Magnetic Resonance Enterography: Safe and Effective Imaging for Stricturing Crohn’s Disease
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Symptomatic Crohn’s disease (CD) patients often undergo diagnostic imaging studies for evaluation of disease activity or complications including bowel strictures and obstruction. Magnetic resonance enterography (MRE) provides information regarding disease activity, chronicity, and stricture formation without using ionizing radiation.
Examine the use of MRE among CD patients presenting with symptoms suggesting obstruction in a tertiary care practice setting.
We performed a retrospective study of all CD patients undergoing MRE at a tertiary IBD referral center over a 3-year study period including a subgroup analysis of patients presenting obstructive symptoms. Positive and negative findings from MRE were correlated with medical and surgical decision outcomes over the subsequent 90-day period.
In the study, 119 CD patients underwent 133 MRE scans, including 40 scans on individuals presenting with obstructive symptoms. Positive findings of CD including active inflammation, stricturing, and penetrating disease were more frequent in MREs ordered to evaluate obstructive symptoms (87.5%) compared other indications (58.1%, p = 0.001). In patients presenting with obstructive symptoms, MRE findings assisted in directing a change of clinical management towards escalation of medical therapy in 55% and surgery in 32.5%. Review of surgical resection specimens corroborated MRE findings of disease activity and fibrosis in 92% of cases going to surgery.
In practice-based use at a tertiary IBD referral center, MRE provided an effective, radiation-free alternative to computed tomography by providing valuable diagnostic information for evaluating and directing care in Crohn’s disease, particularly for patients presenting with obstructive symptoms.
- Cosnes J, Cattan S, Blain A, et al. Long-term evolution of disease behavior of Crohn’s disease. Inflamm Bowel Dis. 2002;8:244–250. CrossRef
- Bruining DH, Loftus EV Jr. Crohn’s disease clinical issues and treatment: what the radiologist needs to know and what the gastroenterologist wants to know. Abdom Imaging. 2009;34:297–302. CrossRef
- Low RN, Francis IR, Politoske D, Bennett M. Crohn’s disease evaluation: comparison of contrast-enhanced MR imaging and single-phase helical CT scanning. J Magn Reson Imaging. 2000;11:127–135. CrossRef
- Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357:2277–2284. CrossRef
- Fazel R, Krumholz HM, Wang Y, et al. Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med. 2009;361:849–857. CrossRef
- Herrmann KA, Michaely HJ, Zech CJ, Seiderer J, Reiser MF, Schoenberg SO. Internal fistulas in Crohn disease: magnetic resonance enteroclysis. Abdom Imaging. 2006;31:675–687. CrossRef
- Leyendecker JR, Bloomfeld RS, DiSantis DJ, Waters GS, Mott R, Bechtold RE. MR enterography in the management of patients with Crohn disease. Radiographics. 2009;29:1827–1846. CrossRef
- Lin MF, Narra V. Developing role of magnetic resonance imaging in Crohn’s disease. Curr Opin Gastroenterol. 2008;24:135–140. CrossRef
- Messaris E, Chandolias N, Grand D, Pricolo V. Role of magnetic resonance enterography in the management of Crohn disease. Arch Surg. 2010;145:471–475. CrossRef
- Sinha R, Murphy P, Hawker P, Sanders S, Rajesh A, Verma R. Role of MRI in Crohn’s disease. Clin Radiol. 2009;64:341–352. CrossRef
- Peloquin JM, Pardi DS, Sandborn WJ, et al. Diagnostic ionizing radiation exposure in a population-based cohort of patients with inflammatory bowel disease. Am J Gastroenterol. 2008;103:2015–2022. CrossRef
- Huprich JE, Fletcher JG. Ct enterography: principles, technique and utility in Crohn’s disease. Eur J Radiol. 2009;69:393–397. CrossRef
- Higgins PD, Caoili E, Zimmermann M, et al. Computed tomographic enterography adds information to clinical management in small bowel Crohn’s disease. Inflamm Bowel Dis. 2007;13:262–268. CrossRef
- Bruining DH, Siddiki HA, Fletcher JG, et al. Benefit of computed tomography enterography in Crohn’s disease: effects on patient management and physician level of confidence. Inflamm Bowel Dis. (Epub ahead of print). doi:10.1002/ibd.21683
- Smith-Bindman R, Lipson J, Marcus R, et al. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med. 2009;169:2078–2086. CrossRef
- Kidd R, Mezwa DG, Ralls PW, et al. Imaging recommendations for patients with newly suspected Crohn’s disease, and in patients with known Crohn’s disease and acute exacerbation or suspected complications. American College of Radiology. ACR appropriateness criteria. Radiology. 2000;215:181–192.
- Desmond AN, O’Regan K, Curran C, et al. Crohn’s disease: factors associated with exposure to high levels of diagnostic radiation. Gut. 2008;57:1524–1529. CrossRef
- Brenner DJ, Doll R, Goodhead DT, et al. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci USA. 2003;100:13761–13766. CrossRef
- Smith-Bindman R. Is computed tomography safe? N Engl J Med. 2010;363:1–4. CrossRef
- Ippolito D, Invernizzi F, Galimberti S, Panelli MR, Sironi S. MR enterography with polyethylene glycol as oral contrast medium in the follow-up of patients with Crohn disease: comparison with CT enterography. Abdom Imaging. 2010;35:563–570. CrossRef
- Lee SS, Kim AY, Yang SK, et al. Crohn disease of the small bowel: comparison of CT enterography, MR enterography, and small-bowel follow-through as diagnostic techniques. Radiology. 2009;251:751–761. CrossRef
- Siddiki HA, Fidler JL, Fletcher JG, et al. Prospective comparison of state-of-the-art MR enterography and CT enterography in small-bowel Crohn’s disease. Am J Roentgenol. 2009;193:113–121. CrossRef
- Rimola J, Rodriguez S, Garcia-Bosch O, et al. Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn’s disease. Gut. 2009;58:1113–1120. CrossRef
- Guimaraes LS, Fidler JL, Fletcher JG, et al. Assessment of appropriateness of indications for CT enterography in younger patients. Inflamm Bowel Dis. 2010;16:226–232.
- Magnetic Resonance Enterography: Safe and Effective Imaging for Stricturing Crohn’s Disease
Digestive Diseases and Sciences
Volume 56, Issue 10 , pp 2906-2913
- Cover Date
- Print ISSN
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- Springer US
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- Crohn’s disease
- Magnetic resonance enterography
- Obstructive symptoms
- Ionizing radiation
- Industry Sectors
- Author Affiliations
- 1. Division of Gastroenterology, Washington University in St. Louis School of Medicine, 660 South Euclid, Campus Box 8124, St. Louis, MO, 63110, USA
- 2. Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 1830 East Monument St, Suite 434, Baltimore, MD, 21287, USA
- 3. Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA