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Magnetic Resonance Enteroclysis imaging of Crohn's
Gabriele Masselli1, Maria Gabriella Brizi, Laura Menchini
1Divisione di Radiologia, Ospedale S. Eugenio, Rome. gabrielemasselli@libero.it
Aim:
The aim of our prospective study was to evaluate the diagnostic accuracy of MR Enteroclysis (MRE) to assess the extension and complications of Crohn's Disease (CD) in comparison with conventional enteroclysis (CE).
Materials And Methods:
The study comprised 30 consecutive patients affected by Crohn's disease (18 women and 12 men; age range 16-76, mean age 40.6 years), who underwent conventional and MR enteroclysis. The MR enteroclysis protocol includes three sequences: coronal and axial FIESTA and ssFSE sequences and T1-3D-FSPGR sequences before and after intravenous injection of gadolinium, acquired after administration of 1.6-2 l of iso-osmolar polyethylene glycol solution via a nasojejunal catheter. Two radiologists blindly scored each sequence for opacification of the lumen, small bowel distension and image quality and evaluated the following parameters: presence of wall ulcers, pseudopolyps, stenoses and fistulae.
Results:
The accuracy of the FIESTA sequence was significantly higher (p<0.01) than the ssFSE and 3D FSPGR sequences in the evaluation of lumen opacification and bowel distension, and for the overall quality of the images (p<0.01). The sensitivity and specificity of MRE were 82% and 100% for the visualisation of parietal ulcers, 87% and 100% for pseudopolyps, 100% and 88% for stenoses, 75% and 100% for parietal fistulae. High-grade stenoses with prestenotic dilation (n=6) and low-grade stenoses (n=9) were visualised both by MRE and CE. MRE also showed abscesses in two patients, not seen at CE. The FIESTA and ssFSE sequences had higher accuracy in the detection of wall ulcers and fistulae, whereas the 3D FSPGR sequences showed higher accuracy in the evaluation of wall thickening.
Conclusions:
MRE is able to demonstrate the spectrum of superficial, intramural and exoenteric alterations in Crohn's disease and closely correlates with CE in demonstrating alterations of the bowel lumen and wall.
Insights
MR Enteroclysis (MRE) accurately assesses Crohn's Disease (CD) extension and complications, closely correlating with conventional enteroclysis (CE). MRE demonstrates superficial, intramural, and exoenteric alterations, offering high sensitivity and specificity for various CD manifestations.
Area of Science:
- Gastroenterology
- Diagnostic Imaging
- Radiology
Background:
- Crohn's Disease (CD) is a chronic inflammatory condition affecting the gastrointestinal tract.
- Accurate assessment of CD extension and complications is crucial for effective patient management.
- Conventional enteroclysis (CE) has been the standard for evaluating small bowel abnormalities.
Purpose of the Study:
- To evaluate the diagnostic accuracy of MR Enteroclysis (MRE) in assessing the extent and complications of Crohn's Disease (CD).
- To compare the diagnostic performance of MRE with conventional enteroclysis (CE).
Main Methods:
- A prospective study involving 30 consecutive patients with Crohn's Disease.
- Patients underwent both conventional enteroclysis (CE) and MR Enteroclysis (MRE).
- MRE protocol included specific sequences (FIESTA, ssFSE, T1-3D-FSPGR) after oral contrast and gadolinium administration.
Main Results:
- The FIESTA sequence showed significantly higher accuracy for lumen opacification, bowel distension, and overall image quality compared to other sequences.
- MRE demonstrated high sensitivity and specificity for detecting ulcers (82%, 100%), pseudopolyps (87%, 100%), stenoses (100%, 88%), and fistulae (75%, 100%).
- MRE identified abscesses in two patients not detected by CE and correlated well with CE in visualizing lumen and wall alterations.
Conclusions:
- MR Enteroclysis (MRE) is a highly accurate imaging modality for evaluating Crohn's Disease.
- MRE effectively visualizes superficial, intramural, and exoenteric changes associated with CD.
- MRE serves as a valuable tool, closely correlating with conventional enteroclysis for assessing bowel lumen and wall alterations in CD.
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