MRI in Crohn's disease—current and future clinical applications

Abstract

Crohn's disease is a chronic, disabling disease that, over time, can lead to irreversible bowel damage. MRI can be used to diagnose and assess the activity, severity and complications of Crohn's disease; however, the role of MRI in therapeutic monitoring of changes in disease-related intestinal damage is still to be defined. Objective, validated MRI-based scores have been developed to assess the activity of Crohn's disease; these indices are based on the extent and severity of intestinal inflammation, postoperative recurrence and perianal disease. MRI is accurate, safe, reproducible and can allow repeated evaluations of patients without radiation exposure. Evidence that MRI might be valuable in the therapeutic monitoring of patients with Crohn's disease is increasing and, in combination with endoscopy and surgical history, this imaging technique could enable clinicians to assess Crohn's-disease-related intestinal damage. MRI could, therefore, have a crucial role in a future 'damage-driven' treatment paradigm--in which imaging is used to monitor intestinal damage and medication use is targeted to prevent the accumulation of further damage. This damage-driven therapeutic approach could potentially change the course of Crohn's disease.

Detection of Small Bowel Mucosal Healing and Deep Remission in Patients With Known Small Bowel Crohn’s Disease Using Biomarkers, Capsule Endoscopy, and Imaging

“…Extensive SB disease and proximal SB involvement are currently recognized as disease factors associated with a worse long-term prognosis and an increased risk of complications ( 20,21 ). VCE is a prime modality for diagnosis of SBCD; however, there are only a handful of studies that evaluate its role as a monitoring tool in established CD (22)(23)(24)(25)(26)(27)(28). Moreover, the prevalence of SBMH and DR in patients with SBCD in clinical or biomarker remission has not been established.…”

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.…”

Update Imaging in Inflammatory Bowel Diseases

“…So far, studies performed with MRI have demonstrated sensitivities of 80-85%, specificities of 89-100% and accuracies 87-90% for describing the correct location, severity and extent of intestinal inflammation in the small and large bowel [44]. When performing such an imaging approach it seems to be important to apply rectal and oral contrast, since colonic inflammation is often not correctly evaluated in patients with oral contrast only [45].…”