European Radiology

, Volume 18, Issue 3, pp 438–447 | Cite as

Comparison of MR enteroclysis with MR enterography and conventional enteroclysis in patients with Crohn’s disease

  • Gabriele Masselli
  • Emanuele Casciani
  • Elisabetta Polettini
  • Gianfranco Gualdi
Gastrointestinal

Abstract

To prospectively compare the diagnostic accuracy of MR enteroclysis with duodenal intubation with MRI after drinking oral contrast agent only (MR enterography) with conventional enteroclysis (conv-E) as reference standard in patients with Crohn’s disease. Forty consecutive patients (22 males and 18 females; mean age 36; range 16–74 years) with proven Crohn’s disease underwent conv-E and MR imaging. Twenty-two patients underwent MR enteroclysis with intubation (MRE) and 18 underwent MR-enterography (MR per OS). Two radiologists reached a consensus about the following imaging findings: luminal distension and visualization of superficial mucosal, mural and mesenteric abnormalities. Standard descriptive statistics and a Wilcoxon rank sum test were used. Statistical significance was inferred at P < 0.05. There was no significant difference in the adequacy of luminal distention between the MRE and conv-E (P = 0.08), and both were statistically superior in comparison to MR per OS in the distension of the jejunum (P < 0.01) and less significant at the ileum and terminal ileum levels (P < 0.05). MRE and conv-E were comparable for the accuracy of superficial mucosal abnormalities; meanwhile conv-E compared with MR per OS was statistically superior (P < 0.01). MRE compared with MR per OS was statistically better when visualizing superficial abnormalities (P < 0.01). No statistically significant differences were found in assessing the diagnostic efficacy between MR examinations for the depiction of mural stenosis (P = 0.105) and fistulae (P = 0.67). The number of detected mesenteric findings was significantly higher with both MRE and MR per OS compared to conv-E (P < 0.01). MRE can serve as the diagnostic procedure for initially evaluating patients suspected of having Crohn’s disease. MR per OS may have a role in patients that refuse or have failed intubation and also for follow-up.

Keywords

MR enteroclysis MR enterography Crohn's disease 

References

  1. 1.
    Horsthuis K, Lavini C, Stoker J (2005) MRI in Crohn’s disease. J Magn Reson Imaging 22:1–12PubMedCrossRefGoogle Scholar
  2. 2.
    Furukawa A, Saotome T, Yamasaki M, Maeda K, Nitta N, Takahashi M, Tsujikawa T, Fujiyama Y, Murata K, Sakamoto T (2004) Cross-sectional Imaging in Crohn’s disease. Radiographics 24:689–702PubMedCrossRefGoogle Scholar
  3. 3.
    Gourtsoyiannis N, Papanikolaou N, Grammatikakis J, Prassopoulos P (2002) MR enteroclysis: technical considerations and clinical applications. Eur Radiol 12(11):2651–2658PubMedGoogle Scholar
  4. 4.
    Masselli G, Brizi MG, Parrella A, Minordi L, Vecchioli A, Marano P (2004) Crohn’s disease: magnetic resonance enteroclysis. Abdom imaging 29:326–334PubMedCrossRefGoogle Scholar
  5. 5.
    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
  6. 6.
    Maglinte DT, Siegelman ES, Kelvin FM (2000) MR enteroclysis: the future of small-bowel imaging? Radiology 215(3):639–641PubMedGoogle Scholar
  7. 7.
    Best WR, Becktel JM, Singleton JW (1979) Rederived values of the eight coefficients of the Crohn’s Disease Activity Index (CDAI). Gastroenterology 77(4 Pt 2):843–846PubMedGoogle Scholar
  8. 8.
    Barkun A, Chiba N, Enns R, Marcon M, Natsheh S, Pham C, Sadowski D, Vanner S (2006) Commonly used preparations for colonoscopy: efficacy, tolerability, and safety—a Canadian association of gastroenterology position paper. Can J Gastroenterol 20(11):699–710PubMedGoogle Scholar
  9. 9.
    Sood RR, Joubert I, Franklin H, Doyle T, Lomas DJ (2002) Small bowel MRI: comparison of a polyethylene glycol preparation and water as oral contrast media. J Magn Reson Imaging 15:401–408PubMedCrossRefGoogle Scholar
  10. 10.
    Laghi A, Carbone I, Catalano C, Iannaccone R, Paolantonio P, Baeli I, Trenna S, Passariello R (2001) Polyethylenglycol solution as an oral contrast agent for MR imaging of the small bowel. AJR 177:1333–1334PubMedGoogle Scholar
  11. 11.
    Maglinte DD, Lappas JC, Heitkamp DE, Bender GN, Kelvin FM (2003) Technical refinements in enteroclysis. Radiol Clin N Am 41:213–229PubMedCrossRefGoogle Scholar
  12. 12.
    Wills JS, Lobis IF, Denstman FJ (1997) Crohn disease: state of the art. Radiology 202:597–610PubMedGoogle Scholar
  13. 13.
    Cirillo LC, Camera L, Della Noce M, Castiglione F, Mazzacca G, Salvatore M (2000) Accuracy of enteroclysis in Crohn’s disease of the small bowel: a retrospective study. Eur Radiol 10(12):1894–1898PubMedCrossRefGoogle Scholar
  14. 14.
    Herlinger H, Maglinte D (1989) Clinical radiology of the small intestine. Saunders, Philadelphia, PaGoogle Scholar
  15. 15.
    Schreyer Ag, Geissler A, Albrich H, Scholmerich J, Feuerbach S, Rogler G, Volk M, Herfath H (2004) Abdominal MRI after enteroclysis or with oral contrast in patients with suspected or proven Crohn’s disease. Clin Gastroenterol Hepatol 2(6):491–497PubMedCrossRefGoogle Scholar
  16. 16.
    Negaard A, Paulsen V, Sandvik L, Berstard AE, Borthne A, Try K, Lygren I, Storaas T, Klow NE (2007) A prospective randomized comparison between two MRI studies of the small bowel in Crohn’s disease, the oral contrast and MR enteroclysis. Eur Radiol epub 05052007Google Scholar
  17. 17.
    Wold PB, Fletcher JG, Johnson CD, Sandborn WJ (2003) Assessment of small bowel crohn disease:non-invasive peroral CT enterography compared with other imaging methods and endoscopy-feasibility study. Radiology 229:275–281PubMedCrossRefGoogle Scholar
  18. 18.
    Maglinte DD (2006) Invited commentary. Radiographics 26:657–662Google Scholar
  19. 19.
    Gourtsoyiannis NC, Grammatikakis J, Papamastorakis G, Koutroumbakis J, Prassopoulos P, Rousomoustakaki M, Papanikolaou N (2006) Imaging of small intestinal Crohn’s disease: comparison between MR enteroclysis and conventional enteroclysis. Eur Radiol 16(9):1915–1925PubMedCrossRefGoogle Scholar
  20. 20.
    Masselli G, Casciani E, Polettini E, Lanciotti S, Bertini L, Gualdi G (2006) Assessment of Crohn’s disease in the small bowel: prospective comparison of magnetic resonance enteroclysis with conventional enteroclysis. Eur Radiol 16(12):2817–2827PubMedCrossRefGoogle Scholar
  21. 21.
    Albert JG, Martiny F, Krummenerl A, Stock K, Lesske J, Gobel CM, Lotterer E, Nietsch HH, Behrmann C, Fleig WE (2005) Diagnosis of small bowel Crohn’s disease: a prospective comparison of capsule endoscopy with magnetic resonance imaging and fluoroscopic enteroclysis. Gut 54:1721–1727PubMedCrossRefGoogle Scholar
  22. 22.
    Golder SK, Schreyer AG, Endlicher E, Feuerbach S, Scholmerich J, Kullmann F, Seitz J, Rogler G, Herfarth H (2006) Comparison of capsule endoscopy and magnetic resonance (MR) enteroclysis in suspected small bowel disease. Int J Colorectal Dis 21(2):97–104, MarPubMedCrossRefGoogle Scholar
  23. 23.
    Hara AK, Leighton JA, Sharma VK, Heigh RI, Fleischer DE (2006 ) Imaging of small bowel disease: comparison of capsule endoscopy, standard endoscopy, barium examination, and CT. Radiology 238(1):128–134PubMedCrossRefGoogle Scholar
  24. 24.
    Mackalski BA, Berstein CN (2006) New diagnostic imaging tools for inflammatory bowel disease. Gut 55:733–741PubMedCrossRefGoogle Scholar
  25. 25.
    Masselli G, Brizi MG, Menchini L, Minordi L, Vecchioli A (2005) Magnetic resonance enteroclysis imaging of Crohn’s. Radiol Med 110(3):221–233Google Scholar
  26. 26.
    Umschaden HW, Gasser J (2003) MR enteroclysis. Radiol Clin N Am 41:231–248PubMedCrossRefGoogle Scholar
  27. 27.
    Prassopoulos P, Papanikolau N, Grammatikakis J, Rousomoustakaki M, Maris T, Gourtsoyiannis N (2001) MR enteroclysis imaging of Crohn’s disease. Radiographics 21:161–172Google Scholar
  28. 28.
    Koh DM, Miao Y, Chinn RJ, Amin Z, Zeegen R, Westaby D, Healy JC (2001) MR imaging evaluation of the activity in Crohn’s disaese. AJR 177:1325–1332PubMedGoogle Scholar
  29. 29.
    Maccioni F, Bruni A, Viscido, Colaiacomo MC, Cocco A, Montesani C, Caprilli R, Marini M (2006) MR imaging in patients with Crohn disease:value of T2-versus T1-weighted gadolinium enhanced MR sequences with use of an oral supermagnetic contrast agent. Radiology 238(2):517–530PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2007

Authors and Affiliations

  • Gabriele Masselli
    • 1
  • Emanuele Casciani
    • 1
  • Elisabetta Polettini
    • 1
  • Gianfranco Gualdi
    • 1
  1. 1.Radiology DEA DepartmentAcademic Hospital “Umberto I”. La Sapienza University RomeRomeItaly

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