Magnetic resonance enterography in pregnant women with Crohn’s disease: case series and literature review

Abstract

BackgroundEvaluation of pregnant women with known or suspected Crohn’s disease (CD) remains a challenge. Magnetic Resonance Enterography (MRE) is a promising diagnostic tool in these patients; however, the clinical data on MRE utilization in pregnancy is scarce. The aim of the study was to describe the experience with MRE in pregnant CD patients in a tertiary referral center.MethodsWe retrospectively reviewed MRE studies performed in pregnant women with known or suspected CD that were performed between January 2007 and November 2012. Imaging findings, clinical management and outcome were extracted from patient’s file and electronic records. Image quality was evaluated.ResultsTen studies of 9 patients were included. MRE protocol was modified to maximize maternal and fetal safety, and intravenous gadolinium was not used. In 7 patients, CD diagnosis was previously established; six were admitted with clinical symptoms consistent with CD exacerbation, and an additional patient with a recurrent groin abscess without apparent luminal symptoms. In all seven patients, imaging features consistent with active CD were detected; new penetrating complications were detected in 4 patients. Two patients underwent MRE for suspected CD which was not comforted by study results. The clinical management was significantly impacted by MRE results in all positive cases. The image quality of the fast MRE sequences obtained without gadolinium was satisfactory and allowed meaningful interpretation.ConclusionMRE with an adapted protocol for pregnancy is a reliable imaging modality to manage in pregnant women with known or suspected CD.

Regulation of Cellular Identity in Cancer

“…Active MAPK signaling is required to maintain the KrasG12D driven dedifferentiated acinar state in PanIN lesions. Conversely, pharmacological inhibition of MAPK pathway effector MEK1/2 drives PanIN cells to re-differentiate into acinar cells (Collins et al, 2014). Several other MAPK pathway factors that are required for Ras transformation such as Protein kinase C iota, serine threonine kinase Protein kinase D1, and immediate early response family IER3 have also been shown to be required for Kras mediated reprogramming of enzyme-producing cells (Garcia et al, 2014; Liou et al, 2015; Scotti et al, 2012).…”

“…Perhaps the most important evidence comes from the use of MAPK inhibitors, which directly antagonize the oncogenic Kras pathway. When the MAPK-ERK pathway was inhibited pharmacologically in Kras-driven animal models, neoplastic cells were able to reverse to their mature acinar differentiation state (Collins et al, 2014). Thus, strengthening or re-establishing the cellular identity may be exploited as a novel therapeutic avenue for PDA treatment.…”

Imaging in pregnancy

“…MRI enables the visualisation of deep soft tissue structures and does not rely on the use of ionising radiation . MRI is useful for assessing a variety of medical conditions – for example, posterior reversible encephalopathy syndrome, cerebral venous thrombosis, acute appendicitis, Crohn's disease and suspected morbidly adherent placenta . Antenatal MRI is increasingly used to further evaluate structural fetal anomalies, including cranial lesions (ventriculomegaly, agenesis of the corpus callosum, gyral or sulcation pattern), neural tube defects, congenital pulmonary airway malformations, congenital diaphragmatic hernia and cardiovascular anomalies (teratoma, rhabdomyoma or vascular abnormalities) …”

How Can Pelvic MRI with Diffusion-Weighted Imaging Help My Pregnant Patient?

“…Accurate diagnosis of a suspected Crohn's flare is critical to expedite treatment and mitigate these risks. 33 Some expert centers perform ultrasound for evaluation of Crohn's disease, and the accuracy of ultrasound for Crohn's disease evaluation is improving. 34,35 However, ultrasound of the small bowel is technically difficult in pregnant patients with bowel displacement by the gravid uterus.…”

“…MR enterography protocols can be modified to be performed without intravenous contrast in pregnant patients and results have been shown to significantly impact clinical management. 33 Some of the findings on MRI of active small bowel inflammation include mural hyperenhancement, thickening, and edema. 36 DWI has been shown to augment depiction of bowel inflammation and active disease 21,37-44 when gadolinium is not used (►Fig.…”