Assessment of Disease Behavior in Patients with Crohn’s Disease by MR Enterography

Schill, G; Iesalnieks, Igors; Haimerl, Michael; Müller-Wille, René; Dendl, Lena Marie; Wiggermann, Philipp; Schleder, Stephan; Rennert, Janine; Ott, Claudia; Agha, Ayman; Stroszczynski, Christian; Schreyer, A. G.

doi:10.1097/mib.0b013e31828029dd

Cited by 21 publications

(24 citation statements)

References 30 publications

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“…In addition, it is possible to draw conclusions about possibly present extraluminal complications, such as abscesses or fistulas, that can be missed by endoscopic methods or conventional radiological double-contrast methods [3, 18 -20]. MRE is also in excellent agreement with current clinical score systems such as the Montreal classification regarding the evaluation of the disease with respect to inflammation, stenosis, or perforating processes [21]. It is therefore suitable for representing the basic radiological examination for further decisions regarding medication-based or surgical treatment concepts.…”

Section: Key Pointsmentioning

confidence: 56%

Interobserver Agreement in MR Enterography for Diagnostic Assessment in Patients with Crohn's Disease

Schleder

Pawlik

Wiggermann

et al. 2013

Fortschr Röntgenstr

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Purpose: To evaluate the extent to which MRE can be used as an observer-independent, objective imaging method for the diagnosis and evaluation of CD with respect to the detection of inflammatory changes of the small bowel and lymphadenopathy as diagnostic criterion and bowel distension as a quality criterion. Materials and Methods: MRE scans of 84 patients (42 female, median age 37 years) were evaluated independently by 4 experienced radiologists. Analysis of inflammatory changes of the bowel wall, lymphadenopathy and adequate bowel distension was conducted separately for the jejunum, ileum and terminal ileum. The Kendall?s W-test was used for the statistical comparison of concordance. Results: In a total of 55 patients, inflammatory activity of the bowel wall was detected and MRE was found to have a high interobserver reproducibility concerning inflammatory changes of the intestinal wall (Kendall?s W 0.527???0.823). Concerning lymphadenopathy (31 cases, 36.9?%), a low to moderate consensus could be shown with a Kendall?s W value of 0.402???0.505. For the assessment of adequate bowel distension, a moderate concordance between the operators could be found (Kendall?s W 0.497???0.581). Conclusion: MRE has proven high interobserver agreement with respect to the diagnosis of inflammatory disease activity of the bowel as a diagnostic criterion in patients with CD. Concerning adequate bowel distension as a quality criterion of the examination itself and lymphadenopathy as a diagnostic criterion, moderate interobserver agreement could be found. This is thought to have a rather small effect on the diagnostic significance and conclusiveness of the method in the daily routine. Key Points: Citation Format:

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Section: Key Pointsmentioning

confidence: 56%

Interobserver Agreement in MR Enterography for Diagnostic Assessment in Patients with Crohn's Disease

Schleder

Pawlik

Wiggermann

et al. 2013

Fortschr Röntgenstr

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“…In a retrospective study comparing MRE and surgical findings on the evaluation of how MRE correctly diagnoses Crohn's disease behavior according to Montreal classification, Schill et al [19] found that the MRE diagnosis of an inflammatory mass had the lowest sensitivity and the lowest negative predictive value. Adhesions between bowel segments are often present in inflammatory mass; so adhesions might have played a role in this result.…”

Section: Discussionmentioning

confidence: 99%

Intra-Abdominal Adhesions Make the Interpretation of Magnetic Resonance Enterography in Crohn's Disease More Difficult

Aaltonen¹,

Keränen²,

Carpelan-Holmström³

et al. 2016

Dig Surg

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Aims: The present study compares preoperative magnetic resonance enterography (MRE) accuracy in diagnosing stenoses, abscesses and fistulas to intraoperative findings in Crohn's disease patients, and determines whether discordance between these methods alter surgical plans. Methods: Our study included 55 consecutive patients scheduled for elective surgery due to Crohn's disease in a single institution between January 2011 and May 2015, whose surgical findings were also compared to preoperative MREs. Data were retrospectively analyzed. Results: Among these 55 patients, we found 80 stenoses, 5 abscesses and 18 fistulas during surgery. The MRE sensitivity, specificity and accuracy, respectively, reached 100, 77.8 and 96.4% for stenoses; 80.0, 90.0 and 89.1% for abscesses; and 77.8, 83.8 and 81.8% for fistulas. The operative plan was modified for 7 patients (12.7%) due to erroneous MRE diagnoses. No patient needed conversion or an unplanned stoma placement due to an incorrect diagnosis using MRE. The MRE diagnosis did not agree with the surgical findings for 36 lesions, 16 of which resulted from adhesions that explained the incorrect MRE diagnoses. Conclusions: Hence, while MRE is a useful diagnostic tool preoperatively in Crohn's disease patients, the presence of intra-abdominal adhesions may cause erroneous diagnosis through MRE.

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“…In patients with known chronic inflammatory bowel disease and acute abdominal pain, the same working group additionally showed that regular emergency CT for intestinal wall evaluation is sufficient and no additional MRE studies are necessary since an advanced finding is often present in these patients [51]. In a further study of the Regensburg group, it was able to be shown in patients undergoing bowel resection that MRE is an excellent imaging modality to correctly evaluate the Montreal classification of disease behavior [52]. The extent to which MRE can be used as an independent objective imaging method in the diagnosis and treatment of Crohn's disease was evaluated in an additional study [53].…”

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confidence: 89%

A Review of Scientific Topics and Literature in Abdominal Radiology in Germany – Part 1: Gastrointestinal Tract

Schreyer

Weßling

Kinner

et al. 2015

Fortschr Röntgenstr

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The working group for abdominal and gastrointestinal diagnosis is a group of the German Radiological Society (DRG) focusing clinically and scientifically on the diagnosis and treatment of the gastrointestinal tract with all parenchymatous abdominal organs. In addition to the clinical and scientific further development of abdominal radiology, the education of radiologists within this core discipline of radiology is one of the major aims. In this article we give an up-to-date literature review of scientific radiological topics especially covered by German radiologists. This manuscript focuses on the most recent literature on the diagnosis of the stomach, small bowel, colon and rectum. The review with a focus on the most recent studies published by German radiologists concludes with a synopsis of mesenterial bleeding and ischemia followed by a critical appraisal of the current literature on conventional abdominal radiography. Key Points: ??Based on recent literature and guidelines there is a change of paradigms regarding the diagnosis of esophagus and gastric cancer towards CT, which is considered equally to endosonography. ??For small bowel imaging in Crohn?s disease ultrasound as well as MRI with a new focus on DWI are the most important imaging modalities scientifically. ??For colonic diagnosis virtual colonoscopy has replaced the conventional radiological methods. For staging of rectal carcinoma as well as for therapeutic stratification a high resolution MRI of the pelvis is of paramount interest. ??Multislice CT is considered the most important modality to assess mesenteric ischemia or bleeding. Citation Format: ??Schreyer AG, Wessling J, Kinner S et?al. A Review of Scientific Topics and Literature in Abdominal Radiology in Germany ? Part 1: Gastrointestinal Tract. Fortschr R?ntgenstr 2016; 188: 134???145

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Assessment of Disease Behavior in Patients with Crohn’s Disease by MR Enterography

Abstract: MRI represents an excellent imaging modality to correctly assess the Montreal classification-based disease behavior in patients scheduled for bowel resection with Crohn's disease.

Cited by 21 publications

References 30 publications

Interobserver Agreement in MR Enterography for Diagnostic Assessment in Patients with Crohn's Disease

Interobserver Agreement in MR Enterography for Diagnostic Assessment in Patients with Crohn's Disease

Intra-Abdominal Adhesions Make the Interpretation of Magnetic Resonance Enterography in Crohn's Disease More Difficult

A Review of Scientific Topics and Literature in Abdominal Radiology in Germany – Part 1: Gastrointestinal Tract

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