Skip to main content

Advertisement

SpringerLink
Log in

Correlation between imaging findings on outpatient MR enterography (MRE) in adult patients with Crohn disease and progression to surgery within 5 years

  • Hollow Organ GI
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To retrospectively evaluate which key imaging features described by SAR–AGA on outpatient surveillance MRE correlate with progression to surgery in adults with CD.

Methods

52 CD patients imaged with outpatient MRE from 10/2015 to 12/2016 and with available clinical information were included. Two abdominal radiologists reviewed the MRE for the presence of active inflammation, intramural edema, restricted diffusion, stricture, probable stricture, ulceration, sacculation, simple fistula, complex fistula, sinus tract, inflammatory mass, abscess, perienteric inflammation, engorged vasa recta, fibrofatty proliferation, and perianal disease. Bowel wall thickness, length of bowel involvement, and degree of upstream dilation in strictures were quantified. Subsequent bowel resection, prior bowel surgery, and available laboratory values were recorded. The association between progression to surgery and imaging features was evaluated using a logistic regression model adjusting for demographics, prior bowel surgery, medication usage, and body mass index.

Results

19.2% (10/52) of patients progressed to surgery. Restricted diffusion, greater degree of upstream dilation from stricture, complex fistula, perienteric inflammation, and fibrofatty proliferation were significantly more common in patients progressing to surgery (all p < 0.05). κ for these significant findings ranged 0.568–0.885. Patients progressing to surgery had longer length bowel involvement (p = 0.03). Platelet count, ESR, and fecal calprotectin were significantly higher, and serum albumin was significantly lower in patients progressing to surgery. Prior bowel surgery, sex, age, and all other parameters were similar.

Conclusion

Radiologists should carefully describe bowel dilation upstream from strictures, penetrating and perienteric findings on outpatient MRE in CD patients, as these findings may herald progression to surgery.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

Available.

Code availability

N/A.

References

  1. Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. ACG Clinical Guideline: Management of Crohn's Disease in Adults. Am J Gastroenterol 2018;113(4):481–517. doi: https://doi.org/10.1038/ajg.2018.27

    Article  PubMed  Google Scholar 

  2. Torres J, Mehandru S, Colombel JF, Peyrin-Biroulet L. Crohn's disease. Lancet 2017;389(10080):1741–1755. doi: https://doi.org/10.1016/S0140-6736(16)31711-1

    Article  PubMed  Google Scholar 

  3. Dane B, Sarkar S, Nazarian M, Galitzer H, O'Donnell T, Remzi F, Chang S, Megibow A. Crohn Disease Active Inflammation Assessment with Iodine Density from Dual-Energy CT Enterography: Comparison with Histopathologic Analysis. Radiology 2021;301(1):144–151. doi: https://doi.org/10.1148/radiol.2021204405

    Article  PubMed  Google Scholar 

  4. Regueiro M, Kip KE, Schraut W, Baidoo L, Sepulveda AR, Pesci M, El-Hachem S, Harrison J, Binion D. Crohn's disease activity index does not correlate with endoscopic recurrence one year after ileocolonic resection. Inflamm Bowel Dis 2011;17(1):118–126. doi: https://doi.org/10.1002/ibd.21355

    Article  PubMed  Google Scholar 

  5. Deepak P, Fletcher JG, Fidler JL, Barlow JM, Sheedy SP, Kolbe AB, Harmsen WS, Therneau T, Hansel SL, Becker BD, Loftus EV, Jr., Bruining DH. Predictors of Durability of Radiological Response in Patients with Small Bowel Crohn's Disease. Inflamm Bowel Dis 2018;24(8):1815–1825. doi: https://doi.org/10.1093/ibd/izy074

    Article  PubMed  PubMed Central  Google Scholar 

  6. Mansuri I, Fletcher JG, Bruining DH, Kolbe AB, Fidler JL, Samuel S, Tung J. Endoscopic Skipping of the Terminal Ileum in Pediatric Crohn Disease. AJR Am J Roentgenol 2017;208(6):W216–W224. doi: https://doi.org/10.2214/AJR.16.16575

    Article  PubMed  Google Scholar 

  7. Samuel S, Bruining DH, Loftus EV, Jr., Becker B, Fletcher JG, Mandrekar JN, Zinsmeister AR, Sandborn WJ. Endoscopic skipping of the distal terminal ileum in Crohn's disease can lead to negative results from ileocolonoscopy. Clin Gastroenterol Hepatol 2012;10(11):1253–1259. doi: https://doi.org/10.1016/j.cgh.2012.03.026

    Article  PubMed  Google Scholar 

  8. Bruining DH, Zimmermann EM, Loftus EV, Jr., Sandborn WJ, Sauer CG, Strong SA, Society of Abdominal Radiology Crohn's Disease-Focused P. Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients with Small Bowel Crohn's Disease. Gastroenterology 2018;154(4):1172–1194. doi: https://doi.org/10.1053/j.gastro.2017.11.274

  9. Fletcher JG, Fidler JL, Bruining DH, Huprich JE. New concepts in intestinal imaging for inflammatory bowel diseases. Gastroenterology 2011;140(6):1795–1806. doi: https://doi.org/10.1053/j.gastro.2011.02.013

    Article  PubMed  Google Scholar 

  10. Ream JM, Doshi A, Lala SV, Kim S, Rusinek H, Chandarana H. High Spatiotemporal Resolution Dynamic Contrast-Enhanced MR Enterography in Crohn Disease Terminal Ileitis Using Continuous Golden-Angle Radial Sampling, Compressed Sensing, and Parallel Imaging. AJR Am J Roentgenol 2015;204(6):W663–669. doi: https://doi.org/10.2214/AJR.14.13674

    Article  PubMed  Google Scholar 

  11. Donner A, Eliasziw M, Klar N. Testing the homogeneity of kappa statistics. Biometrics 1996;52(1):176–183.

    Article  CAS  Google Scholar 

  12. Donner A, Shoukri MM, Klar N, Bartfay E. Testing the equality of two dependent kappa statistics. Stat Med 2000;19(3):373–387. doi: https://doi.org/10.1002/(sici)1097-0258(20000215)19:3<373::aid-sim337>3.0.co;2-y

    Article  CAS  PubMed  Google Scholar 

  13. Grass F, Fletcher JG, Alsughayer A, Petersen M, Bruining DH, Bartlett DJ, Mathis KL, Lightner AL. Development of an Objective Model to Define Near-Term Risk of Ileocecal Resection in Patients with Terminal Ileal Crohn Disease. Inflamm Bowel Dis 2019;25(11):1845–1853. doi: https://doi.org/10.1093/ibd/izz079

    Article  PubMed  Google Scholar 

  14. Inoue A, Bartlett DJ, Shahraki N, Sheedy SP, Heiken JP, Voss BA, Fidler JL, Tootooni MS, Sir MY, Pasupathy K, Baker ME, Rieder F, Lightner AL, Deepak P, Bruining DH, Fletcher JG. Predicting Risk of Surgery in Patients With Small Bowel Crohn's Disease Strictures Using Computed Tomography and Magnetic Resonance Enterography. Inflamm Bowel Dis 2022. doi: https://doi.org/10.1093/ibd/izab332

    Article  PubMed  Google Scholar 

  15. Kopylov U, Yung DE, Engel T, Avni T, Battat R, Ben-Horin S, Plevris JN, Eliakim R, Koulaouzidis A. Fecal calprotectin for the prediction of small-bowel Crohn's disease by capsule endoscopy: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2016;28(10):1137–1144. doi: https://doi.org/10.1097/MEG.0000000000000692

    Article  CAS  PubMed  Google Scholar 

  16. Jones GR, Fasci-Spurio F, Kennedy NA, Plevris N, Jenkinson P, Lyons M, Wong L, MacLean P, Glancy S, Lees CW. Faecal Calprotectin and Magnetic Resonance Enterography in Ileal Crohn's Disease: Correlations Between Disease Activity and Long-Term Follow-Up. J Crohns Colitis 2019;13(4):442–450. doi: https://doi.org/10.1093/ecco-jcc/jjy187

    Article  CAS  PubMed  Google Scholar 

  17. Nguyen GC, Loftus EV, Jr., Hirano I, Falck-Ytter Y, Singh S, Sultan S, Committee AGAICG. American Gastroenterological Association Institute Guideline on the Management of Crohn's Disease After Surgical Resection. Gastroenterology 2017;152(1):271–275. doi: https://doi.org/10.1053/j.gastro.2016.10.038

  18. Guimaraes LS, Fidler JL, Fletcher JG, Bruining DH, Huprich JE, Siddiki H, Sandborn WJ, Loftus EV, Jr., Pardi DS, McCollough CH. Assessment of appropriateness of indications for CT enterography in younger patients. Inflamm Bowel Dis 2010;16(2):226–232. doi: https://doi.org/10.1002/ibd.21025

    Article  PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. NYU Langone Health Department of Radiology, 660 1st Avenue, New York, NY, 10016, USA

    Bari Dane, Paul Smereka, Jonathan Foster, Chenchan Huang & Sooah Kim

  2. NYU Langone Health Department of Biostatistics, 180 Madison Avenue, New York, NY, 10016, USA

    Kun Qian

  3. NYU Grossman School of Medicine, New York, NY, 10016, USA

    Rachel Krieger

  4. NYU Langone Health Department of Gastroenterology, 305 E 33rd Street, New York, NY, 10016, USA

    Shannon Chang

Authors
  1. Bari Dane
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kun Qian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rachel Krieger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paul Smereka
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jonathan Foster
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chenchan Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shannon Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sooah Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bari Dane.

Ethics declarations

Conflict of interest

None.

Ethical approval

This study was institutional review board approved and Health Insurance Portability and Accountability Act compliant.

Informed consent

Waiver of the requirement for informed consent.

Consent for publication

Yes.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dane, B., Qian, K., Krieger, R. et al. Correlation between imaging findings on outpatient MR enterography (MRE) in adult patients with Crohn disease and progression to surgery within 5 years. Abdom Radiol 47, 3424–3435 (2022). https://doi.org/10.1007/s00261-022-03624-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-022-03624-z

Keywords

Search

Navigation