Comparing the Diagnostic Accuracy of Magnetic Resonance Enterography and Computed Tomography Enterography in...

Inflammatory bowel diseases (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), are chronic relapsing inflammatory disorders requiring accurate diagnosis and periodic monitoring. Cross-sectional imaging modalities such as magnetic resonance enterography (MRE) and computed tomography enterography (CTE) have become pivotal in evaluating bowel wall and extraintestinal involvement. This study aimed to compare the diagnostic efficacy and feature agreement between MRE and CTE in assessing key mural and extramural characteristics of IBD.

A comparative cross-sectional study was conducted on patients diagnosed with IBD who underwent both MRE and CTE. Imaging findings were independently reviewed to assess diagnostic agreement on parameters including mural thickening, mural stratification, skip lesions, luminal stenosis, and creeping fat sign. Statistical analyses were performed using chi-square tests (χ²) and independent t-tests to evaluate agreement, discrepancies, and demographic correlations.

The mean age of participants was 43.40 ± 13.38 years (range: 20-63 years), with 19 (54.3%) patients diagnosed with CD and 16 (45.7%) with UC. No significant difference was observed in age between agreement and discrepancy groups (t = -0.05, p = 0.9611). Overall, MRE showed higher agreement with clinical diagnosis for mural stratification (p<0.05) and creeping fat (p<0.01) than CTE. Feature-wise comparison revealed agreement rates of 68.97% for mural thickening (χ² = 0.18, p = 0.6756), 74.19% for mural stratification (χ² = 0.0, p = 1.0), 66.67% for skip lesions (χ² = 0.0, p = 0.9901), 63.64% for luminal stenosis (χ² = 0.19, p = 0.6589), and 66.67% for creeping fat (χ² = 0.27, p = 0.6044).

MRE and CTE demonstrated comparable diagnostic agreement in evaluating IBD features, with MRE offering superior tissue characterization and radiation-free imaging, while CTE provided faster acquisition and higher spatial resolution. Despite moderate agreement levels, both modalities remain complementary in clinical practice. MRE should be preferred for longitudinal follow-up, particularly in younger patients, given its safety profile and diagnostic comprehensiveness.