MR colonography for the assessment of colonic anastomoses

Abstract

Purpose: To assess colonic anastomoses in patients after surgical treatment by means of MR colonography (MRC) in comparison with conventional colonoscopy (CC). Materials and Methods:A total of 39 patients who had previously undergone colonic resection and end-to-endanastomosis were included in the study. MRI was based on a dark-lumen approach. Contrast-enhanced T1-weighted (T1w) three-dimensional (3D) images were collected following the rectal administration of water for colonic distension. The MRC data were evaluated by two radiologists. The criteria employed to evaluate the anastomoses included bowel wall thickening and increased contrast uptake in this region. Furthermore, all other colonic segments were assessed for the presence of pathologies. Results:In 23 and 20 patients the anastomosis was rated to be normal by MRC and CC, respectively. In three patients CC revealed a slight inflammation of the anastomosis that was missed by MRI. A moderate stenosis of the anastomosis without inflammation was detected by MRC in five patients, which was confirmed by CC. In the remaining 11 patients a relevant pathology of the anastomosis was diagnosed by both MRC and CC. Recurrent tumor was diagnosed in two patients with a history of colorectal carcinoma. In the other nine patients inflammation of the anastomosis was seen in seven with Crohn's disease (CD) and two with ulcerative colitis. MRC did not yield any falsepositive findings, resulting in an overall sensitivity/specificity for the assessment of the anastomosis of 84%/100%. Conclusion:MRC represents a promising alternative to CC for the assessment of colonic anastomoses in patients with previous colonic resection.

MR colonography with fecal tagging: Do individual patient characteristics influence image quality?

“…Initial results suggest MRC to be sensitive and specific for the detection of clinically relevant colorectal polyps and carcinomas (12)(13)(14). Furthermore, moderate and severe bowel wall inflammation can be accurately depicted (15)(16)(17).…”

Magnetic resonance colonography in clinical use: How far have we come?

“…MRC has also been used in assessing colonic anastomosis after surgical treatment. In a study by Ajaj et al [37], promising results showing an overall sensitivity/ specificity of 84%/100% for the assessment of the anastomosis were obtained with MRC. Furthermore, recurrent tumors were diagnosed in two patients.…”

Clinical use of MRI: Virtual Dark-Lumen MR Colonography: Technique, Application and Accuracy

“…Even after second or third resection, the perianastomotic area remains the most frequent site of disease recurrence (51)(52)(53)(54)(55). In a study by Ajaj et al (56) to assess the diagnostic accuracy of MRC for the evaluation of colonic anastomosis, 39 patients with previous colonic resection and end-to-end-anastomosis underwent Dark-Lumen MRC. In this study, the anastomosis was rated to be normal by means of MRC in 23 patients (CC: 20 patients).…”