Acute Complications of Crohn’s Disease: Comparison of Multidetector-Row Computed Tomographic Enterography with Magnetic Resonance Enterography

Abstract

Objective: To compare multidetector-row computed tomographic (MDCT) enterography with magnetic resonance (MR) enterography performed upon acute exacerbation of Crohn’s disease. Subjects and Methods: Fifty-seven patients (mean age 33.5) with proven Crohn’s disease and symptoms suggesting acute exacerbation were prospectively included. After oral administration of 1–2 liters of 5% methylcellulose, MDCT and MR enterography were performed on each patient (mean delay <24 h). Three radiologists blindly and independently evaluated each examination for technical quality and in terms of 8 pathological features of Crohn’s disease. Observers’ agreement, sensitivity and specificity resulted from comparison with the reference standard [surgery (n = 24), endoscopy (n = 17) and long-term follow-up (n = 16)]. Results: MDCT enterography demonstrated fewer artifacts than MR enterography (p < 0.0001). In 48 MDCT/MR enterography examinations, active disease was demonstrated: abscesses (n = 11), fistulas (n = 13), stenoses (n = 23) and/or intestinal inflammation (n = 38). Observers’ agreement (range 0.56–0.87) was not significantly different between MDCT and MR enterography, neither in terms of sensitivity (range 58–95%) nor specificity (range 67–100%) for each of the 8 pathological features. Conclusion: Statistically, MR enterography is of similar diagnostic value as MDCT enterography for acute complications of Crohn’s disease. Since the typical Crohn’s disease patient is young and will very likely undergo life-long imaging, and given concerns about radiation exposure with MDCT, MR enterography should be the preferred modality.

Magnetic resonance enterography in Crohn's disease: a comparison with the findings at surgery

“…We found that MR was also accurate at identifying ileo‐enteric and ileosigmoid fistulae (Fig. a,b) in common with previous studies . We could not, however, accurately identify the number of fistulae when more than one was present, either on MR or at surgery.…”

“…Concerns about ionizing radiation involved in these investigations [1,2] and improvements in magnetic resonance (MR) technology have prompted the increased use of MR imaging of the small bowel as a radiation-free alternative. In order to view small bowel pathology, adequate bowel distension is needed and this is achieved by drinking contrast (MR enterography [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]) or by contrast introduction via a nasoduodenal tube inserted under fluoroscopic control (MR enteroclysis [21][22][23][24][25][26][27][28][29][30]). MR enteroclysis may achieve better jejunal distension and mucosal visualization than MR enterography [7] but no statistical difference has been found between these techniques in a direct comparison [15].…”

Systematic review with meta‐analysis: magnetic resonance enterography signs for the detection of inflammation and intestinal damage in Crohn's disease

“…The literature search revealed 2501 abstracts related to MRI use in CD. Of these, 244 were retrieved and 62 studies were deemed appropriate for inclusion (Figure ).…”

Imaging of the small bowel: Crohn’s disease in paediatric patients

“…In young adults MR enterography showed a diagnostic value similar to MDCT enterography at least for acute complications of CD, such as fistulas and abscesses [79] . The abscesses can be treated by percutaneous interventions.…”