and true FISP sequences

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