European Radiology

, Volume 16, Issue 1, pp 207–214 | Cite as

Bowel magnetic resonance imaging of pediatric patients with oral mannitol

MRI compared to endoscopy and intestinal ultrasound
  • Arne S. Borthne
  • Michael Abdelnoor
  • Jarle Rugtveit
  • Göri Perminow
  • Tor Reiseter
  • Nils-Einar Kløw


The purpose of this study was to assess the sensitivity, specificity, and diagnostic accuracy of magnetic resonance imaging (MRI) in pediatric patients with clinical suspicion of inflammatory bowel disease (IBD) by comparing MRI and ultrasound (US) to endoscopy, the gold standard. A median volume of 300 ml of mannitol in a 4.5% watery solution were ingested by 43 children prior to examination. The 53 MRI examinations were compared with 20 endoscopies and 41 US of the terminal ileum. The outcomes were MRI quality; pathologic findings; level of adverse events; and concordance between endoscopy, MRI, and US estimated by kappa statistics. The ileum and terminal ileum were very good or excellently imaged in approximately 80% of cases. Wall thickening and enhancement were most frequent in the terminal ileum. MRI compared with endoscopy had a sensitivity of 81.8% [95% confidence interval (CI)], specificity of 100%, diagnostic accuracy of 90%, and kappa value of 0.80 (95% CI), indicating a good degree of concordance. A similar degree of concordance was achieved between US and endoscopy. In spite of the frequent adverse reactions, such as diarrhea and nausea, half of the patients were prepared to repeat the examination. The results of MRI are concordant with endoscopy and US of the terminal ileum.


Diagnostic Magnetic resonance imaging Ultrasound Endoscopy Small bowel 


  1. 1.
    Geboes K, De Hertogh G (2003) Inderterminate colitis. Inflamm Bowel Dis 9:324–331PubMedCrossRefGoogle Scholar
  2. 2.
    Laghi A, Borrelli O, Paolantonio P et al (2003) Contrast enhanced magnetic resonance imaging of the terminal ileum in children with Crohn’s disease. Gut 52:393–397PubMedCrossRefGoogle Scholar
  3. 3.
    Present DH (2002) Serologic tests are not helpful in managing inflammatory bowel disease. Inflamm Bowel Dis 8:227–229PubMedCrossRefGoogle Scholar
  4. 4.
    Maccioni F, Viscido A, Broglia L et al (2000) Evaluation of Crohn’s disease activity with magnetic resonance imaging. Abdom Imaging 25:219–228PubMedCrossRefGoogle Scholar
  5. 5.
    Darbari A, Sena L, Argani P, Oliva-Hemker M, Thompson R, Cuffari C (2004) Gadolinium-enhanced magnetic resonance imaging. A useful radiological tool in diagnosing pediatric IBD. Inflamm Bowel Dis 10:67–72PubMedCrossRefGoogle Scholar
  6. 6.
    Ha AS, Levine MS, Rubesin SE, Laufer I, Herlinger H (2003) Radiographic examination of the small bowel: survey of practice patterns in the United States. Radiology 231:407–411Google Scholar
  7. 7.
    Low RN, Francis IR, Politoske D, Bennett M (2000) Crohn’s disease evaluation: comparison of contrast-enhanced MR imaging and single-phase helical CT scanning. J Magn Reson Imaging 11:127–135PubMedCrossRefGoogle Scholar
  8. 8.
    Schreyer A, Seiz J, Feuerbach S, Rogler G, Herfarth H (2004) Modern imaging using computer tomography and magnetic resonance imaging for inflammatory bowel disease (IBD) AU1. Inflamm Bowel Dis 10:45–54PubMedCrossRefGoogle Scholar
  9. 9.
    Parente F, Greco S, Molteni M, Anderloni A, Maconi G, Porro GB (2004) Modern imaging of Crohn’s disease using bowel ultrasound. Inflamm Bowel Dis 10:452–461PubMedCrossRefGoogle Scholar
  10. 10.
    Miao YM, Koh D-M, 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
  11. 11.
    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
  12. 12.
    Rieber A, Nüssle K, Reinshagen M, Brambs H-J, Gabelmann A (2002) MRI of the abdomen with positive oral contrast agents for the diagnosis of inflammatory small bowel disease. Abdom Imaging 27:394–399PubMedCrossRefGoogle Scholar
  13. 13.
    Fletcher RH, Fletcher SW, Wagner EH (1996) In: Clinical epidemiology. The essentials, 3rd edn. Williams and Wilkins, Philadelphia, pp 48–49Google Scholar
  14. 14.
    Altman DG (1996) Practical statistics for medical research, Chapman & Hall, London, pp 404Google Scholar
  15. 15.
    Gourtsoyiannis N, Papanikolaou N, Grammatikakis J, Maris T (2000) MR imaging of the small bowel with a true-FISP sequence after enteroclysis with water solution. Invest Radiol 35:707–711PubMedCrossRefGoogle Scholar
  16. 16.
    Rieber A, Aschoff A, Nüssle K et al (2000) MRI in the diagnosis of small bowel disease: use of positive and negative oral contrast media in combination with enteroclysis. Eur Radiol 1377–1382Google Scholar
  17. 17.
    Masselli G, Brizi GM, Parrella A, Minordi LM, Vecchioli A, Marano P (2004) Crohn disease: magnetic resonance enteroclysis. Abdom Imaging 29:326–334PubMedCrossRefGoogle Scholar
  18. 18.
    Schunk K, Kern A, Oberholzer K et al (2000) Hydro-MRI in Crohn’s disease: appraisal of disease activity. Invest Radiol 35:431–437PubMedCrossRefGoogle Scholar
  19. 19.
    Ajaj W, Goehde SC, Schneemann H, Ruehm SG, Debatin JF, Lauenstein TC (2004) Oral contrast agents for small bowel MRI: comparison of different additives to optimize bowel distension. Eur Radiol 14:458–464PubMedCrossRefGoogle Scholar
  20. 20.
    Narin B, Ajaj W, Gohde S et al (2004) Combined small and large bowel MR imaging in patients with Crohn’s disease: a feasibility study. Eur Radiol 14:1535–1542PubMedCrossRefGoogle Scholar
  21. 21.
    Borthne AS, Dormagen JB, Gjesdal KI, Storaas T, Lygren I, Geitung JT (2003) Bowel MR imaging with oral Gastrografin: an experimental study with healthy volunteers. Eur Radiol 13:100–106PubMedGoogle Scholar
  22. 22.
    Borthne AS, Abdelnoor M, Hellund JC et al (2005) MR imaging of the small bowel with increasing concentrations of an oral osmotic agent. Eur Radiol 15:666–671PubMedCrossRefGoogle Scholar
  23. 23.
    Schunk K (2002) Small bowel magnetic resonance imaging for inflammatory bowel disease. Top Magn Reson Imaging 13:409–425PubMedCrossRefGoogle Scholar
  24. 24.
    Bigard M, Gaucher P, Lasalle C (1979) Fatal colonic explosion during colonoscopic polypectomy. Gastroenterology 77:1307–1310PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Arne S. Borthne
    • 1
  • Michael Abdelnoor
    • 2
  • Jarle Rugtveit
    • 3
  • Göri Perminow
    • 4
  • Tor Reiseter
    • 1
  • Nils-Einar Kløw
    • 5
  1. 1.Department of Pediatric RadiologyUllevaal University HospitalOsloNorway
  2. 2.Section of Epidemiology and Biostatistics, Centre of Clinical ResearchUllevaal University HospitalOsloNorway
  3. 3.Department of Pediatric GastroenterologyUllevaal University HospitalOsloNorway
  4. 4.Department of PediatricsAkershus County University HospitalNordbyhagenNorway
  5. 5.Department of Cardiovascular RadiologyUllevaal University HospitalOsloNorway

Personalised recommendations