Magnetic Resonance Enterography for Crohn’s Disease: What the Surgeon Can Take Home

Pozza, Anna; Scarpa, Marco; Lacognata, Carmelo; Corbetti, Francesco; Mescoli, Claudia; Ruffolo, Cesare; Frego, Mauro; D’Incà, R.; Bardini, Romeo; Sturniolo, Giacomo Carlo; Angriman, Imerio

doi:10.1007/s11605-011-1622-7

Cited by 20 publications

(7 citation statements)

References 37 publications

(45 reference statements)

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“…The literature search revealed 2501 abstracts related to MRI use in CD. Of these, 244 were retrieved and 62 studies were deemed appropriate for inclusion (Figure ).…”

Section: Resultsmentioning

confidence: 99%

Systematic review with meta‐analysis: magnetic resonance enterography signs for the detection of inflammation and intestinal damage in Crohn's disease

Church

Turner

Feldman

et al. 2014

Aliment Pharmacol Ther

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Summary Background In the treatment of Crohn's disease (CD), mucosal healing has become a major goal, with the hope of avoiding intestinal damage from chronic inflammation. Magnetic resonance enterography (MRE) has emerged as a non‐invasive means of monitoring inflammation and damage. Aims As part of the development of MRE‐based multi‐item measures of inflammation and damage for paediatric studies, we carried out a systematic review and meta‐analysis to identify MRE variables used to describe these two distinct concepts. Methods 2501 studies of MRI and CD were identified. Studies written in any language reporting individual MRE signs for patients diagnosed with CD were included. Two‐hundred‐and‐forty‐four studies were fully reviewed and 62 were included (inflammation, n = 51; damage, n = 24). Sensitivity, specificity and associated confidence intervals were calculated, and hierarchical summary ROC curves were constructed for each MRE sign. Results A total of 22 MRE signs were used to reflect inflammation, and 9 to reflect damage. Diagnostic accuracy of MRE signs of inflammation and damage was heterogeneous; however, wall enhancement, mucosal lesions and wall T2 hyperintensity were the most consistently useful for inflammation (most sensitivities >80% and specificities >90%), and detection of abscess and fistula were most consistently useful for damage (most sensitivities >90%, specificities >95%). Conclusions Identifying the best MRE variables to reflect inflammation and damage will maximise the utility of this rapidly emerging technique and is the first stage of constructing MRE‐based indices for evaluating inflammation and intestinal damage.

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“…The literature search revealed 2501 abstracts related to MRI use in CD. Of these, 244 were retrieved and 62 studies were deemed appropriate for inclusion (Figure ).…”

Section: Resultsmentioning

confidence: 99%

Systematic review with meta‐analysis: magnetic resonance enterography signs for the detection of inflammation and intestinal damage in Crohn's disease

Church

Turner

Feldman

et al. 2014

Aliment Pharmacol Ther

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“…With an experienced radiologist reading magnetic resonance enterography studies that have been obtained using a highly specialized protocol, MRE can be an exceptional investigative tool to diagnose unclear illnesses. MRE has been shown to be a useful tool in diagnosing Crohn's patients as it was found that it correlates significantly with disease activity and therefore aids in therapeutic plans [ 8 , 9 ]. In addition to MRE being used in Crohn's disease, our search of literature did not produce too many additional papers that talk about its other uses.…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Enterography: The Test of Choice in Diagnosing Intestinal “Zebras”

Kumar

Coralic

Vegeler

et al. 2015

Case Reports in Gastrointestinal Medicine

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Small bowel tumors and other rare intestinal disorders are often exceedingly difficult to identify. Even cutting-edge technologies, such as push enteroscopy and capsule endoscopy, can fail to determine the cause of a patient's symptoms. At our institution magnetic resonance enterography (MRE) has become an increasingly reliable tool in the difficult-to-diagnose or difficult-to-monitor patient. In this retrospective case series, we discuss four patients with four rare intestinal disorders that were successfully diagnosed using MRE after failing to be diagnosed using more routine technologies, such as CT scans and flexible sigmoidoscopies. With the discussion of these four cases we demonstrate that MRE is a useful diagnostic modality in patients whose surveillance is difficult or to diagnose rare colorectal disease phenomena, colloquially referred to as “zebras.”

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“…Indeed, fibrotic stenosis ordinarily is treated surgically, whereas inflammatory stenosis may be initially managed medically [ 22 ]. Some studies evaluating CD patient populations have found that imaging, including magnetic resonance enterography [ 23 ] and PET/CT enterography [ 24 ], may help to identify patients with strictures containing severe inflammation, thereby stratifying them to initial medical treatment rather than surgical therapy. However, these promising preliminary reports must be interpreted with caution.…”

Section: Discussionmentioning

confidence: 99%

Azathioprine is More Effective than Mesalazine at Preventing Recurrent Bowel Obstruction in Patients with Ileocecal Crohn’s Disease

et al. 2014

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BackgroundPatients with subocclusive Crohn’s disease (CD) who received azathioprine (AZA) therapy had lower re-hospitalization rates due to all causes and for surgical management of CD compared to those treated with mesalazine during a 3-year period. We investigated whether AZA also was effective for prevention of recurrent bowel obstruction.Material/MethodsRates of recurrent bowel occlusion were compared between patients treated with AZA and those treated with mesalazine. We assessed the time interval-off intestinal obstruction as well as the occlusion-free survival for both groups.ResultsThere was a significantly lower cumulative rate of patients with recurrent subocclusion in the AZA group (56%) compared with the mesalazine group (79%; OR 3.34, 95% CI 1.67–8.6; P=0.003), with the number needed to treat in order to prevent 1 subocclusion episode of 3.7 favoring AZA. The occlusion-free time interval was longer in the AZA group compared with the mesalazine group (28.8 vs. 18.3 months; P=0.000). The occlusion-free survival at 12, 24, and 36 months was significantly higher in the AZA group (91%, 81%, and 72%, respectively) than in the mesalazine group (64.7%, 35.3%, and 23.5%, respectively; P<0.05 for all comparisons).ConclusionsIn an exploratory analysis of patients with subocclusive ileocecal CD, maintenance therapy with AZA is more effective than mesalazine for eliminating or postponing recurrent intestinal obstruction during 3 years of therapy.

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Magnetic Resonance Enterography for Crohn’s Disease: What the Surgeon Can Take Home

Cited by 20 publications

References 37 publications

Systematic review with meta‐analysis: magnetic resonance enterography signs for the detection of inflammation and intestinal damage in Crohn's disease

Systematic review with meta‐analysis: magnetic resonance enterography signs for the detection of inflammation and intestinal damage in Crohn's disease

Magnetic Resonance Enterography: The Test of Choice in Diagnosing Intestinal “Zebras”

Azathioprine is More Effective than Mesalazine at Preventing Recurrent Bowel Obstruction in Patients with Ileocecal Crohn’s Disease

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