A prospective randomized comparison between two MRI studies of the small bowel in Crohn’s disease, the oral contrast method and MR enteroclysis

Abstract

The aim was to compare bowel distension and diagnostic properties of magnetic resonance imaging of the small bowel with oral contrast (MRI per OS) with magnetic resonance enteroclysis (MRE). Forty patients with suspected Crohn's disease (CD) were examined with both MRI methods. MRI per OS was performed with a 6% mannitol solution and MRE with nasojejunal intubation and a polyethylenglycol solution. MRI protocol consisted of balanced fast field echo (B-FFE), T2 and T1 sequences with and without gadolinium. Two experienced radiologists individually evaluated bowel distension and pathological findings including wall thickness (BWT), contrast enhancement (BWE), ulcer (BWU), stenosis (BWS) and edema (EDM). The diameter of the small bowel was smaller with MRI per OS than with MRE (difference jejunum: 0.55 cm, p < 0.001; ileum: 0.35 cm, p < 0.001, terminal ileum: 0.09 cm, p = 0.08). However, CD was diagnosed with high diagnostic accuracy (sensitivity, specificity, positive and negative predictive values: MRI per OS 88%, 89%, 89%, 89%; MRE 88%, 84%, 82%, 89%) and inter-observer agreement (MRI per OS k = 0.95; MRE k = 1). In conclusion, bowel distension was inferior in MRI per OS compared to MRE. However, both methods diagnosed CD with a high diagnostic accuracy and reproducibility.

Comparison of neutral oral contrast versus positive oral contrast medium in abdominal multidetector CT

“…We, therefore, used a 3% mannitol solution in the expectation that mannitol's slight osmotic effect would produce better distention. This contrast agent is used at some institutions as part of a routine MR protocol for the examination of the small bowel, providing good small bowel distension without absorption [8,9,14,24].…”

Radiologische Charakterisierung chronisch-entzündlicher Darmerkrankungen

“…Die Gefahr einer inkompletten Füllung ist bei der MR-Enterographie höher als beim MR-Enteroklysma [3,20]. Bei der Beurteilung von Patienten mit M. Crohn wurden jedoch keine signifikanten Unterschiede zwischen beiden Füllungsme-thoden gefunden, wenngleich oberfläch-liche Pathologien besser mit dem MREnteroklysma abgrenzbar waren [17,20,25] Befunde beim M. Crohn…”

Magnetic Resonance Imaging of the Bowel: Today and Tomorrow

“…While the question whether the contrast medium should be delivered to the intestinal tract orally (MR enterography) or via an already in place nasojejunal probe (MR enteroclysis) is widely debated, it has been the subject of only a few comparative studies. In their respective comparative studies, Masselli et al and Negaard et al found that significantly better distension was achieved with MR enteroclysis than with MR enterography [19,20]. However, Negaard et al were able to detect Crohn's-typical changes with high diagnostic accuracy and reproducibility using either method [20].…”