Clinical significance of isolated abnormal intestinal findings in magnetic resonance enterography in patients with suspected small bowel disease

  • Yesim Ozen Alahdab
  • Coskun Ozer DemirtasEmail author
  • Haluk Tarik Kani
  • Davut Tuney
  • Lamia Seker
  • Tugba Tolu
  • Ozlen Atug
Hollow Organ GI



Magnetic resonance imaging (MRE) is a well-established adjunct diagnostic tool for the diagnosis of Crohn’s Disease (CD), as ileocolonoscopy can sometimes be falsely reassuring when CD skips distal terminal ileum. We aimed to determine the frequency and clinical significance of isolated abnormal small bowel findings in MRE with normal ileal view in ileoscopy.


We retrospectively reviewed findings from 1611 MRE studies that were conducted between 2012 and 2018 to detect patients bearing abnormal intestinal findings and having full ileocolonoscopy. After exclusion of normal or repetitive MRE scans and previously known CD, 147 patients with abnormal MRE detected. MRE scans were categorized as suspicious of CD and non-specific findings.


Out of 147 patients with abnormal MRE, 122 (83%) had terminal ileum involvement in MRE consistent with ileoscopy findings. Twenty-five (17%) patients were found to have solitarily abnormal intestinal findings in MRE with normal ileoscopy. Only 3 (12%) were diagnosed with CD initially, and all had MRE findings suspicious of CD. The remainder 40% (n = 10) were diagnosed with non-Crohn’s small bowel disease after further investigation, while in the other 48% (n = 12) abnormal MRE findings could not be explained with any organic disease in the follow-up.


The present study demonstrated that only a small portion of patients with isolated abnormal intestinal findings in MRE is CD, and more than that are non-crohn’s small bowel diseases. These findings, even if they carry the suspicion of CD, do not transform to CD in the long-term follow-up.


Magnetic resonance enterography Crohn’s disease Small bowel disease Ileocolonoscpy 




Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the local ethics committee of Marmara University, School of Medicine (Approval Date: 14.12.2018, Approval Number: 09.2018.789).

Informed consent

Informed consent was not obtained as this was a retrospective study.


  1. 1.
    Baumgart DC, Sandborn WJ (2012) Crohn’s disease. Lancet 380:1590-1605.CrossRefGoogle Scholar
  2. 2.
    Yacoub JH, Obara P, Oto A (2013) Evolving role of MRI in Crohn’s disease. J Magn Reson Imaging 37:1277-1289. Scholar
  3. 3.
    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 17:1073-1080. Scholar
  4. 4.
    Magro F, Gionchetti P, Eliakim R et al (2017) Third European evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders. J Crohns Colitis 11:649-670. Scholar
  5. 5.
    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 193:113-121.CrossRefGoogle Scholar
  6. 6.
    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 1. Radiology 251:751-761. Scholar
  7. 7.
    Saibeni S, Rondonotti E, Iozzelli A et al (2007) Imaging of the small bowel in Crohn’s disease: a review of old and new techniques. World J Gastroenterol 13:3279-3287.CrossRefGoogle Scholar
  8. 8.
    Grand DJ, Harris A, Loftus EV (2012) Imaging for luminal disease and complications: CT enterography, MR enterography, small-bowel follow-through, and ultrasound. Gastroenterol Clin North Am 41:497-512. Scholar
  9. 9.
    Sinha R, Verma R, Verma S, Rajesh A (2011) MR enterography of Crohn disease: part 1, rationale, technique, and pitfalls. AJR Am J Roentgenol 197:76-79. Scholar
  10. 10.
    Masselli G, Gualdi GMR (2012) Imaging of the small bowel. Radiology 264:333-338.CrossRefGoogle Scholar
  11. 11.
    Kavaliauskiene G, Ziech ML, Nio CY (2011) Small bowel MRI in adult patient: Not just Crohn’s disease-a tutorial. Insights Imaging 2:501-513.CrossRefGoogle Scholar
  12. 12.
    Tolan DJ, Greenhalgh R, Zealley IA, Halligan S, Taylor SA (2010) MR enterographic manifestations of small bowel Crohn disease. Radiographics 30:367-384.CrossRefGoogle Scholar
  13. 13.
    Tse CS, Deepak P, Smyrk TC, Raffals LE (2017) Isolated Acute Terminal Ileitis Without Preexisting Inflammatory Bowel Disease Rarely Progresses to Crohn’s Disease. Dig Dis Sci 62:3557-3562.CrossRefGoogle Scholar
  14. 14.
    Chang H-S, Lee D, Kim JC et al (2010) Isolated terminal ileal ulcerations in asymptomatic individuals: natural course and clinical significance. Gastrointest Endosc 72:1226-1232.CrossRefGoogle Scholar
  15. 15.
    Courville EL, Siegel CA, Vay T, Wilcox AR, Suriawinata AA, Srivastava A (2009) Isolated asymptomatic ileitis does not progress to overt Crohn disease on long-term follow-up despite features of chronicity in ileal biopsies. Am J Surg Pathol 33:1341-1347.CrossRefGoogle Scholar
  16. 16.
    Fangbin Z, Weiwei H, Wugan Z, Cong Z, Yanjun C, Feng X (2014) The analysis of factors associated with progression of isolated terminal ileal lesions. PLoS ONE. 2014;9:e90797. Scholar
  17. 17.
    O’Donnell S, Crotty PL, O’Sullivan M et al (2013) Isolated active ileitis: Is it a mild subtype of Crohn’s disease? Inflamm Bowel Dis 19:1815-1822.Google Scholar
  18. 18.
    Mansuri I, Fletcher JG, Bruining DH, Kolbe AB, Fidler JL, Samuel S, Tung J (2017) Endoscopic Skipping of the Terminal Ileum in Pediatric Crohn Disease. AJR Am J Roentgenol 208:216-224. Scholar
  19. 19.
    von der Weid PY, Rehal S, Ferraz JG (2011) Role of the lymphatic system in the pathogenesis of Crohn’s disease. Curr Opin Gastroenterol 27:335-341Google Scholar
  20. 20.
    Behr MA (2010) The path to Crohn’s disease: is mucosal pathology a secondary event? Inflamm Bowel Dis 2010 16:896-902CrossRefGoogle Scholar
  21. 21.
    Cherian S, Singh P (2004) Is routine ileoscopy useful? An observational study of procedure times, diagnostic yield, and learning curve. Am J Gastroenterol 99:2324-2329CrossRefGoogle Scholar
  22. 22.
    McHugh JB, Appelman HD, McKenna BJ (2007) The diagnostic value of endoscopic terminal ileum biopsies. Am J Gastroenterol 102:1084-1089Google Scholar
  23. 23.
    Daniela Bojic, Srdjan Markovic (2011) Terminal ileitis is not always Crohn’s disease. Ann Gastroenterol 24:271-275.Google Scholar
  24. 24.
    DiLauro S, Crum-Cianflone NF (2010) Ileitis: when it is not Crohn’s disease? Curr Gastroenterol Rep 12:249-258.CrossRefGoogle Scholar
  25. 25.
    Frye JM, Hansel SL, Dolan SG et al (2015) NSAID enteropathy: appearance at CT and MR enterography in the age of multi-modality imaging and treatment. Abdom Imaging 40:1011-1025.CrossRefGoogle Scholar
  26. 26.
    Griffin N, Westerland O (2016) The Role of Magnetic Resonance Enterography in the Evaluation of Non-Crohn’s Pathologies. Semin Ultrasound CT MR 37:292-300.CrossRefGoogle Scholar
  27. 27.
    Maccioni F, Al Ansari N, Mazzamurro F et al (2012) Surveillance of patients affected by Peutz-Jeghers syndrome: Diagnostic value of MR enterography in prone and supine position. Abdom Imaging 37:279-287.CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of GastroenterologyMarmara University, School of MedicineIstanbulTurkey
  2. 2.Department of RadiologyMarmara University, School of MedicineIstanbulTurkey
  3. 3.Department of Internal MedicineMarmara University, School of MedicineIstanbulTurkey

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