Abdominal Imaging

, Volume 34, Issue 2, pp 141–148 | Cite as

Assessment of the extension and the inflammatory activity in Crohn’s disease: comparison of ultrasound and MRI

  • María J. Martínez
  • Tomás Ripollés
  • José M. Paredes
  • Esther Blanc
  • Luis Martí-Bonmatí



The purpose of this prospective study was twofold: to examine the efficacy of MRI and sonography in the assessment of Crohn’s disease (CD) activity in comparison with clinical scoring and biologic tests and to compare both techniques in the evaluation of extension and transmural complications.

Material and methods

Thirty patients with histologically proven Crohn’s disease were prospectively examined the same day first with sonography and after MRI. Sonographic exam included evaluation of bowel wall thickness, vascularity pattern, and perienteric changes. Thirty minutes prior to MRI imaging, patients were given 250 mL of dilute sodium phosphate solution and additional 750 mL of water orally. MRI images evaluation included bowel wall thickening, bowel wall enhancement, and perienteric changes. The gastrointestinal tract was divided into five segments. Findings and extension of the both techniques were verified by means of barium studies, surgery, or/and colonoscopy. The sonographic and MR findings were compared with clinical and laboratory data.


About 53 of 119 (45%) bowel segments showed pathological changes in gold standard tests. Sonography was superior to MRI in the localization of affected bowel segments (sensitivity: US 91%; MRI 83%; intertechniques agreement, kappa: 0.905) and in recognizing transmural complications (sensitivity: US 80%; MRI 72%), although significant differences were not found (p > 0.05). A statistically significant correlation between color Doppler flow and MR bowel wall enhancement (segment-by-segment analysis and per patient analysis; p > 0.5), and between perienteric changes in both techniques (p > 0.5) were found. Wall thickness measured on sonography was significantly greater in the group of patients with clinical activity (p = 0.023) or with clinical-biologic activity (p = 0.024). Grades of hyperemia and MR contrast enhancement of patients with clinical–biologic activity was higher than in patients without clinical–biologic activity (p = 0.019; p = 0.023).


In summary, both ultrasound and MRI are sensitive to localize the affected bowel segments and to detect transmural complications in patients with Crohn’s disease. A significant correlation between color Doppler flow and bowel wall enhancement on MRI was found. Sonographic wall thickness, color Doppler flow, and bowel wall enhancement on MRI are related with clinical or biologic activity.


Crohn’s disease Bowel sonography Doppler sonography MRI Gastrointestinal imaging Inflammatory bowel disease 


  1. 1.
    Stange EF, Travis SP, Vermeire S, et al. (2006) European Crohn’s and Colitis organization (ECCO). European evidence based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis Gut 55:1–15CrossRefGoogle Scholar
  2. 2.
    Gasche C, Moser G, Turetschek K, Schober E, Moeschl P, Oberhuber G (1999) Transabdominal bowel sonography for the detection of intestinal complications in Crohn’s disease Gut 44:112–117PubMedCrossRefGoogle Scholar
  3. 3.
    Valette PJ, Rioux M, Pilleul F, Saurin JC, Fouque P, Henry L (2001) Ultrasonography of chronic inflammatory bowel disease Eur Radiol 11:1859–1866PubMedCrossRefGoogle Scholar
  4. 4.
    Maconi G, Sampietro GM, Parente F, Pompili G, Russo A, Cristaldi M, et al. (2003) Contrast radiology, computed tomography and ultrasonography in detecting internal fistulas and intra-abdominal abscesses in Crohn’s disease: a prospective comparative study Am J Gastroenterol 98:1545–1555PubMedCrossRefGoogle Scholar
  5. 5.
    Potthast S, Rieber A, von Tirpitz C, Wruk D, Adler G, Brambs HJ (2002) Ultrasound and magnetic resonance imaging in Crohn’s disease: a comparison Eur Radiol 12:1416–1422PubMedCrossRefGoogle Scholar
  6. 6.
    Gourtsoyiannis N, Papanikolaou N, Grammatikakis J, et al. (2002) MR enteroclysis: technical considerations and clinical applications Eur Radiol 12:2651–2658PubMedGoogle Scholar
  7. 7.
    Best WR, Becktel JM, Singleton JW, Kern FJ (1976) Development of a Crohn’s disease activity index: national cooperative Crohn’s disease study Gastroenterology 70:439–444PubMedGoogle Scholar
  8. 8.
    Maccioni F, Viscido A, Broglia L, Marrollo M, Masciangelo R, Caprilli R, et al. (2000) Evaluation of Crohn disease activity with magnetic resonance imaging Abdom Imaging 25:219–228PubMedCrossRefGoogle Scholar
  9. 9.
    Fraquelli M, Colli A, Casazza G, Paggi S, Colucci A, Massironi S, et al. (2005) Role of US in detection of Crohn disease: meta-analysis Radiology 236:95–101PubMedCrossRefGoogle Scholar
  10. 10.
    Spalinguer J, Patriquin H, Miron MC, Marx G, Herzog D, Dubois J, et al. (2000) Doppler US in patients with Crohn disease: vessel density in the diseased bowel reflects disease activity Radiology 217:787–791Google Scholar
  11. 11.
    Esteban JM, Maldonado L, Sanchiz J, Minguez M, Benages A (2001) Activity of Crohn disease assessed by color Doppler ultrasound analysis of the affected loops Eur Radiol 11:1423–1428PubMedCrossRefGoogle Scholar
  12. 12.
    Haber HP, Busch A, Ziebach R, Stern M (2000) Bowel wall thickness measured by ultrasound as a marker of Crohn’s disease activity in children Lancet 355:1239–1240PubMedCrossRefGoogle Scholar
  13. 13.
    Haber HP, Busch A, Ziebach R, Dette S, Ruck P, Stern M (2002) Ultrasonographic findings correspond to clinical, endoscopic, and histologic findings in inflammatory bowel disease and other enterocolitides J Ultrasound Med 21:375–382PubMedGoogle Scholar
  14. 14.
    Dubbins PA (1984) Ultrasound demonstration of bowel wall thickness in inflammatory disease Clin Radiol 35:227–231PubMedCrossRefGoogle Scholar
  15. 15.
    Ruess L, Nussbaum AR, Bulas D, Mohan P, Bader A, Latimer JS, et al. (2000) Inflammatory bowel disease in children and young adults: correlation of sonographic and clinical parameters during treatment AJR 175:79–84PubMedGoogle Scholar
  16. 16.
    Kettriz U, Isaacs K, Warshauer DM, et al. (1995) Crohn’s disease. Pilot study comparing MRI of the abdomen with clinical evaluation J Clin Gastroenterol 21(3):249–253CrossRefGoogle Scholar
  17. 17.
    Madsen SM, Thomsen HS, Schlinchting P, et al. (1999) Evaluation of treatment response in active Crohn’s disease by low-field magnetic resonance imaging Abdom Imaging 24:164–166CrossRefGoogle Scholar
  18. 18.
    Schunk K, Kerne A, Oberholzer K, et al. (2000) Hydro-MRI in Crohn’s disease: appraisal of disease activity Invest Radiol 35:431–437PubMedCrossRefGoogle Scholar
  19. 19.
    Koh DM, Miao Y, Chinn RJS, Amin Z, Zeegen R, Westaby D, et al. (2001) MR imaging evaluation of the activity of Crohn’s disease Am J Roentgenol 177:1325–1336Google Scholar
  20. 20.
    Miao YM, Koh DM, Amin Z, et al. (2002) Ultrasound and magnetic resonance imaging assessment of active bowel segments in Crohn’s disease Clin Radiol 57:913–918PubMedCrossRefGoogle Scholar
  21. 21.
    Gourtsoyiannis N, Papanikolaou N, Grammatikakis J, et al. (2004) Assessment of Crohn’s disease activity in the small bowel with MR and conventional enteroclysis: preliminary results Eur Radiol 14:1017–1024PubMedCrossRefGoogle Scholar
  22. 22.
    Parente F, Greco S, Molteni M, et al. (2004) Modern imaging of Crohn’s disease using bowel ultrasound Inflamm Bowel Dis 10:452–461PubMedCrossRefGoogle Scholar
  23. 23.
    Maccioni F, Bruni A, Viscido A, Colaiacomo MCh, Cocco A, Montesani Ch, et al. (2006) MR imaging in patients with Crohn disease: value of T2-versus T1-weighted Galdolinium-enhanced MR sequences with use of an oral superparamagnetic contrast agent Radiology 238:517–530PubMedCrossRefGoogle Scholar
  24. 24.
    Masselli G, Casciani E, Polettini E, Lanciotti S, Bertini L, Gualkdi G (2006) Assessment of Crohn’s disease in the small bowel: prospective comparison of magnetic resonance enteroclysis with conventional enteroclysis Eur Radiol 16:2817–2827PubMedCrossRefGoogle Scholar
  25. 25.
    Maccioni F, Viscido A, Marini M, Caprilli R (2002) MRI evaluation of Crohn’s disease of the small and large bowel with the use of negative superparamagnetic oral contrast agents Abdom Imaging 27:384–393PubMedCrossRefGoogle Scholar
  26. 26.
    Maconi G, Parente F, Bollani S, et al. (1996) Abdominal ultrasound in the assessment of extent and activity of Crohn’s disease: clinical significance and implication of bowel wall thickening Am J Gastroenterol 91:1604–1609PubMedGoogle Scholar
  27. 27.
    Neye H, Voderholzer W, Rickes S, Weber J, Wermke W, Lochs H (2004) Evaluation of criteria for the activity of Crohn’s disease by power Doppler sonography Dig Dis 22:67–72PubMedCrossRefGoogle Scholar
  28. 28.
    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 16:2410–2417PubMedCrossRefGoogle Scholar
  29. 29.
    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 Am J Roentgenol 186:1384–1392CrossRefGoogle Scholar
  30. 30.
    Ajaj WM, Lauenstein TC, Pelster G, Gerken G, Ruehm SG, Debatin JF, et al. (2005) Magnetic resonance colonography for the detection of inflammatory disease of the large bowel: quantifying the inflammatory activity Gut 54:257–263PubMedCrossRefGoogle Scholar
  31. 31.
    Sempere GA, Martinez Sanjuán V, Medina Chulea, et al. (2005) MRI evaluation of inflammatory activity in Crohn’s disease Am J Roentgenol 184:1829–1835Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • María J. Martínez
    • 1
  • Tomás Ripollés
    • 1
  • José M. Paredes
    • 2
  • Esther Blanc
    • 1
  • Luis Martí-Bonmatí
    • 1
  1. 1.Department of RadiologyHospital Universitario Dr. PesetValenciaSpain
  2. 2.Department of GastroenterologyHospital Universitario Dr. PesetValenciaSpain

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