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Magnetic Resonance Enterography: Safe and Effective Imaging for Stricturing Crohn’s Disease

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Abstract

Background

Symptomatic Crohn’s disease (CD) patients often undergo diagnostic imaging studies for evaluation of disease activity or complications including bowel strictures and obstruction. Magnetic resonance enterography (MRE) provides information regarding disease activity, chronicity, and stricture formation without using ionizing radiation.

Aim

Examine the use of MRE among CD patients presenting with symptoms suggesting obstruction in a tertiary care practice setting.

Methods

We performed a retrospective study of all CD patients undergoing MRE at a tertiary IBD referral center over a 3-year study period including a subgroup analysis of patients presenting obstructive symptoms. Positive and negative findings from MRE were correlated with medical and surgical decision outcomes over the subsequent 90-day period.

Results

In the study, 119 CD patients underwent 133 MRE scans, including 40 scans on individuals presenting with obstructive symptoms. Positive findings of CD including active inflammation, stricturing, and penetrating disease were more frequent in MREs ordered to evaluate obstructive symptoms (87.5%) compared other indications (58.1%, p = 0.001). In patients presenting with obstructive symptoms, MRE findings assisted in directing a change of clinical management towards escalation of medical therapy in 55% and surgery in 32.5%. Review of surgical resection specimens corroborated MRE findings of disease activity and fibrosis in 92% of cases going to surgery.

Conclusions

In practice-based use at a tertiary IBD referral center, MRE provided an effective, radiation-free alternative to computed tomography by providing valuable diagnostic information for evaluating and directing care in Crohn’s disease, particularly for patients presenting with obstructive symptoms.

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Abbreviations

CD:

Crohn’s disease

CT:

Computed tomography

MRE:

Magnetic resonance enterography

MR:

Magnetic resonance

SBFT:

Small bowel follow-through

SEM:

Standard error of the mean

CTE:

Computed tomography enterography

ACR:

American College of Radiology

UC:

Ulcerative colitis

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Acknowledgments

MAC is the recipient of a Career Development Award from the Crohn’s and Colitis Foundation of America and NIH grant DK089016 and L30 RR030244.

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Authors and Affiliations

  1. Division of Gastroenterology, Washington University in St. Louis School of Medicine, 660 South Euclid, Campus Box 8124, St. Louis, MO, 63110, USA

    Christina Y. Ha, Nitin Kumar & Matthew A. Ciorba

  2. Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 1830 East Monument St, Suite 434, Baltimore, MD, 21287, USA

    Christina Y. Ha

  3. Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA

    Constantine A. Raptis & Vamsi R. Narra

Authors
  1. Christina Y. Ha
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  2. Nitin Kumar
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  3. Constantine A. Raptis
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  4. Vamsi R. Narra
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  5. Matthew A. Ciorba
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Corresponding authors

Correspondence to Christina Y. Ha or Matthew A. Ciorba.

Additional information

C. Y. Ha and N. Kumar contributed equally to this work.

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Ha, C.Y., Kumar, N., Raptis, C.A. et al. Magnetic Resonance Enterography: Safe and Effective Imaging for Stricturing Crohn’s Disease. Dig Dis Sci 56, 2906–2913 (2011). https://doi.org/10.1007/s10620-011-1781-0

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  • DOI: https://doi.org/10.1007/s10620-011-1781-0

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