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Magnetic Resonance enteroclysis imaging in Crohn's disease
Laura Broglia1, Paola Gigante, Claudio Papi
1UOC Radiologia Interventistica e dell'Alta Tecnologia, Azienda Complesso Ospedaliero S. Filippo Neri, Rome, Italy. laura.broglia@tin.it
Purpose:
To assess the role of magnetic resonance enteroclysis (MRE) in patients with Crohn's disease, in order to identify involved segments, define the extension and evaluate transmural alterations.
Materials And Methods:
Eighteen patients with known Crohn's disease were studied with MR (1.5 T), with breath-hold T2-weighted TSE, T2-weighted TSE SPIR and 3D T1-weighted sequences before and after gadolinium injection (0.2 mmol/kg) in the coronal and axial planes. The small bowel was distended by the administration of 2 l of methylcellulose through a nasojejunal tube and drug induced hypotony. Typical patterns of Crohn's disease, such as mucosal abnormalities, parietal thickening and narrowing of the bowel, prestenotic dilation, fibrofatty proliferation and enlarged lymph nodes were analysed on radiological and MRE images. MRE was performed within 30 days from conventional radiological studies (conventional enteroclysis and small bowel follow-through).
Results:
Good distension of the bowel wall was obtained in all cases. MRE assessed the presence of parietal thickening and narrowing of the bowel wall (14/18 cases) and the presence of prestenotic dilatation (12/18 cases). Vascular enhancement (14/18 cases), transmural abnormalities (8/18 cases), fibrofatty proliferation (3/18 cases), abscess formation (2/18 cases) and enlarged mesenteric lymph nodes (6/18 cases) were also observed. MRE missed small fistulas which were visible in radiological studies in two patients.
Conclusions:
MRE appears to be a promising technique in patients with Crohn's disease. Due to limited spatial resolution MRE could be a useful adjunct to radiological studies and in following up selected groups of patients with prior known disease.
Insights
Magnetic resonance enteroclysis (MRE) shows promise for evaluating Crohn's disease, identifying bowel segments, and assessing transmural changes. It serves as a valuable adjunct to conventional radiology for disease monitoring.
Area of Science:
- Gastroenterology
- Radiology
- Medical Imaging
Background:
- Crohn's disease is a chronic inflammatory bowel disease affecting the gastrointestinal tract.
- Accurate assessment of disease extent and complications is crucial for patient management.
- Conventional radiological studies have limitations in fully characterizing small bowel involvement.
Purpose of the Study:
- To evaluate the efficacy of magnetic resonance enteroclysis (MRE) in Crohn's disease.
- To identify involved small bowel segments and determine disease extension.
- To assess transmural alterations and complications in Crohn's disease patients.
Main Methods:
- Eighteen patients with known Crohn's disease underwent MRE using a 1.5 T MR scanner.
- T2-weighted and 3D T1-weighted sequences were acquired before and after gadolinium contrast administration.
- Small bowel distension was achieved using methylcellulose and pharmacologically induced hypotonia.
Main Results:
- MRE successfully visualized parietal thickening, bowel narrowing, and prestenotic dilatation in most patients.
- Vascular enhancement, transmural abnormalities, fibrofatty proliferation, abscesses, and lymphadenopathy were identified.
- MRE missed two small fistulas detected by conventional radiology.
Conclusions:
- MRE is a promising imaging technique for evaluating Crohn's disease.
- Its limited spatial resolution may necessitate its use as an adjunct to conventional radiology.
- MRE is beneficial for follow-up assessments in selected Crohn's disease patients.