Abstract
Background
Crohn’s disease (CD) is a life-long, chronic, relapsing condition requiring often morphological assessment. MR enterography (MRE) offers advantages of not using ionizing radiation and yielding intraluminal and intra-abdominal informations. The aim of our study was to identify how MRE can be useful in planning surgical procedures.
Patients and Methods
In this retrospective study, 35 patients who underwent MRE and then surgery for CD were enrolled from 2006 to 2010. MRE findings were compared to intraoperative findings. Histology of operative specimens, systemic inflammatory parameters, and fecal lactoferrin were also evaluated. Cohen’s κ agreement test, sensitivity and sensibility, uni-/multivariate logistic regression, and non-parametric statistics were performed.
Results
MRE identified bowel stenosis with a sensitivity of 0.95 (95% CI 0.76–0.99) and a specificity of 0.72 (95% CI 0.39–0.92). The concordance of MRE findings with intraoperative findings was high [Cohen’s κ = 0.72 (0.16)]. Abscesses were detected at MRE with a sensitivity of 0.92 (95% CI 0.62–0.99) and a specificity of 0.90 (95% CI 0.69–0.98) with a Cohen’s κ = 0.82 (0.16). The grade of proximal bowel dilatation resulted to be a significant predictor of the possibility of using strictureplasty instead of/associated to bowel resection either at univariate or at multivariate analysis.
Conclusion
Our study confirmed that MRE findings correlate significantly with disease activity. Detailed information about abscess could suggest percutaneous drainage that could ease the following surgery or avoid emergency laparotomy. Proximal bowel dilatation can suggest the possibility to perform bowel sparing surgery such as strictureplasty.
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References
Singleton JW, Law DH, Kelley ML Jr, Mekhjian HS, Sturdevant RA. National Cooperative Crohn’s Disease Study: adverse reactions to study drugs. Gastroenterology 1979;77:870–882
Etienney I, Bouhnik Y, Gendre JP, Lemann M, Cosnes J, Matuchansky C, Beaugerie L, Modigliani R, Rambaud JC. Crohn’s disease over 20 years after diagnosis in a referral population. Gastroenterol Clin Biol 2004;28:1233–1239
Scarpa M, Ruffolo C, Bassi D, Boetto R, D’Incà R, Buda A, Sturniolo GC, Angriman I. Intestinal surgery for Crohn’s disease: predictors of recovery, quality of life, and costs. J Gastrointestinal Surg 2009;13(12):2128–35.
Dunker MS, Stiggelbout AM, van Hogezand RA, Ringers J, Griffioen G, Bemelman WA. Cosmesis and body image after laparoscopic-assisted and open ileocolic resection for Crohn’s disease. Surg Endosc. 1998;12: 1334–1340.
Maartense S, Dunker MS, Slors JF, Cuesta MA, Pierik EG, Gouma DJ, Hommes DW, Sprangers MA, Bemelman WA. Laparoscopic-assisted versus open ileocolic resection for Crohn’s disease: a randomized trial. Ann Surg. 2006;243:143–149.
Fearnhead NS, Chowdhury R, Box B, George BD, Jewell DP, Mortensen NJ. Long-term follow-up of stricturoplasty for Crohn’s disease. Br J Surg. 2006;93:475-482.
Yamamoto T, Fazio VW, Tekkis PP. Safety and efficacy of stricturoplasty for Crohn’s disease: a systematic review and meta-analysis. Dis Colon Rectum. 2007;50:1968–1986.
Angriman I, Scarpa M, Ruffolo C, Pomerri F, Filosa T, Polese L, Pagano D, Norberto L, D’Amico DF. Double contrast small bowel radiography in the preoperative assessment of Crohn’s disease patients: is it still useful? Surg Today 2008;38(8):700-4
Marmo R, Rotondano G, Piscopo R, Bianco MA, Siani A, Catalano O, Cipolletta L. Capsule endoscopy versus enteroclysis in the detection of small-bowel involvement in Crohn’s disease: a prospective trial. Clin Gastroenterol Hepatol 2005; 3: 772-776
Triester SL, Leighton JA, Leontiadis GI, Gurudu SR, Fleischer DE, Hara AK, Heigh RI, Shiff AD, Sharma VK. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with non-stricturing small bowel Crohn’s disease. Am J Gastroenterol 2006; 101: 954–964
Solem CA, Loftus EV Jr, Fletcher JG, Baron TH, Gostout CJ, Petersen BT, Tremaine WJ, Egan LJ, Faubion WA, Schroeder KW, Pardi DS, Hanson KA, Jewell DA, Barlow JM, Fidler JL, Huprich JE, Johnson CD, Harmsen WS, Zinsmeister AR, Sandborn WJ. Small-bowel imaging in Crohn’s disease: a prospective, blinded, 4-way comparison trial. Gastrointest Endosc 2008; 68: 255-266
Doerfler OC, Ruppert-Kohlmayr AJ, Reittner P, Hinterleitner T, Petritsch W, Szolar DH. Helical CT of the small bowel with an alternative oral contrast material in patients with Crohn disease. Abdom Imaging 2003; 28: 313–318
Desmond AN, O’Regan K, Curran C, McWilliams S, Fitzgerald T, Maher MM, Shanahan F. Crohn’s disease: factors associated with exposure to high levels of diagnostic radiation. Gut. 2008; 57(11):1524-9.
Sinha R, Murphy P, Hawker P, Sanders S, Rajesh A, Verma R. Role of MRI in Crohn’s disease. Clin Radiol. 2009; 64(4):341–52.
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(3):438-447.
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(6):1450-60.
Florie J, Wasser MN, Arts-Cieslik K, Akkerman EM, Siersema PD, Stoker J. Dynamic contrast-enhanced MRI of the bowel wall for assessment of disease activity in Crohn’s disease. Am J Roentgenol 2006; 186: 1384-1392.
Koh DM, Miao Y, Chinn RJ, Amin Z, Zeegen R, Westaby D, Healy JC. MR imaging evaluation of the activity of Crohn’s disease. Am J Roentgenol 2001; 177: 1325-1332
Silva AC, Pimenta M, Guimarães LS. Small bowel obstruction: what to look for. Radiographics 2009; 29(2):423-439
Lazarus DE, Slywotsky C, Bennett GL, Megibow AJ, Macari M. Frequency and Relevance of the “Small-Bowel Feces” Sign on CT in Patients with Small-Bowel Obstruction Am J Radiology 2004; 183:1361–1366
Laghi A, Borrelli O, Paolantonio P et al. Contrast enhanced magnetic resonance imaging of the terminal ileum in children with Crohn’s disease. Gut 2003; 52:393–397
Shoenut JP, Semelka RC, Magro CM, Silverman R, Yaffe CS, Micflikier AB. Comparison of magnetic resonance imaging and endoscopy in distinguishing the type and severity of inflammatory bowel disease. J Clin Gastroenterol 1994; 19:31-35
Durno CA, Sherman P, Williams T, Shuckett B, Dupuis A, Griffiths AM. Magnetic resonance imaging to distinguish the type and severity of pediatric inflammatory bowel diseases. J Pediatr Gastroenterol Nutr 2000; 30:170-174
Schreyer AG, Rath HC, Kikinis R et al. Comparison of magnetic resonance imaging colonography with conventional colonoscopy for the assessment of intestinal inflammation in patients with inflammatory bowel disease: a feasibility study. Gut 2005; 54:250-256
Van Gemert-Horsthuis K, Florie J, Hommes DW et al. Feasibility of evaluating Crohn’s disease activity at 3.0 Tesla. J Magn Reson Imaging 2006; 24:340-348
Florie J, Horsthuis K, Hommes DW et al. Magnetic resonance imaging compared with ileocolonoscopy in evaluating disease severity in Crohn’s disease. Clin Gastroenterol Hepatol 2005; 3:1221–1228
Schreyer AG, Golder S, Scheibl K et al. Dark lumen magnetic resonance enteroclysis in combination with MRI colonography for whole bowel assessment in patients with Crohn’s disease: first clinical experience. Inflamm Bowel Dis 2005; 11:388-394
Messaris E, Chandolias N, Grand D, Pericolo V. Role of magnetic resonance enterography in the management of Crohn’s disease. Arch Surg 2010; 145(5): 471-475
Parisinos CA, McIntyre VED, Heron T, Subedi D, Arnott IDR, Mowat C, Wilson Dc, McGurk S, Glancy S, Zeally IA, Satsangi J, Lees CW. Magnetic resonance follow-through imaging for evaluation of disease activity in ilela Crohn’s disease: an observational retrospective cohort study. Inflamm Bowel Dis. 2010;16(7):1219–26.
Lawrence IC, Welamn 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(27): 3367-3375
Gourtsoyiannis N, Grammatikakis J, Papamastorakis G, et al. Imaging of small intestinal Crohn’s disease: comparison between MR enteroclysis and conventional enteroclysis. Eur Radiol 2006;16:1915-25.
Masselli G, Casciani E, Polettini E, et al. Assessment of Crohn’s disease in the small bowel: prospective comparison of magnetic resonance enteroclysis with conventional enteroclysis. Eur Radiol 2006;16:2817-27.
Horsthuis K, Stokkers P, Stoker J. Detection of inflammatory bowel disease: diagnostic performance of cross-sectional imaging modalities. Abdom Imaging 2008;33:417-24.
Ryan ER, Heaslip ISE. Magnetic resonance enteroclysis compared with conventional enteroclysis and computed tomography enteroclysis: a critically appraised topic. Abdom Imaging 2008;33:34-7.
Plato. The Republic. Book VII: 514a–520a (chapter IX in Robin Waterfield’s translation)
Ruffolo C, Angriman I, Scarpa M, Polese L, Barollo M, Bertin M, Pagano D, D’Amico DF. Minimally invasive management of Crohn’s disease complicated by ureteral stenosis. Surg Laparoscopy, Endoscopy and Percutaneus Techniques. 2004;14(5):292-4
Ruffolo C, Scarpa M, Polese L, D’Amico FE, Boetto R, Pozza A, D’Incà R, Checchin D, Sturniolo GC, Bassi N, Angriman I. Clinical presentation and diagnosis of intestinal adenocarcinoma in Crohn’s disease: analysis of clinical predictors and of the life-time risk. J Gastrointestinal Surg 2010:14;1746–1751
Glick SN, Teplick SK, Goodman LR, et al. Development of lymphoma in patients with Crohn disease. Radiology 1984; 153:337-9.
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Pozza, A., Scarpa, M., Lacognata, C. et al. Magnetic Resonance Enterography for Crohn’s Disease: What the Surgeon Can Take Home. J Gastrointest Surg 15, 1689–1698 (2011). https://doi.org/10.1007/s11605-011-1622-7
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DOI: https://doi.org/10.1007/s11605-011-1622-7