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

Abstract

Magnetic resonance enterography identifies small bowel Crohn's disease with an accuracy similar to or better than those of previously published series. Fistulation, abscess formation and large bowel disease can be reliably identified and disease activity assessed. Normal, uninvolved small bowel length can also be measured. Discrete proximal small bowel lesions may not always be detected. In our practice, MR enterography has replaced conventional radiology in the assessment of symptomatic patients with Crohn's disease.

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

“…MRE may prove useful during preoperative planning among Crohn's disease patients since it can diagnose small bowel and colonic lesions as well as extraintestinal lesions such as abscesses and fistulas [10][11][12][13] . Given that Crohn's disease follows a recurrent pattern, whereby patients will require multiple imaging examinations throughout their lives, the advantage of MRE over other imaging techniques lies in its lack of exposure to radiation [10,13] .…”

Current MR-Enterography In The Diagnosis Of Crohn’s Disease, An Update.

“…Surgical approaches are most evident at stenosing form whereas medical conservative therapy aids more in ulcerative form. In fistulising form, both medical and surgical therapies can be applied (6)(7)(8)(9)(10)(11)15).…”

“…In endoscopy; Aftos ulcerations and erosions are found out initially in the normal bowel mucosa than at later stages, mural stratification with longitudinal and transverse ulcerations are observed (7,14,20,21). On MRI; High bowel wall enhancement is particular at active inflammation, increased signal at bowel wall and adjacent mesentery on T2W images, strictures-fistulization and abcesses are the main complications and hyperintense on T2W images, asymmetrically thickened mucosal folds and lymphadenopathy, mesenteric stranding of the effected bowel wall and prominent draining vessels of the inflamed intestinal loops(comb sign), presence of intramural fat at chronic phase and target sign due to wall thickening at acute phase, surrounding periintestinal edema in acute phase are the main findings of Crohn's disease (7,12,14,(18)(19)(20)(21) (Figure 2a-b) Mucosal irregularities and ulcerations, strictures and fistulas at chronic stage can also be visualized by enteroclysis (3,4,14,15,22) (Figure 3a-b-c).Clinical signs of Crohn's disease are; Abdominal ache, diarrhea, fever, loss of weight, malnutrition, hemorrhage and fistulas, its extra-intestinal manifestations are: Arthritis, iridocyclitis, erthytema nodosum, aftoz stomatitis, cholelithiasis, primary sclerosing cholangitis and ankylosing spondylitis (8)(9)(10)(11)(12)(13)(14)(15)(16)(20)(21)(22).In the differential diagnosis; Ulcerative colitis(UC), ischemic colitis(IC), infectious-fungal and tuberculous(Tbc) enteritis, radiation enteritis, major pathognomonic findings of it, lung involvementcalcified mesenteric lymphadenopathy and peritonitis are the common manifestations of Tbc (24)(25)(26). In the infectious en...…”

“…At this point of view, MRE may be currently used for accurate diagnosis and treatment of inflammatory bowel diseases (1-4,7-9). Most standard MRE protocols achieve adequate intestinal distention via OCA, mural involvement and enhancement can be depicted by suboptimal bowel distention but, however mucosal ulcerations, skip lesions or strictures may be compromised (3,(6)(7)(8)(9)(10)12,14,18,20). MRE examines; the number, distribution, shape and thickness of the plicae of intestine, diameter of the intestinal lumen and presence of intra or extra-luminal mass, thickness and contour of colonic wall, presence of abnormal bowel wall enhancement, mural or transmural inflammation, edema or hyperemia of bowel wall, irregularity and ulceration of mucosa, halo or target sign, stenosis or perforation of intestinal segments, mesenteric lympadenopathies, fistula formation, vascular engorgement and presence of other extra-intestinal pathologies (7,12,14,(16)(17)(18)(19)(20).…”

“…Adequate small bowel distention is vital for an optimal enterographic examination as collapsed or contracted small bowel loops may mimic some pathologies, mask some intraluminal lesions or may cause overdiagnosis with exaggerating of wall thickness (3,(6)(7)(8). OCA has been administered to ensure the optimal bowel distention, they are classified into three groups: Negative-Positive-Biphasic intestinal contrast agents (4,5).…”