Abstract
Objective
To describe the role of magnetic resonance enterography (MRE) in patients with inflammatory bowel disease (IBD), and to review the expected post-operative appearance, as well as, potential surgical complications in this unique patient population.
Conclusion
MRE compares favorably to CT Enterography (CTE) in terms of overall diagnostic accuracy and may provide better functional assessment of the small bowel through cine-MRI, diffusion-weighted imaging and dynamic contrast-enhancement. In the post-operative population, MRE provides critical information including: normal post-surgical anatomy, chronic strictures vs. active inflammation and disease/treatment-related complications. The post-operative IBD patient undergoes frequent repeated imaging and MRE may significantly reduce cumulative radiation dose while providing similar or improved diagnostic accuracy compared to CTE. MRE should be considered as an alternative imaging modality in this population.
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References
Molodecky NA, Soon IS, Rabi DM, et al. (2012) Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 142(1):46–54.e42; quiz e30. doi:10.1053/j.gastro.2011.10.001
Siddiki HA, Fidler JL, Fletcher JG, et al. (2009) Prospective comparison of state-of-the-art MR enterography and CT enterography in small-bowel Crohn’s disease. AJR Am J Roentgenol 193(1):113–121. doi:10.2214/AJR.08.2027
Martin DR, Kalb B, Sauer CG, Alazraki A, Goldschmid S (2012) Magnetic resonance enterography in Crohn’s disease: techniques, interpretation, and utilization for clinical management. Diagn Interv Radiol 18(4):374–386. doi:10.4261/1305-3825.DIR.4893-11.2
Desmond AN, O’Regan K, Curran C, et al. (2008) Crohn’s disease: factors associated with exposure to high levels of diagnostic radiation. Gut 57(11):1524–1529. doi:10.1136/gut.2008.151415
Palmer L, Herfarth H, Porter CQ, et al. (2009) Diagnostic ionizing radiation exposure in a population-based sample of children with inflammatory bowel diseases. Am J Gastroenterol 104(11):2816–2823. doi:10.1038/ajg.2009.480
Newnham E, Hawkes E, Surender A, et al. (2007) Quantifying exposure to diagnostic medical radiation in patients with inflammatory bowel disease: are we contributing to malignancy? Aliment Pharmacol Ther 26(7):1019–1024. doi:10.1111/j.1365-2036.2007.03449.x
Jaffe TA, Gaca AM, Delaney S, et al. (2007) Radiation doses from small-bowel follow-through and abdominopelvic MDCT in Crohn’s disease. AJR Am J Roentgenol 189(5):1015–1022. doi:10.2214/ajr.07.2427
Chatu S, Subramanian V, Pollok RC (2012) Meta-analysis: diagnostic medical radiation exposure in inflammatory bowel disease. Aliment Pharmacol Ther 35(5):529–539. doi:10.1111/j.1365-2036.2011.04975.x
Sinha R, Verma R, Verma S, Rajesh A (2011) MR enterography of Crohn disease: part 1, rationale, technique, and pitfalls. AJR Am J Roentgenol 197(1):76–79. doi:10.2214/AJR.10.7253
Leyendecker JR, Bloomfeld RS, DiSantis DJ, et al. (2009) MR enterography in the management of patients with Crohn disease. Radiographics: Rev Publ Radiol Soc N Am 29(6):1827–1846. doi:10.1148/rg.296095510
Lee SS, Kim AY, Yang SK, et al. (2009) Crohn disease of the small bowel: comparison of CT enterography, MR enterography, and small-bowel follow-through as diagnostic techniques. Radiology 251(3):751–761. doi:10.1148/radiol.2513081184
Schmidt S, Guibal A, Meuwly JY, et al. (2010) Acute complications of Crohn’s disease: comparison of multidetector-row computed tomographic enterography with magnetic resonance enterography. Digestion 82(4):229–238. doi:10.1159/000288521
Horsthuis K, Bipat S, Bennink RJ, Stoker J (2008) Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta-analysis of prospective studies. Radiology 247(1):64–79. doi:10.1148/radiol.2471070611
Qiu Y, Mao R, Chen BL, et al. (2014) Systematic review with meta-analysis: magnetic resonance enterography vs. computed tomography enterography for evaluating disease activity in small bowel Crohn’s disease. Aliment Pharmacol Ther 40(2):134–146. doi:10.1111/apt.12815
Hara AK, Leighton JA, Heigh RI, et al. (2006) Crohn disease of the small bowel: preliminary comparison among CT enterography, capsule endoscopy, small-bowel follow-through, and ileoscopy. Radiology 238(1):128–134. doi:10.1148/radiol.2381050296
Wold PB, Fletcher JG, Johnson CD, Sandborn WJ (2003) Assessment of small bowel Crohn disease: noninvasive peroral CT enterography compared with other imaging methods and endoscopy–feasibility study. Radiology 229(1):275–281. doi:10.1148/radiol.2291020877
Albert JG, Martiny F, Krummenerl A, et al. (2005) Diagnosis of small bowel Crohn’s disease: a prospective comparison of capsule endoscopy with magnetic resonance imaging and fluoroscopic enteroclysis. Gut 54(12):1721–1727. doi:10.1136/gut.2005.069427
Bernstein CN, Greenberg H, Boult I, et al. (2005) A prospective comparison study of MRI versus small bowel follow-through in recurrent Crohn’s disease. Am J Gastroenterol 100(11):2493–2502. doi:10.1111/j.1572-0241.2005.00239.x
Maglinte DD, Sandrasegaran K, Chiorean M, et al. (2007) Radiologic investigations complement and add diagnostic information to capsule endoscopy of small-bowel diseases. AJR Am J Roentgenol 189(2):306–312. doi:10.2214/ajr.07.2253
Tielbeek JA, Ziech ML, Li Z, et al. (2014) Evaluation of conventional, dynamic contrast enhanced and diffusion weighted MRI for quantitative Crohn’s disease assessment with histopathology of surgical specimens. Eur Radiol 24(3):619–629. doi:10.1007/s00330-013-3015-7
Giusti S, Faggioni L, Neri E, et al. (2010) Dynamic MRI of the small bowel: usefulness of quantitative contrast-enhancement parameters and time-signal intensity curves for differentiating between active and inactive Crohn’s disease. Abdom Imaging 35(6):646–653. doi:10.1007/s00261-010-9624-6
Masselli G, Gualdi G (2013) CT and MR enterography in evaluating small bowel diseases: when to use which modality? Abdom Imaging 38(2):249–259. doi:10.1007/s00261-012-9961-8
Torkzad MR, Vargas R, Tanaka C, Blomqvist L (2007) Value of cine MRI for better visualization of the proximal small bowel in normal individuals. Eur Radiol 17(11):2964–2968. doi:10.1007/s00330-007-0721-z
Allen BC, Leyendecker JR (2014) MR enterography for assessment and management of small bowel Crohn disease. Radiol Clin North Am 52(4):799–810. doi:10.1016/j.rcl.2014.02.001
Udayasankar UK, Martin D, Lauenstein T, et al. (2008) Role of spectral presaturation attenuated inversion-recovery fat-suppressed T2-weighted MR imaging in active inflammatory bowel disease. J Magn Reson Imaging 28(5):1133–1140. doi:10.1002/jmri.21574
Cronin CG, Lohan DG, Mhuircheartaigh JN, et al. (2008) MRI small-bowel follow-through: prone versus supine patient positioning for best small-bowel distention and lesion detection. AJR Am J Roentgenol 191(2):502–506. doi:10.2214/ajr.07.2338
Negaard A, Paulsen V, Sandvik L, et al. (2007) A prospective randomized comparison between two MRI studies of the small bowel in Crohn’s disease, the oral contrast method and MR enteroclysis. Eur Radiol 17(9):2294–2301. doi:10.1007/s00330-007-0648-4
Young BM, Fletcher JG, Booya F, et al. (2008) Head-to-head comparison of oral contrast agents for cross-sectional enterography: small bowel distention, timing, and side effects. J Comput Assist Tomogr 32(1):32–38. doi:10.1097/RCT.0b013e318061961d
Ajaj W, Goyen M, Schneemann H, et al. (2005) Oral contrast agents for small bowel distension in MRI: influence of the osmolarity for small bowel distention. Eur Radiol 15(7):1400–1406. doi:10.1007/s00330-005-2711-3
Negaard A, Sandvik L, Berstad AE, et al. (2008) MRI of the small bowel with oral contrast or nasojejunal intubation in Crohn’s disease: randomized comparison of patient acceptance. Scand J Gastroenterol 43(1):44–51. doi:10.1080/00365520701494813
Masselli G, Casciani E, Polettini E, Gualdi G (2008) Comparison of MR enteroclysis with MR enterography and conventional enteroclysis in patients with Crohn’s disease. Eur Radiol 18(3):438–447. doi:10.1007/s00330-007-0763-2
Tonolini M, Campari A, Bianco R (2011) Ileal pouch and related complications: spectrum of imaging findings with emphasis on MRI. Abdom Imaging 36(6):698–706. doi:10.1007/s00261-011-9693-1
Hoeffel C, Arrive L, Mourra N, et al. (2006) Anatomic and pathologic findings at external phased-array pelvic MR imaging after surgery for anorectal disease. Radiographics: Rev Publ Radiol Soc N Am 26(5):1391–1407. doi:10.1148/rg.265055723
Broder JC, Tkacz JN, Anderson SW, Soto JA, Gupta A (2010) Ileal pouch-anal anastomosis surgery: imaging and intervention for post-operative complications. Radiographics: Rev Publ Radiol Soc N Am 30(1):221–233. doi:10.1148/rg.301095084
Buisson A, Joubert A, Montoriol PF, et al. (2013) Diffusion-weighted magnetic resonance imaging for detecting and assessing ileal inflammation in Crohn’s disease. Aliment Pharmacol Ther 37(5):537–545. doi:10.1111/apt.12201
Oto A, Kayhan A, Williams JT, et al. (2011) Active Crohn’s disease in the small bowel: evaluation by diffusion weighted imaging and quantitative dynamic contrast enhanced MR imaging. J Magn Reson Imaging 33(3):615–624. doi:10.1002/jmri.22435
Guglielmo FF, Mitchell DG, O’Kane PL, et al. (2014) Erratum to: Identifying decreased peristalsis of abnormal small bowel segments in Crohn’s disease using cine MR enterography: the frozen bowel sign. Abdom Imaging . doi:10.1007/s00261-014-0293-8
Heye T, Stein D, Antolovic D, et al. (2012) Evaluation of bowel peristalsis by dynamic cine MRI: detection of relevant functional disturbances—initial experience. J Magn Reson Imaging 35(4):859–867. doi:10.1002/jmri.22851
Florie J, Wasser MN, Arts-Cieslik K, et al. (2006) Dynamic contrast-enhanced MRI of the bowel wall for assessment of disease activity in Crohn’s disease. AJR Am J Roentgenol 186(5):1384–1392. doi:10.2214/ajr.04.1454
Pauls S, Gabelmann A, Schmidt SA, et al. (2006) Evaluating bowel wall vascularity in Crohn’s disease: a comparison of dynamic MRI and wideband harmonic imaging contrast-enhanced low MI ultrasound. Eur Radiol 16(11):2410–2417. doi:10.1007/s00330-006-0330-2
Del Vescovo R, Sansoni I, Caviglia R, et al. (2008) Dynamic contrast enhanced magnetic resonance imaging of the terminal ileum: differentiation of activity of Crohn’s disease. Abdom Imaging 33(4):417–424. doi:10.1007/s00261-007-9267-4
Yacoub JH, Obara P, Oto A (2013) Evolving role of MRI in Crohn’s disease. J Magn Reson Imaging 37(6):1277–1289. doi:10.1002/jmri.24081
Roses RE, Rombeau JL (2008) Recent trends in the surgical management of inflammatory bowel disease. World J Gastroenterol 14(3):408–412
Shaffer VO, Wexner SD (2013) Surgical management of Crohn’s disease. Langenbeck’s archives of surgery/Deutsche Gesellschaft fur Chirurgie 398(1):13–27. doi:10.1007/s00423-012-0919-7
Nanda K, Courtney W, Keegan D, et al. (2013) Prolonged avoidance of repeat surgery with endoscopic balloon dilatation of anastomotic strictures in Crohn’s disease. J Crohn’s Colitis 7(6):474–480. doi:10.1016/j.crohns.2012.07.019
Sinha R, Verma R, Verma S, Rajesh A (2011) MR enterography of Crohn disease: part 2, imaging and pathologic findings. AJR Am J Roentgenol 197(1):80–85. doi:10.2214/AJR.11.6740
Yacoub JH, Oto A (2014) New magnetic resonance imaging modalities for Crohn disease. Magn Reson Imaging Clin N Am 22(1):35–50. doi:10.1016/j.mric.2013.07.005
Knuesel PR, Kubik RA, Crook DW, Eigenmann F, Froehlich JM (2010) Assessment of dynamic contrast enhancement of the small bowel in active Crohn’s disease using 3D MR enterography. Eur J Radiol 73(3):607–613. doi:10.1016/j.ejrad.2008.12.001
Horsthuis K, Bipat S, Stokkers PC, Stoker J (2009) Magnetic resonance imaging for evaluation of disease activity in Crohn’s disease: a systematic review. Eur Radiol 19(6):1450–1460. doi:10.1007/s00330-008-1287-0
Kiryu S, Dodanuki K, Takao H, et al. (2009) Free-breathing diffusion-weighted imaging for the assessment of inflammatory activity in Crohn’s disease. J Magn Reson Imaging 29(4):880–886. doi:10.1002/jmri.21725
Griffin N, Grant LA, Anderson S, Irving P, Sanderson J (2012) Small bowel MR enterography: problem solving in Crohn’s disease. Insights Imaging 3(3):251–263. doi:10.1007/s13244-012-0154-3
Oussalah A, Laurent V, Bruot O, et al. (2010) Diffusion-weighted magnetic resonance without bowel preparation for detecting colonic inflammation in inflammatory bowel disease. Gut 59(8):1056–1065. doi:10.1136/gut.2009.197665
Oto A, Zhu F, Kulkarni K, et al. (2009) Evaluation of diffusion-weighted MR imaging for detection of bowel inflammation in patients with Crohn’s disease. Acad Radiol 16(5):597–603. doi:10.1016/j.acra.2008.11.009
Silva AC, Pimenta M, Guimaraes LS (2009) Small bowel obstruction: what to look for. Radiographics: Rev Publ Radiol Soc N Am 29(2):423–439. doi:10.1148/rg.292085514
Tirumani H, Vassa R, Fasih N, Ojili V (2014) Small bowel obstruction in the emergency department: MDCT features of common and uncommon causes. Clin Imaging . doi:10.1016/j.clinimag.2014.04.010
Martin LC, Merkle EM, Thompson WM (2006) Review of internal hernias: radiographic and clinical findings. AJR Am J Roentgenol 186(3):703–717. doi:10.2214/ajr.05.0644
Lam TJ, van Bodegraven AA, Felt-Bersma RJ (2014) Anorectal complications and function in patients suffering from inflammatory bowel disease: a series of patients with long-term follow-up. Int J Colorectal Dis 29(8):923–929. doi:10.1007/s00384-014-1926-7
Iesalnieks I, Kilger A, Kalisch B, et al. (2011) Treatment of the anastomotic complications in patients with Crohn’s disease. Int J Colorectal Dis 26(2):239–244. doi:10.1007/s00384-010-1031-5
de Miguel Criado J, del Salto LG, Rivas PF, del Hoyo LF, Velasco LG, de las Vacas MI, Marco Sanz AG, Paradela MM, Moreno EF (2012) MR imaging evaluation of perianal fistulas: spectrum of imaging features. Radiographics: Rev Publ Radiol Soc N Am 32(1):175–194. doi:10.1148/rg.321115040
Myhr GE, Myrvold HE, Nilsen G, Thoresen JE, Rinck PA (1994) Perianal fistulas: use of MR imaging for diagnosis. Radiology 191(2):545–549. doi:10.1148/radiology.191.2.8153337
Szurowska E, Wypych J, Izycka-Swieszewska E (2007) Perianal fistulas in Crohn’s disease: MRI diagnosis and surgical planning: MRI in fistulazing perianal Crohn’s disease. Abdom Imaging 32(6):705–718. doi:10.1007/s00261-007-9188-2
Halligan S, Stoker J (2006) Imaging of fistula in ano. Radiology 239(1):18–33. doi:10.1148/radiol.2391041043
Bellolio F, Cohen Z, Macrae HM, et al. (2013) Outcomes following surgery for perforating Crohn’s disease. Brit J Surg 100(10):1344–1348. doi:10.1002/bjs.9212
Liu B, Ramalho M, AlObaidy M, et al. (2014) Gastrointestinal imaging-practical magnetic resonance imaging approach. World J Radiol 6(8):544–566. doi:10.4329/wjr.v6.i8.544
Oto A, Schmid-Tannwald C, Agrawal G, et al. (2011) Diffusion-weighted MR imaging of abdominopelvic abscesses. Emerg Radiol 18(6):515–524. doi:10.1007/s10140-011-0976-1
Magnano G, Granata C, Barabino A, et al. (2003) Polyethylene glycol and contrast-enhanced MRI of Crohn’s disease in children: preliminary experience. Pediatr Radiol 33(6):385–391. doi:10.1007/s00247-003-0903-z
Keighley MR (2000) The final diagnosis in pouch patients for presumed ulcerative colitis may change to Crohn’s disease: patients should be warned of the consequences. Acta Chir Iugosl 47(4 Suppl 1):27–31
Hyman NH, Fazio VW, Tuckson WB, Lavery IC (1991) Consequences of ileal pouch-anal anastomosis for Crohn’s colitis. Dis Colon Rectum 34(8):653–657
Subramaniam K, D’Rozario J, Pavli P (2013) Lymphoma and other lymphoproliferative disorders in inflammatory bowel disease: a review. J Gastroenterol Hepatol 28(1):24–30. doi:10.1111/jgh.12015
Claessen MM, Siersema PD, Vleggaar FP (2011) IBD-related carcinoma and lymphoma. Best Pract Res Clin Gastroenterol 25(Suppl 1):S27–S38. doi:10.1016/s1521-6918(11)70007-5
Masselli G, Polettini E, Casciani E, et al. (2009) Small-bowel neoplasms: prospective evaluation of MR enteroclysis. Radiology 251(3):743–750. doi:10.1148/radiol.2513081819
Lohan DG, Alhajeri AN, Cronin CG, Roche CJ, Murphy JM (2008) MR enterography of small-bowel lymphoma: potential for suggestion of histologic subtype and the presence of underlying celiac disease. AJR Am J Roentgenol 190(2):287–293. doi:10.2214/ajr.07.2721
van der Paardt MP, Zijta FM, Boellaard TN, et al. (2014) Magnetic resonance colonography with automated carbon dioxide insufflation: Diagnostic accuracy and distension. Eur J Radiol 83(5):743–750. doi:10.1016/j.ejrad.2014.01.013
van der Paardt MP, Stoker J (2014) Magnetic resonance colonography for screening and diagnosis of colorectal cancer. Magn Reson Imaging Clin N Am 22(1):67–83. doi:10.1016/j.mric.2013.07.006
Pappalardo G, Gualdi G, Nunziale A, et al. (2013) Impact of magnetic resonance in the preoperative staging and the surgical planning for treating small bowel neoplasms. Surg Today 43(6):613–619. doi:10.1007/s00595-012-0270-1
Patel DR, Levine MS, Rubesin SE, Zafar H, Lev-Toaff AS (2013) Comparison of small bowel follow through and abdominal CT for detecting recurrent Crohn’s disease in neoterminal ileum. Eur J Radiol 82(3):464–471. doi:10.1016/j.ejrad.2012.10.032
Fiorino G, Bonifacio C, Peyrin-Biroulet L, et al. (2011) Prospective comparison of computed tomography enterography and magnetic resonance enterography for assessment of disease activity and complications in ileocolonic Crohn’s disease. Inflamm Bowel Dis 17(5):1073–1080. doi:10.1002/ibd.21533
Sherman J, Greenstein AJ, Greenstein AJ (2014) Ileal J Pouch Complications and Surgical Solutions: a review. Inflamm Bowel Dis . doi:10.1097/mib.0000000000000086
Hurst RD, Molinari M, Chung TP, Rubin M, Michelassi F (1996) Prospective study of the incidence, timing and treatment of pouchitis in 104 consecutive patients after restorative proctocolectomy. Arch Surg (Chicago, Ill: 1960) 131(5):497–500; discussion 501-492
Nadgir RN, Soto JA, Dendrinos K, et al. (2006) MRI of complicated pouchitis. AJR Am J Roentgenol 187(4):W386–W391. doi:10.2214/ajr.05.1019
Crema MD, Richarme D, Azizi L, et al. (2006) Pouchography, CT, and MRI features of ileal J pouch-anal anastomosis. AJR Am J Roentgenol 187(6):W594–W603. doi:10.2214/ajr.05.0870
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Quon, J.S., Quon, P.R., Lim, C.S. et al. Magnetic resonance enterography in post-operative inflammatory bowel disease. Abdom Imaging 40, 1034–1049 (2015). https://doi.org/10.1007/s00261-015-0392-1
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DOI: https://doi.org/10.1007/s00261-015-0392-1