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

Abstract

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.

Comparison of Diagnostic Performance of Ultrasonography and Magnetic Resonance Enterography in the Assessment of Active Bowel Lesions in Patients with Crohn’s Disease: A Systematic Review and Meta-Analysis

“…Studies with SICUS or CEUS were included (three studies) and analyzed to determine whether they were better than the conventional US. Previous studies reported superior sensitivity in the detection of small bowel lesions with SICUS (96–100% vs. 57–96%) and reduced interobserver variability compared with the conventional US [ 38 ]. Likewise, the previous meta-analysis reported the pooled sensitivity, specificity, and summary AUC of CEUS for an active CD to be 93%, 87%, and 0.96, respectively, which were superior to those of US in our study [ 39 ].…”

Predictive Markers of Crohn’s Disease in Small Bowel Capsule Endoscopy: A Retrospective Study of Small Bowel Capsule Endoscopy

“…While the diagnosis of CD can be simple in the upper gastrointestinal tract or in the colon as they can be easily assessed in endoscopy, the large area of the small bowel is difficult to access in conventional endoscopy. Magnetic resonance enterography (MRE) can be used to detect severe lesions like transmural inflammation, stenosis, fistulae or extraintestinal abscesses [ 2 , 3 ]. MRE is not sensitive enough to detect luminal lesions in the small bowel [ 4 , 5 , 6 , 7 ].…”