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[MRI with oral filling in patients with chronic inflammatory bowel diseases]
C Born1, B Nagel, G Leinsinger
1Institut für Klinische Radiologie/Innenstadt, Klinikum der Universität München, Munich. christine.born@radin.med.uni-muenchen.de
Aim:
Evaluation of mannitol-MRI in patients with suspected or established Crohn's disease (CD). METHODS. 75 patients with suspected or established Crohn's disease were included. 1.5 l of mannitol-solution were administered orally within 1 h before imaging. A rectal filling was also employed. Butylscopolamin was applied i.v. Native-sequences were acquired. T1w sequences (axial, coronal) were acquired before and after (fs-T1-w-BH) i.v.Gd-DTPA. Additionally a dynamic CM-study was performed.
Results:
In 45% of the examinations good image quality was achieved. In 28% opacification of the terminal ileum was insufficient. However, diagnostic assessment was possible. Motion artifacts due to breathing were rare, artifacts due to peristalsis were noted in 16% of the examinations. Alterations indicative to CD were found in 69% of the patients. The SI-increase of the thickened bowel-wall was significantly higher than the increase of not thickened wall (117 vs.75%; p = 0,001 in t-test). We detected stenoses in 56%, fistulas in 23% and an abscess in one patient.
Conclusion:
Mannitol-MRI is a valuable method in the diagnostic work-up of inflammatory bowel disease. Improvement of distal distension should be attempted, because of the good acceptance of the patients and high diagnostical value.
Insights
Mannitol-enhanced MRI is a valuable tool for diagnosing Crohn's disease (CD), showing high diagnostic accuracy despite some limitations in bowel distension.
Area of Science:
- Gastroenterology
- Radiology
- Medical Imaging
Background:
- Crohn's disease (CD) diagnosis requires accurate imaging.
- Optimizing MRI protocols for CD assessment is crucial.
Purpose of the Study:
- To evaluate the efficacy of mannitol-enhanced MRI in diagnosing Crohn's disease.
- Assess image quality and diagnostic yield of this technique.
Main Methods:
- 75 patients with suspected or established CD underwent MRI.
- Oral mannitol solution and rectal filling were used for bowel distension.
- T1-weighted sequences before and after contrast administration, plus dynamic imaging, were performed.
Main Results:
- Diagnostic assessment was possible in most cases, with 69% showing CD-indicative alterations.
- Significant signal increase in thickened bowel walls (p=0.001).
- Detected stenoses (56%), fistulas (23%), and an abscess (1 patient).
Conclusions:
- Mannitol-MRI is a valuable method for diagnosing inflammatory bowel disease.
- Further improvements in distal bowel distension are recommended.
- High patient acceptance and diagnostic value support its use.