European Radiology

, Volume 17, Issue 9, pp 2294–2301 | Cite as

A prospective randomized comparison between two MRI studies of the small bowel in Crohn’s disease, the oral contrast method and MR enteroclysis

  • Anne NegaardEmail author
  • Vemund Paulsen
  • Leiv Sandvik
  • Audun Elnaes Berstad
  • Arne Borthne
  • Kirsti Try
  • Idar Lygren
  • Tryggve Storaas
  • Nils-Einar Klow


The aim was to compare bowel distension and diagnostic properties of magnetic resonance imaging of the small bowel with oral contrast (MRI per OS) with magnetic resonance enteroclysis (MRE). Forty patients with suspected Crohn’s disease (CD) were examined with both MRI methods. MRI per OS was performed with a 6% mannitol solution and MRE with nasojejunal intubation and a polyethylenglycol solution. MRI protocol consisted of balanced fast field echo (B-FFE), T2 and T1 sequences with and without gadolinium. Two experienced radiologists individually evaluated bowel distension and pathological findings including wall thickness (BWT), contrast enhancement (BWE), ulcer (BWU), stenosis (BWS) and edema (EDM). The diameter of the small bowel was smaller with MRI per OS than with MRE (difference jejunum: 0.55 cm, p < 0.001; ileum: 0.35 cm, p < 0.001, terminal ileum: 0.09 cm, p = 0.08). However, CD was diagnosed with high diagnostic accuracy (sensitivity, specificity, positive and negative predictive values: MRI per OS 88%, 89%, 89%, 89%; MRE 88%, 84%, 82%, 89%) and inter-observer agreement (MRI per OS k = 0.95; MRE k = 1). In conclusion, bowel distension was inferior in MRI per OS compared to MRE. However, both methods diagnosed CD with a high diagnostic accuracy and reproducibility.


Comparative studies Crohn’s disease Small bowel imaging Osmolarity MR enteroclysis 


  1. 1.
    Gourtsoyiannis NC, Papanikolaou N (2005) Magnetic resonance enteroclysis. Semin Ultrasound CT MR 26:237–246PubMedCrossRefGoogle Scholar
  2. 2.
    Rieber A, Aschoff A, Nussle 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 10:1377–1382PubMedCrossRefGoogle Scholar
  3. 3.
    Umschaden HW, Gasser J (2003) MR enteroclysis. Radiol Clin North Am 41:231–248PubMedCrossRefGoogle Scholar
  4. 4.
    Wiarda BM, Kuipers EJ, Heitbrink MA, van Oijen A, Stoker J (2006) MR Enteroclysis of inflammatory small-bowel diseases. Am J Roentgenol 187:522–531CrossRefGoogle Scholar
  5. 5.
    Gourtsoyiannis NC, Grammatikakis J, Papamastorakis G et al (2006) Imaging of small intestinal Crohn’s disease: comparison between MR enteroclysis and conventional enteroclysis. Eur Radiol 16:1915–1925PubMedCrossRefGoogle Scholar
  6. 6.
    Rieber A, Wruk D, Potthast S et al (2000) Diagnostic imaging in Crohn’s disease: comparison of magnetic resonance imaging and conventional imaging methods. Int J Colorectal Dis 15:176–181PubMedCrossRefGoogle Scholar
  7. 7.
    Umschaden HW, Szolar D, Gasser J, Umschaden M, Haselbach H (2000) Small-bowel disease: comparison of MR enteroclysis images with conventional enteroclysis and surgical findings. Radiology 215:717–725PubMedGoogle Scholar
  8. 8.
    Laghi A, Carbone I, Paolantonio P, Iannaccone R, Passariello R (2002) Polyethylene glycol solution as an oral contrast agent for MR imaging of the small bowel. Acad Radiol 9(Suppl 2):S355–S356PubMedCrossRefGoogle Scholar
  9. 9.
    Lauenstein TC, Schneemann H, Vogt FM, Herborn CU, Ruhm SG, Debatin JF (2003) Optimization of oral contrast agents for MR imaging of the small bowel. Radiology 228:279–283PubMedCrossRefGoogle Scholar
  10. 10.
    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
  11. 11.
    Patak MA, Froehlich JM, von Weymarn C, Ritz MA, Zollikofer CL, Wentz K (2001) Non-invasive distension of the small bowel for magnetic-resonance imaging. Lancet 358:987–988PubMedCrossRefGoogle Scholar
  12. 12.
    Pilleul F, Godefroy C, Yzebe-Beziat D, Dugougeat-Pilleul F, Lachaux A, Valette PJ (2005) Magnetic resonance imaging in Crohn’s disease. Gastroenterol Clin Biol 29:803–808PubMedCrossRefGoogle Scholar
  13. 13.
    Schreyer AG, Herfarth H, Kikinis R et al (2002) 3D modeling and virtual endoscopy of the small bowel based on magnetic resonance imaging in patients with inflammatory bowel disease. Invest Radiol 37:528–533PubMedCrossRefGoogle Scholar
  14. 14.
    Schunk K (2002) Small bowel magnetic resonance imaging for inflammatory bowel disease. Top Magn Reson Imaging 13:409–425PubMedCrossRefGoogle Scholar
  15. 15.
    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
  16. 16.
    Schreyer AG, Geissler A, Albrich H et al (2004) Abdominal MRI after enteroclysis or with oral contrast in patients with suspected or proven Crohn’s disease. Clin Gastroenterol Hepatol 2:491–497PubMedCrossRefGoogle Scholar
  17. 17.
    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
  18. 18.
    Legnani P, Abreu MT (2006) Use of capsule endoscopy for established Crohn’s disease. Gastrointest Endosc Clin N Am 16:299–306PubMedCrossRefGoogle Scholar
  19. 19.
    Stange EF, Travis SP, Vermeire S et al (2006) European evidence based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis. Gut 55(Suppl 1):i1–i15PubMedCrossRefGoogle Scholar
  20. 20.
    Prassopoulos P, Papanikolaou N, Grammatikakis J, Rousomoustakaki M, Maris T, Gourtsoyiannis N (2001) MR enteroclysis imaging of Crohn disease. Radiographics 21 Spec No:S161–S172Google Scholar
  21. 21.
    Ajaj W, Goehde SC, Schneemann H, Ruehm SG, Debatin JF, Lauenstein TC (2004) Dose optimization of mannitol solution for small bowel distension in MRI. J Magn Reson Imaging 20:648–653PubMedCrossRefGoogle Scholar
  22. 22.
    Schmidt S, Lepori D, Meuwly JY et al (2003) Prospective comparison of MR enteroclysis with multidetector spiral-CT enteroclysis: interobserver agreement and sensitivity by means of “sign-by-sign” correlation. Eur Radiol 13:1303–1311PubMedGoogle Scholar
  23. 23.
    Ochsenkuhn T, Herrmann K, Schoenberg SO, Reiser MF, Goke B, Sackmann M (2004) Crohn disease of the small bowel proximal to the terminal ileum: detection by MR-enteroclysis. Scand J Gastroenterol 39:953–960PubMedCrossRefGoogle Scholar
  24. 24.
    Gourtsoyiannis N, Papanikolaou N, Grammatikakis J, Prassopoulos P (2002) MR enteroclysis: technical considerations and clinical applications. Eur Radiol 12:2651–2658PubMedGoogle Scholar
  25. 25.
    Maglinte DD, Siegelman ES, Kelvin FM (2000) MR enteroclysis: the future of small-bowel imaging? Radiology 215:639–641PubMedGoogle Scholar
  26. 26.
    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 15:1400–1406PubMedCrossRefGoogle Scholar
  27. 27.
    Borthne AS, Abdelnoor M, Storaas T, Pierre-Jerome C, Klow NE (2006) Osmolarity: a decisive parameter of bowel agents in intestinal magnetic resonance imaging. Eur Radiol 16:1331–1336PubMedCrossRefGoogle Scholar
  28. 28.
    Gourtsoyiannis NC, Papanikolaou N, Karantanas A (2006) Magnetic resonance imaging evaluation of small intestinal Crohn’s disease. Best Pract Res Clin Gastroenterol 20:137–156PubMedCrossRefGoogle Scholar
  29. 29.
    Maccioni F, Bruni A, Viscido A et al (2006) MR imaging in patients with Crohn disease: value of T2- versus T1-weighted gadolinium-enhanced MR sequences with use of an oral superparamagnetic contrast agent. Radiology 238:517–530PubMedCrossRefGoogle Scholar
  30. 30.
    Gourtsoyiannis N, Papanikolaou N, Grammatikakis J, Papamastorakis G, Prassopoulos P, Roussomoustakaki M (2004) Assessment of Crohn’s disease activity in the small bowel with MR and conventional enteroclysis: preliminary results. Eur Radiol 14:1017–1024PubMedCrossRefGoogle Scholar
  31. 31.
    Madsen SM, Thomsen HS, Munkholm P, Schlichting P, Davidsen B (1997) Magnetic resonance imaging of Crohn disease: early recognition of treatment response and relapse. Abdom Imaging 22:164–166PubMedCrossRefGoogle Scholar
  32. 32.
    Sempere GA, Martinez SV, Medina CE et al (2005) MRI evaluation of inflammatory activity in Crohn’s disease. Am J Roentgenol 184:1829–1835Google Scholar
  33. 33.
    Borthne AS, Abdelnoor M, Rugtveit J, Perminow G, Reiseter T, Klow NE (2006) Bowel magnetic resonance imaging of pediatric patients with oral mannitol MRI compared to endoscopy and intestinal ultrasound. Eur Radiol 16(1):207–214PubMedCrossRefGoogle Scholar
  34. 34.
    Bigard MA, Gaucher P, Lassalle C (1979) Fatal colonic explosion during colonoscopic polypectomy. Gastroenterology 77:1307–1310PubMedGoogle Scholar
  35. 35.
    Zanoni CE, Bergamini C, Bertoncini M, Bertoncini L, Garbini A (1982) Whole-gut lavage for surgery. A case of intraoperative colonic explosion after administration of mannitol. Dis Colon Rectum 25:580–581PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Anne Negaard
    • 1
    Email author
  • Vemund Paulsen
    • 2
  • Leiv Sandvik
    • 3
  • Audun Elnaes Berstad
    • 4
  • Arne Borthne
    • 5
  • Kirsti Try
    • 5
  • Idar Lygren
    • 2
  • Tryggve Storaas
    • 6
  • Nils-Einar Klow
    • 7
  1. 1.Department of RadiologyUllevål University Hospital and Faculty of Medicine University of OsloOsloNorway
  2. 2.Department of GastroenterologyUllevål University HospitalOsloNorway
  3. 3.Department of Statistics and EpidemiologyUllevål University Hospital and Faculty of Medicine, University of OsloOsloNorway
  4. 4.Department of RadiologyRikshospitalet-Radiumhospitalet Medical CenterOsloNorway
  5. 5.Department of Pediatric RadiologyUllevål University HospitalOsloNorway
  6. 6.Department of Medical PhysicsUllevål University HospitalOsloNorway
  7. 7.Department of Cardiovascular RadiologyUllevål University Hospital and Faculty of Medicine, University of OsloOsloNorway

Personalised recommendations