Using of magnetic resonance enterography in the management of Crohn's disease of the small intestine: First year of experience

Mendoza, Juan L.; González-Lama, Yago; Taxonera, Carlos; Suárez-Ferrer, Cristina; Teresa, F. Matute; Vera, María Isabel Paredes; López-Palacios, Natalia; Mayo, Pablo; Calvo, Marta; Méndez, Ramiro; Pastrana, Miguel; González, C.; Lana, Raquel Martins; Rodríguez, Ricardo; Abreu, Luís

doi:10.4321/s1130-01082012001100005

Cited by 20 publications

(12 citation statements)

References 18 publications

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“…As the outpatient clinic in this study is the referral centre for IBD, it is expected that we would have a greater concentration of patients with severe disease. The indications for MRE in this study were broad, with a spectrum ranging from asymptomatic patients in the posttreatment follow-up to patients with active disease based on the HBI and ileocolonoscopy, similar to other retrospective studies [28]. Despite this, the percentage of normal imaging (25.7%) was not higher than that in studies that included only symptomatic patients [20].…”

Section: Discussionsupporting

confidence: 59%

Changes in the Management of Patients with Crohn’s Disease Based on Magnetic Resonance Enterography Patterns

Chinem

Esberard

Moreira

et al. 2019

Gastroenterology Research and Practice

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Background and Aims. Magnetic resonance enterography (MRE) has become an important modality of radiological imaging in the evaluation of Crohn’s disease (CD). The aim of this study was to investigate the impact of MRE in the assessment of disease activity and abdominal complications and in the making of therapeutic decisions for patients with CD. Methods. In a cross-sectional retrospective study, we selected 74 patients with CD who underwent MRE and ileocolonoscopy with an interval between the two exams of up to 30 days between January 2011 and December 2017. We assessed the parameters of the images obtained by MRE and investigated the agreement with the level of disease activity and complications determined by a clinical evaluation, inflammatory biomarkers, and endoscopy, as well as the resulting changes in medical and surgical management. Results. Changes in medical management were detected in 41.9% of patients. Significant changes in medical decisions were observed in individuals with a purely penetrating (P=.012) or a mixed (P=.024) MRE pattern. Patients with normal MRE patterns had a correlation with unchanged medical decisions (P=.001). There were statistically significant agreements between the absence of inflammatory criteria on MRE and remission according to the Harvey and Bradshaw index (HBI) (P=.037), the presence of inflammatory criteria on MRE and positive results for calprotectin (P=.005), and penetrating criteria on MRE and the scoring endoscopic system for Crohn’s disease (SES-CD), indicating active disease (P=.048). Finally, there was significant agreement between the presence of fibrostenotic criteria and a long disease duration (P=.027). Conclusion. MRE discloses disease activity and complications not apparent with other modalities and results in changes in therapeutic decisions. In addition to being used for diagnosis, MRE should be routinely used in the follow-up of CD patients.

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Section: Discussionsupporting

confidence: 59%

Changes in the Management of Patients with Crohn’s Disease Based on Magnetic Resonance Enterography Patterns

Chinem

Esberard

Moreira

et al. 2019

Gastroenterology Research and Practice

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“…MRE is one of the most widely used imaging techniques for monitoring small intestinal CD lesions, predicting the outcome of CD, and helping physicians to make clinical decisions[6, 28, 29]. According to a previous study, it has poorer sensitivity than endoscopy for detecting active lesions[13].…”

Section: Discussionmentioning

confidence: 99%

Combination of colonoscopy and magnetic resonance enterography is more useful for clinical decision making than colonoscopy alone in patients with complicated Crohn's disease

et al. 2019

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Background/aims The small bowel is affected in more than half of patients with Crohn’s disease (CD) at the time of diagnosis, and small bowel involvement has a negative impact on the long-term outcome. Many patients reportedly have active lesions in the small intestine even in patients in clinical remission. This study was performed to compare findings of magnetic resonance enterography (MRE) and ileocolonoscopy. Methods A single-center retrospective study was conducted in 50 patients (60 imaging series) with CD, for whom MRE was additionally performed during the bowel preparation for subsequent ileocolonoscopy. Endoscopic remission was defined as a Simple Endoscopic Score for CD (SES-CD) of <5. MRE remission was defined as a Magnetic Resonance Index of Activity (MaRIA) score of <50. The time to treatment escalation was assessed by the log-rank test. Results Importantly, 7 of 29 patients (24.1%) with endoscopic remission had a MaRIA score of ≥50. Both SES-CD and MaRIA correlated with the need for treatment escalation ( P = 0.025, P = 0.009, respectively). MRE predicted the need for treatment escalation even in patients with endoscopic remission. Although no correlation was present between SES-CD and MaRIA score in patients with structuring/penetrating disease, or insufficient ileal insertion (<10cm), a high MaRIA score still correlated with the need for treatment escalation in stricturing or penetrating disease ( P = 0.0306). Conclusions The MaRIA score predicts the need for treatment escalation even in patients with endoscopic remission, indicating that addition of MRE to conventional ileocolonoscopy alone can be a useful, noninvasive tool for monitoring CD especially in stricturing or penetrating disease.

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“…Retrospective review, however, did not provide consistent temporally related biochemical and clinical disease activity assessment and thus could not be reliably included in this analysis. The reported influence of cross-sectional imaging on the management of IBD is significant, ranging from 51 to 61% [ 37 – 39 ]; however, little has been reported regarding the influence of US compared to other modalities. The average likely impact of US was realized in this study within 21 days, with 22/115 patients (19%) having US as the predominant factor for change in management.…”

Section: Discussionmentioning

confidence: 99%

Impact of Intestinal Ultrasound on Classification and Management of Crohn’s Disease Patients with Inconclusive Colonoscopy

Wilkens

Novak

Lebeuf-Taylor

et al. 2016

Canadian Journal of Gastroenterology and Hepatology

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Background and Aims. We aim to evaluate the benefit of ultrasound in the assessment of Crohn's disease and to demonstrate its potential contribution to disease management. Methods. We conduct a retrospective review of adult patients with Crohn's disease examined with sonography and colonoscopy within 30 days. Study patients were identified in whom colonoscopy did not access a pathological segment, detected and evaluated by ultrasonography. Changes in management were predominantly attributed to ultrasound in those cases where the diseased segment was not assessed on endoscopy. Results. From 115 patients with temporally related ileocolonoscopy and ultrasound, 41 had disease fully assessed on ultrasound only, with complications in 26/41. Twenty-nine of 41 had mild or no endoscopic inflammation with moderate or severe disease on ultrasound at the same segment or at a segment proximal to the reach of the endoscope. Changes in management were significantly attributed to ultrasound in 22 of these 29 patients. Conclusion. The benefit of cross-sectional imaging is invaluable for the comprehensive assessment of bowel not shown on ileocolonoscopy. Ultrasound may make a significant contribution to correct classification of disease extent and severity of Crohn's disease. Prospective studies are needed to further understand the contribution of US in patient management.

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Using of magnetic resonance enterography in the management of Crohn's disease of the small intestine: First year of experience

Cited by 20 publications

References 18 publications

Changes in the Management of Patients with Crohn’s Disease Based on Magnetic Resonance Enterography Patterns

Changes in the Management of Patients with Crohn’s Disease Based on Magnetic Resonance Enterography Patterns

Combination of colonoscopy and magnetic resonance enterography is more useful for clinical decision making than colonoscopy alone in patients with complicated Crohn's disease

Impact of Intestinal Ultrasound on Classification and Management of Crohn’s Disease Patients with Inconclusive Colonoscopy

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