Magnetic resonance imaging of the small bowel in Crohn's disease

Frøkjær, Jens Brøndum; Larsen, Eva Ladekjær; Steffensen, Elena; Nielsen, A.; Drewes, Asbjørn Mohr

doi:10.1080/00365520510015683

Cited by 44 publications

(13 citation statements)

References 25 publications

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“…However, the extent of inflammation need not be extensive; indeed, while the majority of patients with SpA have intestinal inflammation [1], only a minority develop frank IBD. Likewise, in our study, the MRI findings were subtle, and none showed the extensive complications previously reported in IBD patients [9,10], and thus none of the patients were diagnosed with IBD on the basis of the MRI. Tumor necrosis factor (TNF) inhibitors differ in their capacity to treat established IBD, with etanercept less efficacious as compared to some of the TNF monoclonal antagonists [23,24].…”

Section: Resultssupporting

confidence: 67%

MR enterography to evaluate sub-clinical intestinal inflammation in children with spondyloarthritis

et al. 2012

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BackgroundMagnetic resonance enterography (MRE) is an established tool to evaluate for changes associated with inflammatory bowel disease (IBD), but has not been studied in sub-clinical IBD. We sought to evaluate the use of MRE in children with spondyloarthritis (SpA), who are at risk of having sub-clinical gut inflammation.MethodsChildren with juvenile idiopathic arthritis (JIA) with evidence of intestinal inflammation as evidence by an abnormal fecal calprotectin assay were offered MRE of their intestines. Flavored sports drink containing polyethylene glycol 3350 was used as oral contrast. Glucagon was used to arrest peristalsis. Patients were imaged in the prone position on a 1.5 T scanner. Heavily T2-weighted fat-suppressed coronal and axial images using breath-hold technique were obtained, followed by post-gadolinium fat-suppressed T1-weighted gradient echo images.ResultsWe recruited five children with juvenile idiopathic arthritis (JIA); four had SpA, and one had poly-articular JIA. All five had evidence of intestinal inflammation based upon a positive fecal calprotectin assay and successfully completed the MRE. Three of the studies showed findings suggestive of IBD, including thickening and contrast uptake at the terminal ileum (TI) in one child, contrast uptake of the distal ileum in another, and prominent vasa recta and mesenteric lymph nodes in the third. The child with evidence of inflammatory changes at the TI underwent colonoscopy, which revealed inflammatory bowel disease limited to the TI.ConclusionsMRE can be used to evaluate for subclinical IBD in children with JIA. This protocol was safe and well-tolerated, and identified mild changes in three of the subjects.

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Section: Resultssupporting

confidence: 67%

MR enterography to evaluate sub-clinical intestinal inflammation in children with spondyloarthritis

et al. 2012

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“…Clinically useful MRI evaluation of the bowel has only been available since the late 1990s 24. MRI has several advantages over CT for the patient with Crohn’s disease:21 24 28 submucosal enhancement can differentiate active inflammation from wall-thickening alone; and improved soft tissue contrast gives better visualisation of fistulae and peri-anal disease. MRI is radiation-free, which allows for safe real-time magnetic resonance fluoroscopy if required.…”

Section: Discussionmentioning

confidence: 99%

Crohn's disease: factors associated with exposure to high levels of diagnostic radiation

Desmond

O’Regan

Curran

et al. 2008

Gut

314

220

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“…Pathological bowel wall enhancement was defined as visually increased intensity of the bowel wall compared to normal bowel wall after intravenous gadolinium and the finding was confirmed with ROI measurements [6]. Bowel stenosis was defined as more than 60% narrowing of bowel lumen compared to adjacent normal bowel [7][8][9].…”

Section: Mri Evaluationmentioning

confidence: 99%

Feasibility of MRI in Experimentally Induced Inflammatory Small Bowel Disease: A Pilot Study in a Porcine Model

et al. 2009

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The purpose of this study was to compare the macroscopic and microscopic findings of experimentally induced inflammatory lesions in jejunum and ileum with magnetic resonance imaging (MRI) findings. Inflammatory small bowel lesions were experimentally induced in six pigs. Bowel segments in jejunum and ileum were isolated, and a solution with trinitrobenzenesulfonic acid and ethanol (TNBS-EtOH) was installed. MRI of the small bowel was performed 7 days after surgery. Before the MRI examination, a 6% mannitol solution was installed through a nasogastric tube. The MRI protocol consisted of single-shot turbo spin echo T2 sequences, steady state free precession (BFFE) sequences, and a 3D T1 gradient echo sequence with fat saturation and intravenous contrast. The following image findings were evaluated: increased bowel wall thickness (BWT), increased bowel wall enhancement (BWE), and bowel stenosis. After the MRI examination, the animals were sacrificed. The small bowel was removed and examined macroscopically and microscopically. Inflammatory lesions developed in jejunum and ileum in all animals. The lesions were visible macroscopically and microscopically. The microscopic findings consisted of variable degrees of inflammation, ulcer formation, and fibrosis. In jejunum the inflammatory lesions were not diagnosed with MRI, except in one pig with a bowel necrosis probably caused by an intramural injection or leakage of the TNBS-EtOH solution. In ileum the bowel wall thickness was increased and the inflammatory lesions were diagnosed with MRI. In conclusion, the inflammatory lesions were visible macroscopically and microscopically. Lesions in ileum had increased BWT and were possible to image with MRI. Lesions in jejunum had normal BWT and were not diagnosed with MRI, except in one pig with increased BWT probably caused by complications to the installation of TNBS-EtOH.

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Magnetic resonance imaging of the small bowel in Crohn's disease

Abstract: MRI using the current technique is preferable to conventional enteroclysis because of superior demonstration of the entire small-bowel pathology, low level of patient discomfort and absence of radiation exposure.

Cited by 44 publications

References 25 publications

MR enterography to evaluate sub-clinical intestinal inflammation in children with spondyloarthritis

MR enterography to evaluate sub-clinical intestinal inflammation in children with spondyloarthritis

Crohn's disease: factors associated with exposure to high levels of diagnostic radiation

Feasibility of MRI in Experimentally Induced Inflammatory Small Bowel Disease: A Pilot Study in a Porcine Model

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