Small Bowel Imaging - Still a Radiologic Approach?

Current MR-Enterography In The Diagnosis Of Crohn’s Disease, An Update.

“…Magnetic resonance enterography(MRE) is a new promising technique that may combine both the crosssectional imaging, conventional enterography and enteroclysis (1)(2)(3). MRE has become preferred approach for the diagnosis of inflammatory bowel diseases, tumors, malabsorbtion etc because of its high soft-tissue contrast resolution and multi-planar imaging capability (1,3,4).…”

“…MRE has become preferred approach for the diagnosis of inflammatory bowel diseases, tumors, malabsorbtion etc because of its high soft-tissue contrast resolution and multi-planar imaging capability (1,3,4). Lack of radiation exposure and superposition of bowel loops, its use in pregnancy and in patients with iodine allergy are the other advantages of MRE (2,5).…”

“…Lack of radiation exposure and superposition of bowel loops, its use in pregnancy and in patients with iodine allergy are the other advantages of MRE (2,5). The other MRI based techniques are the routine dynamic abdominal MRI and MR Enteroclysis which present the disadvantages of high costs, motion artefacts and long scanning time, motion artefacts can be eliminated by some fast imaging sequences (2,(4)(5)(6) MR Enteroclysis has the disadvantage of nasojejunal intubation which is performed under flouroscopy and exposure to ionizing radiation, MRE eliminates this disadvantage with the administration of oral contrast agent (3,(5)(6)(7).A few limitations for MRE are reported up to now, those are: Patients intolerance for drinking the Oral contrast agents(OCA), nausea and vomit of the patients, patients dyscomfort in the magnet and claustrophobia, general contraindications against MR imaging and magnetic field due to inappropriate instruments of the patients against the magnet like metalic prosthesis and implants, cardiac pacemakers, metalic sutures,etc.…”

“…Adequate small bowel distention is vital for an optimal enterographic examination as collapsed or contracted small bowel loops may mimic some pathologies, mask some intraluminal lesions or may cause overdiagnosis with exaggerating of wall thickness (3,(6)(7)(8). OCA has been administered to ensure the optimal bowel distention, they are classified into three groups: Negative-Positive-Biphasic intestinal contrast agents (4,5).…”

“…Capsule endoscopy, balloon-assissted endoscopy, CT enterography and enteroclysis, conventional endoscopy with biopsy,conventional small intestine graphy are the other examination techniques for the diagnosis of Crohn's disease (3,9).These methods require high technical expertise, time consuming CT-based techniques cause radiation exposure, endoscopic approaches and conventional scopic bowel graphy with oral Barium contrast can be associated with false positive findings , incomplete bowel wall evaluation and risk of bowel injury (3,5,9). MRE has precise superiority over all those diagnostic methods with higher sensitivity and specificity without any ionizing radiation exposure.…”