Utility of High-Resolution MR Imaging in Demonstrating Transmural Pathologic Changes in Crohn Disease

Sinha, Rakesh; Rajiah, Prabhakar; Murphy, P.; Hawker, P C; Sanders, Scott

doi:10.1148/rg.296095503

Cited by 71 publications

(46 citation statements)

References 53 publications

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“…Based on our relevant experience [18] and in agreement with other authors [3,8,9,10,13,20,28,29], we chose a macromolecular oral contrast agent with negative CT and biphasic MR properties, i.e. 5% methylcellulose.…”

Section: Discussionmentioning

confidence: 96%

“…4). Low spatial resolution and short T2 filtering effects with consecutive image blurring that are inherent to the HASTE sequence [29], as well as mesenteric fat saturation with gadolinium-enhanced gradient-echo sequences [9], also contribute to the difficulty of detecting mesenteric lymph nodes (kappa 0.60) and acute mesenteric fat edema (kappa 0.59) in MRI. Several authors report excellent analysis of the peritoneal fat, especially the improved detection of lymph nodes, by means of the True-FISP sequence [9,10].…”

Section: Discussionmentioning

confidence: 99%

“…Some authors perform MRE with patients in the prone position, thus facilitating the separation of the small bowel loops by exerting mild pressure on the abdominal wall [9,10,29]. According to our experience, this position would not have improved image quality since most of our patients were very thin without significant mesenteric fat.…”

Section: Discussionmentioning

confidence: 99%

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Acute Complications of Crohn’s Disease: Comparison of Multidetector-Row Computed Tomographic Enterography with Magnetic Resonance Enterography

Schmidt

Guibal²,

Meuwly³

et al. 2010

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Objective: To compare multidetector-row computed tomographic (MDCT) enterography with magnetic resonance (MR) enterography performed upon acute exacerbation of Crohn’s disease. Subjects and Methods: Fifty-seven patients (mean age 33.5) with proven Crohn’s disease and symptoms suggesting acute exacerbation were prospectively included. After oral administration of 1–2 liters of 5% methylcellulose, MDCT and MR enterography were performed on each patient (mean delay <24 h). Three radiologists blindly and independently evaluated each examination for technical quality and in terms of 8 pathological features of Crohn’s disease. Observers’ agreement, sensitivity and specificity resulted from comparison with the reference standard [surgery (n = 24), endoscopy (n = 17) and long-term follow-up (n = 16)]. Results: MDCT enterography demonstrated fewer artifacts than MR enterography (p < 0.0001). In 48 MDCT/MR enterography examinations, active disease was demonstrated: abscesses (n = 11), fistulas (n = 13), stenoses (n = 23) and/or intestinal inflammation (n = 38). Observers’ agreement (range 0.56–0.87) was not significantly different between MDCT and MR enterography, neither in terms of sensitivity (range 58–95%) nor specificity (range 67–100%) for each of the 8 pathological features. Conclusion: Statistically, MR enterography is of similar diagnostic value as MDCT enterography for acute complications of Crohn’s disease. Since the typical Crohn’s disease patient is young and will very likely undergo life-long imaging, and given concerns about radiation exposure with MDCT, MR enterography should be the preferred modality.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Acute Complications of Crohn’s Disease: Comparison of Multidetector-Row Computed Tomographic Enterography with Magnetic Resonance Enterography

Schmidt

Guibal²,

Meuwly³

et al. 2010

Digestion

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“…The most commonly used imaging features are well established in the literature for both CT scan [1][2][3][4] and MRI [5][6][7][8][9][10][11][12][13][14][15]. These include bowel wall thickening, bowel wall edema, perienteric edema and fluid, and mucosal, transmural, and possibly serosal hyperenhancement after intravenous contrast or gadolinium administration.…”

Section: Introductionmentioning

confidence: 99%

Erratum to: Identifying decreased peristalsis of abnormal small bowel segments in Crohn’s disease using cine MR enterography: the frozen bowel sign

et al. 2014

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Purpose: The purpose of this study was to evaluate whether affected bowel in Crohn's disease patients can be identified by observing decreased peristalsis (frozen bowel sign) using cine balanced steady-state free precession (cine BSSFP) images. Materials and methods: 5 radiologists independently reviewed cine BSSFP sequences from randomized MR Enterography (MRE) exams for 30 normal and 30 Crohn's disease patients, graded overall small bowel peristalsis from slowest to fastest, and graded peristalsis for the most abnormal small bowel segment. Sensitivity and specificity of the frozen bowel sign for diagnosing Crohn's disease were calculated. T tests of the peristalsis difference between abnormal segments and overall small bowel were conducted. Results: For 5 readers, the sensitivity and specificity of cine BSSFP of the frozen bowel sign for diagnosing Crohn's disease ranged from 70% to 100% and 87% to 100%, respectively. There were significant differences in peristalsis between abnormal small bowel segments and the overall small bowel for Crohn's patients, but not in the overall small bowel between normal-MRE patients and Crohn's disease patients. Conclusion: Abnormal Crohn's small bowel segments have significantly decreased peristalsis compared to normal small bowel, which can be identified using cine BSSFP sequences as the frozen bowel sign.Key words: MR enterography-Small bowelPeristalsis-Motility-Cine MRI-Crohn's disease Erratum to: Abdom Imaging DOI 10.1007/s00261-014-0258-yThe original publication did not include the images pertaining to the supplementary video files. This has been corrected in this article.Using MR enterography (MRE) to diagnose inflamed small bowel segments in patients with Crohn's disease requires a multiparametric approach, evaluating imaging features from several different pulse sequences. The most commonly used imaging features are well established in the literature for both CT scan [1][2][3][4] and MRI [5][6][7][8][9][10][11][12][13][14][15]. These include bowel wall thickening, bowel wall edema, perienteric edema and fluid, and mucosal, transmural, and possibly serosal hyperenhancement after intravenous contrast or gadolinium administration. With MRE, these Electronic supplementary material: The online version of this article

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“…Chronic fibrotic strictures have low intensity signal on T1 and T2 sequences with inhomogeneous contrast enhancement (lack of mural inflammation) edema and surrounding mesenteric hyperemia [59,60] and in many patients are likely due to a combination of active and chronic inflammation and fibrosis [61] ( Figure 6) and on MR cine imaging, it appears as a peristaltic bowel segments with mural thickening and luminal narrowing [48,62] . As pediatric CD, uncommonly manifests initially as a strictures [63] , the cumulative incidence of strictures increases with time, from 5.5% at 1-year following diagnosis to 20.5% at 10 years [64] .…”

Section: Indicationsmentioning

confidence: 99%

Current tecniques and new perpectives research of magnetic resonance enterography in pediatric Crohn’s disease

Masselli

Mastroiacovo

Marco

et al. 2016

WJR

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Crohn's disease affects more than 500000 individuals in the United States, and about 25% of cases are diagnosed during the pediatric period. Imaging of the bowel has undergone dramatic changes in the past two decades. The endoscopy with biopsy is generally considered the diagnostic reference standard, this combination can evaluates only the mucosa, not inflammation or fibrosis in the mucosa. Actually, the only modalities that can visualize submucosal tissues throughout the small bowel are the computed tomography (CT) enterography (CTE) with the magnetic resonance enterography (MRE). CT generally is highly utilized, but there is growing concern over ionizing radiation and cancer risk; it is a very important aspect to keep in consideration in pediatric patients. In contrast to CTE, MRE does not subject patients to ionizing radiation and can be used to detect detailed morphologic information and functional data of bowel disease, to monitor the effects of medical therapy more accurately, to detect residual active disease even in patients showing apparent clinical resolution and to guide treatment more accurately.

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Utility of High-Resolution MR Imaging in Demonstrating Transmural Pathologic Changes in Crohn Disease

Cited by 71 publications

References 53 publications

Acute Complications of Crohn’s Disease: Comparison of Multidetector-Row Computed Tomographic Enterography with Magnetic Resonance Enterography

Acute Complications of Crohn’s Disease: Comparison of Multidetector-Row Computed Tomographic Enterography with Magnetic Resonance Enterography

Erratum to: Identifying decreased peristalsis of abnormal small bowel segments in Crohn’s disease using cine MR enterography: the frozen bowel sign

Current tecniques and new perpectives research of magnetic resonance enterography in pediatric Crohn’s disease

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