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Published on: October 17, 2013
Small bowel stricture is associated with abnormal motility on the cine MRI sequence in patients with Crohn's disease
Tiffany Lambrou1, Naueen A Chaudhry1, Joseph R Grajo2
1Division of Gastroenterology, Hepatology and Nutrition, University of Florida College of Medicine, Gainesville, FL, USA.
Purpose:
A multiphasic cine sequence performed during magnetic resonance enterography (MRE) has been shown to increase diagnostic accuracy of MRE demonstrating limited movement in inflamed intestine in patients with Crohn's disease (CD). Our aim was to confirm in our study population that intestinal inflammation was associated with decreased motility and determine if factors suggestive of complicated disease such as the presence of a stricture or fistula were associated with decreased motility on the MRE cine sequence.
Methods:
This was a retrospective study of 59 patients (mean age 40.8 ± 16.1) with Crohn's disease who had a small bowel lesion on MRE. Two gastrointestinal radiologists independently scored MRE findings using a qualitative, subjective scoring system. Univariate and multivariable ordered logistic regression models were used to evaluate the associations between cine sequence score, radiologic image findings, and clinical data.
Results:
On univariate analysis, radiologic findings reflecting active inflammation, the presence of a stricture, and penetrating disease were associated with decreased motility. On multivariable analysis, hyper-enhancement, the presence of a comb sign, and global evidence of active inflammation remained associated with decreased motility. Of the factors suggesting complicated disease, the presence of stricture (Odds Ratio 0.40, 95% Confidence Interval 0.17-0.95, p-value 0.038) was associated with decreased motility.
Conclusions:
As previously shown, well-established radiologic findings of bowel inflammation were associated with decreased small bowel motility. In this study, we have added that the radiologic finding of a fixed stricture is also associated with decreased motility.
Insights
Magnetic resonance enterography (MRE) cine sequences show that intestinal inflammation in Crohn's disease (CD) is linked to reduced bowel movement. Fixed strictures, a sign of complicated CD, also correlate with decreased motility.
Area of Science:
- Gastroenterology
- Radiology
- Medical Imaging
Background:
- Magnetic resonance enterography (MRE) with multiphasic cine sequences enhances diagnostic accuracy for Crohn's disease (CD).
- Previous studies suggest reduced intestinal motility is associated with inflammation in CD patients.
Purpose of the Study:
- To confirm the association between intestinal inflammation and decreased motility in CD patients using MRE cine sequences.
- To investigate if complicated disease factors, like strictures or fistulas, correlate with reduced motility on MRE cine sequences.
Main Methods:
- Retrospective analysis of 59 CD patients who underwent MRE.
- Independent scoring of MRE findings by two gastrointestinal radiologists using a qualitative system.
- Statistical analysis using univariate and multivariable logistic regression models.
Main Results:
- Active inflammation, strictures, and penetrating disease were associated with decreased motility on univariate analysis.
- Hyper-enhancement, comb sign, and global active inflammation remained significant predictors of decreased motility on multivariable analysis.
- Fixed strictures were significantly associated with decreased motility (OR 0.40, 95% CI 0.17-0.95).
Conclusions:
- Radiologic findings of bowel inflammation are confirmed to be associated with decreased small bowel motility in CD.
- This study adds that a fixed stricture, a sign of complicated Crohn's disease, is also associated with reduced intestinal motility.
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