Evaluation of Treatment Response in Active Crohn's disease by low-field magnetic resonance imaging

Abstract

Background: To evaluate low-field magnetic resonance imaging (MRI) in detecting therapeutic response in active Crohn's disease during treatment with systemic steroids. Methods: Eight patients with active Crohn's disease were examined before and during treatment with systemic steroids (1 mg/kg/day) using low-field MRI (0.1 T) in transverse and coronal planes before and after an intravenously administered bolus of gadodiamide. Five healthy persons were once examined in the same way. MRI images were evaluated without knowledge of diagnosis, treatment, or findings of endoscopy, conventional radiography, and surgery. Proximal and mid small bowel, terminal ileum, right-sided colon, transverse colon, and left-sided colon were evaluated separately. Results: Statistically significant differences were shown for both signal intensity on T2-(SI T2 ) and increment in signal intensity on T1-weighted images after contrast (%SI T1 ) when comparing diseased bowel segments with both nondiseased bowel segments (SI T2 : p ϭ 0.0001; %SI T1 : p ϭ 0.0009) and segments from the control group (SI T2 : p Ͻ 0.00005; %SI T1 : p Ͻ 0.00005). In 53 of 56 bowel segments evaluated (95%), agreement was found between findings by MRI, conventional radiography, endoscopy and/or surgery regarding disease extension. Extension was underestimated in two patients. All bowel segments in the control subjects were evaluated to be normal on MRI. Significant correlation was found between both SI T1 (p Ͻ 0.0025) and %SIT1 (p Ͻ 0.025) versus endoscopic activity gradings. During treatment, significant decrements of both SI T2 (p Ͻ 0.00005), %SI T1

Crohn's disease and color Doppler sonography: Response to treatment and its relationship with long‐term prognosis

“…Changes during treatment have been shown on imaging studies, such as CT or MRI, which parallel changes from the active phase of the disease to remission. [8][9][10][11][12] Previous sonographic studies have shown a decrease in maximum bowel wall thickness and color Doppler grade after anti-inflammatory therapy. 4,5,[13][14][15] Our results show that these changes can be seen a few days after the initial sonogram, though in only a limited number of patients.…”

Developing role of magnetic resonance imaging in Crohn??s disease

“…In the quiescent stage of the disease, the wall signal intensity decreases to 138 Small intestine reflect underlying fibrosis. Excellent correlation between biological activity and T2-weighted wall signal intensity has been found [24,25]. The images produced by this technique are highly resistant to magnetic susceptibility or chemical shift artifacts, therefore permitting accurate measurement of intestinal wall thickness.…”

Assessment of mucosal healing in inflammatory bowel disease: review

“…65,66 Initial studies investigating the value of MRE in monitoring disease activity and treatment response showed inconsistent results. Some investigators demonstrated a significant correlation between MRE signal intensity and treatment response, 67 whereas others found that, although significant improvements in MRE findings occurred, normalization of findings with treatment was rare despite meaningful changes in clinical disease activity. 68 This raised concerns that MRE might be overly sensitive, and MRE-guided therapy could result in unnecessary adjustments in treatment.…”