The Diagnostic Role of Magnetic Resonance Enterography as a Complementary Test to Colonoscopy in Active Crohn’s Disease

Abstract

BACKGROUND According to recent studies comparing magnetic resonance enterography (MRE) with ileocolonoscopy for assessing inflammation of small bowel and colonic segments in adults with active Crohn’s disease (CD), we aimed to compare the accuracy of these two diagnostic methods in Iranian population. METHODS During 2013-2014 a follow-up study was done on 30 patients with active CD in a gastroenterology clinic affiliated to Tehran University of Medical Sciences. MRE and ileocolonoscopy were performed for all the patients. All statistical analyses were performed using SPSS (version 18) and p-value<0.05 was considered as statistically significant. RESULTS Of the 30 patients with active CD, 11(36.7%) were men and 19 (63.3%) were women with mean age of 37.30±13.66 years (range: 19-67 years). MRE had sensitivity and specificity of 50% and 90% with positive predictive value (PPV) and negative predictive value (NPV) of 71.43 and 78.26, respectively for localizing sigmoid lesions and ileum had sensitivity and specificity of 84.21 and 45.45 with PPV and NPV of 72.73 and 62.50, respectively. CONCLUSION While moderate sensitivity and high specificity of MRE in localizing colonic lesions makes it an appropriate confirmatory test after colonoscopy, the reported high sensitivity and moderate specificity of MRE versus colonoscopy in detecting ileal lesions makes it a suitable screening test for ileal lesions. Finally we can conclude that MRE can be an important complementary test to colonoscopy in detecting active disease.

The Spectrum of Magnetic Resonance Enterography Findings and the Role of Diffusion-Weighted Imaging in Patients with Active Crohn’s Disease

“…Additionally, MRE demonstrated a high sensitivity and average specificity in identifying ileal lesions, making it a valuable and comparable alternative to colonoscopy. 14 …”

Assessment of the usefulness of imaging studies and biomarkers in the activity of Crohn’s disease

“…Generally, it is thought that MRE, used as a tool for assessing CD activity, shows an average sensitivity and high specificity within the large intestine [ 31 ]. It seems that MRE is a more sensitive diagnostic tool when detecting complications of the disease, such as fistulae or stenoses [ 27 ].…”

Crohn’s disease activity evaluation based on imaging studies and biomarkers

“…Generally, it is thought that MRE, used as a tool for assessing CD activity, shows an average sensitivity and high specificity within the large intestine. 47 In a study by Maccioni et al, 48 the sensitivity and specificity were calculated at 100.0% in the ileum. In other studies, where CTE and MRE were compared, the values stood at 89.0% vs. 83.0% for the sensitivity and 80.0% vs. 100.0% for the specificity.…”

“…In other studies, where CTE and MRE were compared, the values stood at 89.0% vs. 83.0% for the sensitivity and 80.0% vs. 100.0% for the specificity. 47 It seems that MRE is a more sensitive diagnostic tool when detecting complications of the disease, such as fistulae or stenosis. 49 All diagnostic tools analyzed above were also compared to each other, using a non-adjusted coefficient of agreement and the Cohen's Kappa coefficient.…”