Detection and differentiation of inflammatory versus fibromatous Crohnʼs disease strictures: Prospective comparison of 18F-FDG-PET/CT, MR-enteroclysis, and transabdominal ultrasound versus endoscopic/histologic evaluation

Lenze, Frank; Weßling, Johannes; Bremer, Janbernd; Ullerich, Hansjoerg; Spieker, Tilmann; Luegering, Andreas; Gonschorrek, Sarid; Heidemann, Jan; Rijcken, Emile; Domschke, W; Kucharzik, Torsten; Maaser, Christian

doi:10.1002/ibd.22930

Cited by 93 publications

(58 citation statements)

References 23 publications

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“…In patients with CD, mucosal disease activity is routinely assessed by endoscopy and histologic evaluation, but in recent studies it has been evaluated the translational potential of noninvasive 18F-FDG PET/CT for the assessment of mucosal damage in CD, as we have done in our second case report (6). The usefulness of this method becomes relevant as an alternative to MRI enterography in the group of patients in which it is not possible to perform an adequate bowel preparation, as in our second case.…”

Section: Discussionmentioning

confidence: 99%

Gastroduodenal involvement as an unusual presentation of Crohn’s disease

Méndez¹,

Martín²,

González³

et al. 2016

Actual. Med.

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It is relatively uncommon for Crohn's disease to implicate the gastric and duodenal regions and occasionally it can cause pyloric stenosis, in which medical therapy may be ineffective and surgery might be required. We report two exceptional cases with prepyloric stenosis secondary to Crohn's disease, aiming to emphasize the clinical suspicion and to describe the diagnostic imaging procedure and surgical treatments. ResumenEs relativamente infrecuente que la enfermedad de Crohs afecte al estomago y duodeno y ocasionalmente puede producir estenosis pilórica, en estas situaciones el tratamiento médico suele ser ineficaz y se requiere tratamiento quirúrgico. Se exponen dos casos clínicos excepcionales de estenosis prepilórica asociada a la enfermedad de Crohn, dirigidos a enfatizar en la sospecha clínica y describir el diagnóstico y el tratamiento quirúrgico Enviado: 22-05-2016 Revisado: 22-07-2016 Aceptado: 01-08-2016 Carlos Actual. Med. 2016; 101: (798): 109-111 PATIENTS AND METHODS:Case Report 1: A 29-year-old woman, diagnosed with controlled ileocolonic Crohn's disease (CD) 7 years ago was admitted with abdominal pain accompanied by anorexia and weight loss (17Kg in a year).An upper endoscopy (UE) revealed a gastric retention and pyloric stenosis, with an inflammatory appearance. The endoscope could not pass through. A biopsy was taken. Negative H.pylori test.Because of the persistence of the symptoms, an endoscopic dilatation was performed up to 12mm due to pyloric stenosis. Furthermore, a MRI enterography was also realized. It revealed important signs of gastric distension and significant reduction of the pyloric region's lumen and first duodenal portion (Figure 1).Clinical deterioration progressed, leading to surgery. Findings showed gastric dilatation with hypertrophy of its wall, pre-pyloric stenosis and an apparently normal pylorus. A longitudinal incision was performed in the pylorus revealing a circumferential stenosis of the antrum 7-8 mm in diameter and a gastric wall hypertrophy with a characteristically "cobblestone" appearance. The mucosal defect was repaired and closed transversely using the Heineke-Mikulicz technique.Case Report 2: A 52-year-old-woman diagnosed with ileocolonic CD 8 years earlier, and with a surgical history of several procedures at the ileum site, was admitted with postprandial vomiting, accompanied by a very significant and painful abdominal distension with no further intestinal transit alterations.Transit studies with barium were conducted, showing an elongated shaped stomach. Moreover, slow emptying with important alterations in bowels' folds was assessed. The UE reported inflammatory stenosis in duodenum, unable to be traversed by the endoscope. Biopsies were taken, with results of intense nonspecific duodenitis. HP test (-). Adalimumab therapy was begun but within two months the patient started to show progressive clinical deterioration with postprandial vomiting and oral intolerance.Due to pyloric stenosis, MRI enterography was not indicated and alternative...

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Section: Discussionmentioning

confidence: 99%

Gastroduodenal involvement as an unusual presentation of Crohn’s disease

Méndez¹,

Martín²,

González³

et al. 2016

Actual. Med.

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“…In addition, PET/MRI exposes patients to less radiation than PET/CT. A study conducted by Lenze et al already demonstrated that the combination of individual examinations yielded better results than 18-F-FDG PET/CT, MR enteroclysis and transabdominal ultrasound alone in the detection and differentiation of acute inflammatory changes over fibrotic strictures in Crohn's disease patients alone [53]. It is expedient for PET and MR data to be acquired simultaneously when PET/MRI is employed.…”

Section: Hybrid Imaging: Pet/mrmentioning

confidence: 99%

Magnetic Resonance Imaging of the Bowel: Today and Tomorrow

Kinner

Hahnemann

Forsting

et al. 2015

Fortschr Röntgenstr

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Magnetic resonance imaging of the small bowel has been feasible for more than 15 years. This review is meant to give an overview of typical techniques, sequences and indications. Furthermore, newly evaluated promising techniques are presented, which have an impact on the advance of MR imaging of the small and large bowel. Key Points: ??T2-weighted sequences both with and without fat saturation and T1-weighted fat saturated sequences prior to and following intravenous injection of a gadolinium-based contrast medium contitute the basics for bowel MR imaging. ??Newer MR applications, such as diffusion-weighted imaging or contrast-enhaced dynamic sequences supply addtional information; they should thus be integrated in a regular sequence protocol f?r bowel MRI. ??Additional new modalities like motility imaging and PET/MRI have to be evaluated in future studies. Citation Format: ??Kinner S, Hahnemann ML, Forsting M et?al. Magnetic Resonance Imaging of the Bowel: Today and Tomorrow. Fortschr R?ntgenstr 2015; 187: 160???167

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“…Detection rates ofthe strictures were not significantly different between FDG-PET/CT, MR enteroclysis, and US; nevertheless, these techniques did not accurately differentiate inflamed from fibrotic strictures. Only a combination of these techniques resulted in a 100% detection rate of strictures requmng surgery or endoscopic dilation therapy, suggesting the combination of these methods as an alternative to endoscopy at least in the group of patients not able to perform an adequate bowel preparation (24).…”

Section: Fdg-pet and Petict In The Assessment Ofibd In Adult Patientsmentioning

confidence: 99%

The Role of Positron Emission Tomography in Inflammatory Bowel Disease

et al. 2012

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Inflammatory bowel diseases (IBD) are a group of pathological conditions characterized by chronic inflammation of the gastrointestinal tract, including Crohn's disease and ulcerative colitis. To date, imaging of IBD is based on several radiological techniques such as barium studies, magnetic resonance imaging, and computed tomography (CT). Endoscopy is the gold standard for the assessment of the large bowel and proximal small intestine in patients with IBD allowing the biopsy of the visualized bowel. Positron emission tomography (PET) and PET/CT with Fluorine-18-fluoro-2-deoxy-D-glucose (FDG) is a functional imaging method used to detect abnormalities in glucose metabolism in a variety of disorders. FDG accumulates mainly in tumours, but increased uptake and retention has been shown also in lesions with a high concentration of inflammatory cells, such as granulocytes and activated macrophages. Recent literature data demonstrate that FDG-PET and PET/CT may be useful noninvasive tools for identifying and localizing active IBD. In patients with an established diagnosis of IBD, FDG-PET and PET/CT may provide information about disease activity, location and extent of the disease within the intestinal tract, allowing early recognition of disease relapse and possible complications. Furthermore, these techniques may play a role in assessing the treatment response to medical therapy in patients with IBD.

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Detection and differentiation of inflammatory versus fibromatous Crohnʼs disease strictures: Prospective comparison of 18F-FDG-PET/CT, MR-enteroclysis, and transabdominal ultrasound versus endoscopic/histologic evaluation

Cited by 93 publications

References 23 publications

Gastroduodenal involvement as an unusual presentation of Crohn’s disease

Gastroduodenal involvement as an unusual presentation of Crohn’s disease

Magnetic Resonance Imaging of the Bowel: Today and Tomorrow

The Role of Positron Emission Tomography in Inflammatory Bowel Disease

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