Guide to magnetic resonance in Crohnʼs disease

Abstract

Considering that multiple imaging examinations are often necessary for monitoring Crohn's disease (CD) activity and severity in order to guide and monitor appropriate treatment, the ideal imaging test would be reproducible, well tolerated by patients, and free of ionizing radiation. For these reasons recent studies have highlighted the role of a magnetic resonance imaging (MRI) technique optimized for small bowel imaging in the evaluation of small bowel disorders. In this regard there are two main methodological approaches represented by MR enterography, following administration of an oral contrast medium, and MR enteroclysis, following administration of contrast medium through a nasojejuneal tube. MRI may be used to demonstrate the pathologic findings and complications of CD. In particular, MR has excellent sensitivity and specificity, ranging from 88%-98% and 78%-100%, respectively, for the detection of active inflammation, wall thickening, ulcerations, increased wall enhancement, increased vascularity, perienteric inflammation, and reactive adenopathy. MR also allows more accurate identification of associated complications including penetrating and fibrostenotic disease as well as the more rare extraintestinal manifestations that are usually associated with severe and longstanding intestinal inflammation, the latter often guiding the therapeutic approach. In the progression of CD some rare complications can occur that, to our knowledge, were only briefly or never mentioned in the radiological literature regarding MR enterography or enteroclysis and in which the application of these techniques play a key role.

Advancing Magnetic Resonance Imaging in Crohn's Disease

“…For these reasons, the desirable imaging modality would be one that is reproducible, well tolerated and free of ionizing radiation. Therefore, recent studies and reviews have focused on the role of new MR techniques optimized for bowel imaging for evaluation of bowel disorders [27,28,29,30,31]. CT has advantages compared with MRI in better spatial resolution, superior image quality and lower acquisition time, while the advantages of MRI include lack of ionizing radiation, high-contrast resolution of soft tissue and a superior safety profile of intravenous contrast compared to that of CT.…”

“…Typically, within 60 min prior to scanning a total of polyethylene glycol (PEG) is administered by dividing it into a plurality of times. Sensitivity ranges from 88 to 98% and specificity from 78 to 100%, respectively, for the detection of active inflammation [17,18,19,20,21,22,23,24,25,26,27,28,29,30,31]. MR enterography can be used to follow up and monitor disease activity and the effects of medical therapy such as immune-modulating agents, because it is free from radiation exposure and the discomfort associated with nasojejunal intubation.…”

Magnetic resonance enterography appraisal of lupus enteritis: A case report

“…During the last years, MRE has already been included in the evaluation protocol of CD patients, due to its accuracy in the appraisal of small bowel lesions and the lack of radiation exposure and invasiveness [16] , [17] .…”

Magnetic Resonance Enterography Findings of Intestinal Behçet Disease in a Child

“…MRE is a relatively new imaging technique, which has demonstrated a good diagnostic value for small bowel pathology [8–10]. In particular, it is currently considered part of the standard evaluation algorithm in the follow-up of CD patients, thanks to its capacity to finely depict pathological alterations of the small bowel and to detect structured segments.…”