Skip to main content

Advertisement

SpringerLink
Log in

An Overview of Magnetic Resonance Enterography for Crohn’s Disease

  • Review
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Magnetic resonance enterography (MRE) is a relatively new imaging modality that has shown promise for diagnosing, staging, and monitoring Crohn’s disease (CD) and its complications while avoiding exposure to ionizing radiation. In addition to clinical implications, MRE has the potential to be used as an objective measure of disease activity for clinical trials. We provide the rationale for MRE, indications for its use, and an overview of the typical procedure and common findings for institutions who want to begin or refine the use of MRE for CD.

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
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Grand DJ, Kampalath V, Harris A, et al. MR enterography correlates highly with colonoscopy and histology for both distal ileal and colonic Crohn’s disease in 310 patients. Eur J Radiol. 2012;81:e763–e769.

    Article  PubMed  Google Scholar 

  2. Jensen MD, Nathan T, Rafaelsen SR, Kjeldsen J. Diagnostic accuracy of capsule endoscopy for small bowel Crohn’s disease is superior to that of MR enterography or CT enterography. Clin Gastroenterol Hepatol. 2011;9:124–129.

    Article  PubMed  Google Scholar 

  3. Böcker U, Dinter D, Litterer C, et al. Comparison of magnetic resonance imaging and video capsule enteroscopy in diagnosing small-bowel pathology: localization-dependent diagnostic yield. Scand J Gastroenterol. 2010;45:490–500.

    Article  PubMed  Google Scholar 

  4. Grobner T. Gadolinium—a specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis? Nephrol Dial Transplant. 2006;21:1104–1108.

    Article  CAS  PubMed  Google Scholar 

  5. Elsayes KM, Al-Hawary MM, Jagdish J, Ganesh HS, Platt JF. CT enterography: principles, trends, and interpretation of findings. Radiographics. 2010;30:1955–1970.

    Article  PubMed  Google Scholar 

  6. Panes J, Bouzas R, Chaparro M, et al. Systematic review: the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn’s disease. Aliment Pharmacol Ther. 2011;34:125–145.

    Article  CAS  PubMed  Google Scholar 

  7. Desmond AN, O’Regan K, Curran C, et al. Crohn’s disease: factors associated with exposure to high levels of diagnostic radiation. Gut. 2008;57:1524–1529.

    Article  CAS  PubMed  Google Scholar 

  8. Levi Z, Fraser E, Krongrad R, et al. Factors associated with radiation exposure in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2009;30:1128–1136.

    Article  CAS  PubMed  Google Scholar 

  9. Kerner C, Carey K, Mills AM, et al. Use of abdominopelvic computed tomography in emergency departments and rates of urgent diagnoses in Crohn’s disease. Clin Gastroenterol Hepatol. 2012;10:52–57.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Fahmy M, Pola, S, Sandborn, WJ, Patel, D. Frequency and yield of computed tomography (CT) scan imaging in the emergency department in patients with inflammatory bowel disease (IBD). Gastroenterology. 2012;142:S-536–S-537.

    Google Scholar 

  11. Peloquin JM, Pardi DS, Sandborn WJ, et al. Diagnostic ionizing radiation exposure in a population-based cohort of patients with inflammatory bowel disease. Am J Gastroenterol. 2008;103:2015–2022.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357:2277–2284.

    Article  CAS  PubMed  Google Scholar 

  13. Hall EJ, Brenner DJ. Cancer risks from diagnostic radiology. Br J Radiol. 2008;81:362–378.

    Article  CAS  PubMed  Google Scholar 

  14. Allen BC, Baker ME, Einstein DM, et al. Effect of altering automatic exposure control settings and quality reference mAs on radiation dose, image quality, and diagnostic efficacy in MDCT enterography of active inflammatory Crohn’s disease. AJR Am J Roentgenol. 2010;195:89–100.

    Article  PubMed  Google Scholar 

  15. Kambadakone AR, Chaudhary NA, Desai GS, Nguyen DD, Kulkarni NM, Sahani DV. Low-dose MDCT and CT enterography of patients with Crohn disease: feasibility of adaptive statistical iterative reconstruction. AJR Am J Roentgenol. 2011;196:W743–W752.

    Article  PubMed  Google Scholar 

  16. Absah I, Bruining DH, Matsumoto JM, et al. MR enterography in pediatric inflammatory bowel disease: retrospective assessment of patient tolerance, image quality, and initial performance estimates. AJR Am J Roentgenol. 2012;199:W367–W375.

    Article  PubMed  Google Scholar 

  17. Cipriano LE, Levesque BG, Zaric GS, Loftus EV Jr, Sandborn WJ. Cost-effectiveness of imaging strategies to reduce radiation-induced cancer risk in Crohn’s disease. Inflamm Bowel Dis. 2012;18:1240–1248.

    Article  PubMed  Google Scholar 

  18. Hafeez R, Punwani S, Boulos P, et al. Diagnostic and therapeutic impact of MR enterography in Crohn’s disease. Clin Radiol. 2011;66:1148–1158.

    Article  CAS  PubMed  Google Scholar 

  19. Leyendecker JR, Bloomfeld RS, DiSantis DJ, Waters GS, Mott R, Bechtold RE. MR enterography in the management of patients with Crohn disease. Radiographics. 2009;29:1827–1846.

    Article  PubMed  Google Scholar 

  20. Fletcher JG, Fidler JL, Bruining DH, Huprich JE. New concepts in intestinal imaging for inflammatory bowel diseases. Gastroenterology. 2011;140:1795–1806.

    Article  PubMed  Google Scholar 

  21. Tielbeek JA, Löwenberg M, Bipat S, et al. Serial magnetic resonance imaging for monitoring medical therapy effects in Crohn’s disease. Inflamm Bowel Dis. 2013;19:1943–1950.

    PubMed  Google Scholar 

  22. Savoye-Collet C, Savoye G, Koning E, Dacher JN, Lerebours E. Fistulizing perianal Crohn’s disease: contrast-enhanced magnetic resonance imaging assessment at 1 year on maintenance anti-TNF-alpha therapy. Inflamm Bowel Dis. 2011;17:1751–1758.

    Article  CAS  PubMed  Google Scholar 

  23. Sailer J, Peloschek P, Reinisch W, Vogelsang H, Turetschek K, Schima W. Anastomotic recurrence of Crohn’s disease after ileocolic resection: comparison of MR enteroclysis with endoscopy. Eur Radiol. 2008;18:2512–2521.

    Article  PubMed  Google Scholar 

  24. Maglinte DD, Sandrasegaran K, Chiorean M, Dewitt J, McHenry L, Lappas JC. Radiologic investigations complement and add diagnostic information to capsule endoscopy of small-bowel diseases. AJR Am J Roentgenol. 2007;189:306–312.

    Article  PubMed  Google Scholar 

  25. Gourtsoyiannis NC, Papanikolaou N. Magnetic resonance enteroclysis. Semin Ultrasound CT MR. 2005;26:237–246.

    Article  PubMed  Google Scholar 

  26. Kelvin FM, Maglinte DD. Enteroclysis or small bowel follow-through in Crohn’ s diseases? Gastroenterology. 1998;114:1349–1351.

    Article  CAS  PubMed  Google Scholar 

  27. Masselli G, Casciani E, Polettini E, Gualdi G. Comparison of MR enteroclysis with MR enterography and conventional enteroclysis in patients with Crohn’s disease. Eur Radiol. 2008;18:438–447.

    Article  PubMed  Google Scholar 

  28. Umschaden HW, Gasser J. MR enteroclysis. Radiol Clin N Am. 2003;41:231–248.

    Article  PubMed  Google Scholar 

  29. Kuehle CA, Ajaj W, Ladd SC, Massing S, Barkhausen J, Lauenstein TC. Hydro-MRI of the small bowel: effect of contrast volume, timing of contrast administration, and data acquisition on bowel distention. AJR Am J Roentgenol. 2006;187:W375–W385.

    Article  PubMed  Google Scholar 

  30. Masselli G, Gualdi G. MR imaging of the small bowel. Radiology. 2012;264:333–348.

    Article  PubMed  Google Scholar 

  31. Rimola J, Rodriguez S, Garcia-Bosch O, et al. Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn’s disease. Gut. 2009;58:1113–1120.

    Article  CAS  PubMed  Google Scholar 

  32. Umschaden HW, Szolar D, Gasser J, Umschaden M, Haselbach H. Small-bowel disease: comparison of MR enteroclysis images with conventional enteroclysis and surgical findings. Radiology. 2000;215:717–725.

    Article  CAS  PubMed  Google Scholar 

  33. Cronin CG, Lohan DG, Mhuircheartaigh JN, et al. MRI small-bowel follow-through: prone versus supine patient positioning for best small-bowel distention and lesion detection. AJR Am J Roentgenol. 2008;191:502–506.

    Article  PubMed  Google Scholar 

  34. Gourtsoyiannis N, Papanikolaou N, Grammatikakis J, Prassopoulos P. MR enteroclysis: technical considerations and clinical applications. Eur Radiol. 2002;12:2651–2658.

    PubMed  Google Scholar 

  35. Yacoub JH, Obara P, Oto A. Evolving role of MRI in Crohn’s disease. J Magn Reson Imaging. 2013;37:1277–1289.

    Article  PubMed  Google Scholar 

  36. Buisson A, Joubert A, Montoriol PF, et al. Diffusion-weighted magnetic resonance imaging for detecting and assessing ileal inflammation in Crohn’s disease. Aliment Pharmacol Ther. 2013;37:537–545.

    Article  CAS  PubMed  Google Scholar 

  37. Oto A, Kayhan A, Williams JT, et al. Active Crohn’s disease in the small bowel: evaluation by diffusion weighted imaging and quantitative dynamic contrast enhanced MR imaging. J Magn Reson Imaging. 2011;33:615–624.

    Article  PubMed  Google Scholar 

  38. Sharman A, Zealley IA, Greenhalgh R, Bassett P, Taylor SA. MRI of small bowel Crohn’s disease: determining the reproducibility of bowel wall gadolinium enhancement measurements. Eur Radiol. 2009;19:1960–1967.

    Article  CAS  PubMed  Google Scholar 

  39. Low RN, Sebrechts CP, Politoske DA, et al. Crohn disease with endoscopic correlation: single-shot fast spin-echo and gadolinium-enhanced fat-suppressed spoiled gradient-echo MR imaging. Radiology. 2002;222:652–660.

    Article  PubMed  Google Scholar 

  40. Koh DM, Miao Y, Chinn RJ, et al. MR imaging evaluation of the activity of Crohn’s disease. AJR Am J Roentgenol. 2001;177:1325–1332.

    Article  CAS  PubMed  Google Scholar 

  41. Del Vescovo R, Sansoni I, Caviglia R, et al. Dynamic contrast enhanced magnetic resonance imaging of the terminal ileum: differentiation of activity of Crohn’s disease. Abdom Imaging. 2008;33:417–424.

    Article  PubMed  Google Scholar 

  42. Schreyer AG, Seitz J, Feuerbach S, Rogler G, Herfarth H. Modern imaging using computer tomography and magnetic resonance imaging for inflammatory bowel disease (IBD) AU1. Inflamm Bowel Dis. 2004;10:45–54.

    Article  PubMed  Google Scholar 

  43. Madureira AJ. The comb sign. Radiology. 2004;230:783–784.

    Article  PubMed  Google Scholar 

  44. Prassopoulos P, Papanikolaou N, Grammatikakis J, Rousomoustakaki M, Maris T, Gourtsoyiannis N. MR enteroclysis imaging of Crohn disease. Radiographics. 2001;21:S161–S172.

    Google Scholar 

  45. Gore RMG, Caroline D. Crohn’s disease of the small bowel. In: Gore RLM, ed. Textbook of gastrointestinal radiology. 3rd ed. Philadelphia: Saunders Elsevier; 2008:781–806.

    Chapter  Google Scholar 

  46. Lee SS, Ha HK, Yang SK, et al. CT of prominent pericolic or perienteric vasculature in patients with Crohn’s disease: correlation with clinical disease activity and findings on barium studies. AJR Am J Roentgenol. 2002;179:1029–1036.

    Article  PubMed  Google Scholar 

  47. Maccioni F, Bruni A, Viscido A, et al. 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. 2006;238:517–530.

    Article  PubMed  Google Scholar 

  48. Zappa M, Stefanescu C, Cazals-Hatem D, et al. Which magnetic resonance imaging findings accurately evaluate inflammation in small bowel Crohn’s disease? A retrospective comparison with surgical pathologic analysis. Inflamm Bowel Dis. 2011;17:984–993.

    Article  PubMed  Google Scholar 

  49. Gourtsoyiannis NC, Grammatikakis J, Papamastorakis G, et al. Imaging of small intestinal Crohn’s disease: comparison between MR enteroclysis and conventional enteroclysis. Eur Radiol. 2006;16:1915–1925.

    Article  PubMed  Google Scholar 

  50. Tolan DJ, Greenhalgh R, Zealley IA, Halligan S, Taylor SA. MR enterographic manifestations of small bowel Crohn disease. Radiographics. 2010;30:367–384.

    Article  PubMed  Google Scholar 

  51. Froehlich JM, Waldherr C, Stoupis C, Ertuk SM, Patak MA. MR motility imaging in Crohn’s disease improves lesion detection compared with standard MR imaging. Eur Radiol. 2010;20:1945–1951.

    Article  PubMed  Google Scholar 

  52. Masselli G. The gastrointestinal string sign. Radiology. 2007;242:632–633.

    Article  PubMed  Google Scholar 

  53. Lawrance IC, Welman CJ, Shipman P, Murray K. Correlation of MRI-determined small bowel Crohn’s disease categories with medical response and surgical pathology. World J Gastroenterol. 2009;15:3367–3375.

    Article  PubMed Central  PubMed  Google Scholar 

  54. Steward MJ, Punwani S, Proctor I, et al. Non-perforating small bowel Crohn’s disease assessed by MRI enterography: derivation and histopathological validation of an MR-based activity index. Eur J Radiol. 2012;81:2080–2088.

    Article  PubMed  Google Scholar 

  55. Rimola J, Ordas I, Rodriguez S, et al. Magnetic resonance imaging for evaluation of Crohn’s disease: validation of parameters of severity and quantitative index of activity. Inflamm Bowel Dis. 2011;17:1759–1768.

    Article  PubMed  Google Scholar 

  56. Ordas I, Rimola J, Rodriguez S, et al. Accuracy of magnetic resonance enterography in assessing response to therapy and mucosal healing in patients with Crohn’s disease. Gastroenterology. 2014;146:374–382.

    Article  CAS  PubMed  Google Scholar 

  57. Van Assche G, Herrmann KA, Louis E, et al. Effects of infliximab therapy on transmural lesions as assessed by magnetic resonance enteroclysis in patients with ileal Crohn’s disease. J Crohns Colitis. 2013;7:950–957.

    Article  PubMed  Google Scholar 

  58. Pariente B, Cosnes J, Danese S, et al. Development of the Crohn’s disease digestive damage score, the Lemann score. Inflamm Bowel Dis. 2011;17:1415–1422.

    Article  PubMed Central  PubMed  Google Scholar 

  59. Horsthuis K, Bipat S, Stokkers PC, Stoker J. Magnetic resonance imaging for evaluation of disease activity in Crohn’s disease: a systematic review. Eur Radiol. 2009;19:1450–1460.

    Article  PubMed  Google Scholar 

  60. Fiorino G, Bonifacio C, Peyrin-Biroulet L, et al. Prospective comparison of computed tomography enterography and magnetic resonance enterography for assessment of disease activity and complications in ileocolonic Crohn’s disease. Inflamm Bowel Dis. 2011;17:1073–1080.

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

C. Santillan is a consultant for Robarts Clinical Research. The remaining authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, University of California San Diego Health System, 9500 Gilman Drive, La Jolla, CA, 92093-0956, USA

    Suresh Pola, Barrett G. Levesque & William J. Sandborn

  2. Department of Radiology, Inflammatory Bowel Disease Center, University of California San Diego Health System, 200 W Arbor Drive MC 8756, San Diego, CA, 92103-8413, USA

    Cynthia Santillan

  3. Robarts Clinical Trials. Inc, Western University, London, ON, Canada

    Barrett G. Levesque, Brian G. Feagan & William J. Sandborn

  4. Robarts Clinical Trials. Inc, 4350 Executive Drive, Suite 210, San Diego, CA, 92121, USA

    Barrett G. Levesque

  5. Departments of Epidemiology and Biostatistics and Medicine, Western University, London, ON, Canada

    Brian G. Feagan

  6. Robarts Clinical Trials, Inc, University of Western Ontario, 100 Perth Drive, London, ON, N6A 5K8, Canada

    Brian G. Feagan

Authors
  1. Suresh Pola
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cynthia Santillan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Barrett G. Levesque
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brian G. Feagan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. William J. Sandborn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cynthia Santillan.

Electronic supplementary material

Below is the link to the electronic supplementary material.

10620_2014_3116_MOESM1_ESM.avi

Cine SSFP images demonstrate a long segment of narrowing with surrounding fibrofatty proliferation in the terminal ileum. The bowel just proximal to this segment is dilated. The narrowed segment of bowel does not demonstrate any peristalsis during the clip. Normal peristalsis is present in the remainder of the bowel. Findings are consistent with a long stricture of the terminal ileum. Supplementary material 1 (AVI 19204 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pola, S., Santillan, C., Levesque, B.G. et al. An Overview of Magnetic Resonance Enterography for Crohn’s Disease. Dig Dis Sci 59, 2040–2049 (2014). https://doi.org/10.1007/s10620-014-3116-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-014-3116-4

Keywords

Search

Navigation