The Role of MR Enterography in Crohn’s Disease

Year 2022, Volume: 4 Issue: 1, 66 - 72, 01.01.2022

Ali Burak Binboğa , Mehmet Onay , Hanifi Ayhan Özkur

https://doi.org/10.37990/medr.1007541

Abstract

Aim: The aim of this study was to investigate the efficacy of magnetic resonance enterography (MRE) in the diagnosis and follow-up of Crohn’s Disease.
Material and Methot: Between November 2013 and April 2014, patients who were MRE examinations for a preliminary or definitive diagnosis of Crohn’s Disease were reviewed retrospectively. MRE imaging of the patients was performed on an 8-channel 1.5 Tesla MRI device. Primary and secondary MRE results and contrast enhancement patterns of active and chronic inflammation of Crohn’s disease in jejunum, ileum, terminal ileum, and colon segments were evaluated by two radiologists.
Results: The results consistent with Crohn’s Disease were detected in 19 (10 male, 9 female) of 42 patients (24 male, 18 female, mean age was 40.64 years, min-max: 20-69, SD±14.27). Signs of active inflammation which were intestinal wall thickening, T2 signal reduction, and pathological mucosal contrast enhancement were observed in 19 patients (26 intestinal segments). Active inflammation findings were most common in the terminal ileum, with 16 (61.5%), followed by 5 (19.2%) in the ascending colon, 2 (7.6%) in the jejunum, 2 (7.6%) in the nonterminal ileum, and 1 (3.8%) in the sigmoid colon. Chronic inflammation findings such as intestinal stenosis (18 intestinal segments), submucosal fat deposition (16 intestinal segments), and prestenotic dilatation (13 intestinal segments) were observed in 13 patients. There was an ileosigmoid fistula in 1 patient, enterovesical fistula in 1 patient, and enterocutaneous fistula in 1 patient.
Conclusion: MRE is an appropriate diagnostic method without ionizing radiation, which can be used to detect the stage of inflammation (active or chronic) in the diseased intestinal segments in the diagnosis and follow-up of Crohn’s disease. 

Keywords

Crohn , MR Enterography , Inflammatory Bowel Disease.

Supporting Institution

None

Project Number

None

Thanks

None

References

• 1. Maglinte D, Kelvin F, O'Connor K, Lappas J, Chernish S. Current status of small bowel radiography. Abdominal imaging. 1996;21(3):247-57.
• 2. Lee SS, Kim AY, Yang S-K, Chung J-W, Kim SY, Park SH, et al. Crohn disease of the small bowel: comparison of CT enterography, MR enterography, and small-bowel follow-through as diagnostic techniques. Radiology. 2009;251(3):751-61.
• 3. Gökhan İ, KORKUT M, TERCAN M, BİLGEN I. İNCE BARSAK LEZYONLARININ GÖSTERİLMESİNDE ENTEROKLİZİSİN YERİ. Ege Tıp Dergisi.40(2):131-5.
• 4. Hara AK, Leighton JA, Heigh RI, Sharma VK, Silva AC, De Petris G, et al. Crohn disease of the small bowel: preliminary comparison among CT enterography, capsule endoscopy, small-bowel follow-through, and ileoscopy. Radiology. 2006;238(1):128-34.
• 5. Lennard-Jones J. Classification of inflammatory bowel disease. Scandinavian Journal of Gastroenterology. 1989;24(sup170):2-6.
• 6. Mekhjian HS, Switz DM, Melnyk CS, Rankin GB, Brooks RK. Clinical features and natural history of Crohn's disease. Gastroenterology. 1979;77(4):898-906.
• 7. Florie J, Wasser MN, Arts-Cieslik K, Akkerman EM, Siersema PD, Stoker J. Dynamic contrast-enhanced MRI of the bowel wall for assessment of disease activity in Crohn's disease. American Journal of Roentgenology. 2006;186(5):1384-92.
• 8. Sempere GJ, Martinez Sanjuan V, Medina Chulia E, Benages A, Tome Toyosato A, Canelles P, et al. MRI evaluation of inflammatory activity in Crohn's disease. American Journal of Roentgenology. 2005;184(6):1829-35.
• 9. Louis E, Collard A, Oger A, Degroote E, El Yafi FAN, Belaiche J. Behaviour of Crohn's disease according to the Vienna classification: changing pattern over the course of the disease. Gut. 2001;49(6):777-82.
• 10. Schill G, Iesalnieks I, Haimerl M, Müller-Wille R, Dendl L-M, Wiggermann P, et al. Assessment of disease behavior in patients with Crohn’s disease by MR enterography. Inflammatory bowel diseases. 2013;19(5):983-90.
• 11. Satsangi J, Silverberg M, Vermeire S, Colombel J. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006;55(6):749-53.
• 12. Castiglione F, Mainenti PP, De Palma GD, Testa A, Bucci L, Pesce G, et al. Noninvasive diagnosis of small bowel Crohn’s disease: direct comparison of bowel sonography and magnetic resonance enterography. Inflammatory bowel diseases. 2013;19(5):991-8.
• 13. Amzallag-Bellenger E, Oudjit A, Ruiz A, Cadiot G, Soyer PA, Hoeffel CC. Effectiveness of MR enterography for the assessment of small-bowel diseases beyond Crohn disease. Radiographics. 2012;32(5):1423-44.
• 14. Neubauer H, Pabst T, Dick A, Machann W, Evangelista L, Wirth C, et al. Small-bowel MRI in children and young adults with Crohn disease: retrospective head-to-head comparison of contrast-enhanced and diffusion-weighted MRI. Pediatric radiology. 2013;43(1):103-14.
• 15. Toma P, Granata C, Magnano G, Barabino A. CT and MRI of paediatric Crohn disease. Pediatric radiology. 2007;37(11):1083-92.
• 16. Amzallag-Bellenger E, Soyer P, Barbe C, Diebold M-D, Cadiot G, Hoeffel C. Prospective evaluation of magnetic resonance enterography for the detection of mesenteric small bowel tumours. European radiology. 2013;23(7):1901-10.
• 17. Kuo PH, Kanal E, Abu-Alfa AK, Cowper SE. Gadolinium-based MR contrast agents and nephrogenic systemic fibrosis. Radiology. 2007;242(3):647-9.
• 18. Buisson A, Joubert A, Montoriol PF, Ines D, Hordonneau C, Pereira B, et al. Diffusion‐weighted magnetic resonance imaging for detecting and assessing ileal inflammation in C rohn's disease. Alimentary pharmacology & therapeutics. 2013;37(5):537-45.
• 19. Fidler JL, Guimaraes L, Einstein DM. MR imaging of the small bowel. Radiographics. 2009;29(6):1811-25.
• 20. Hidalgo LH, Moreno EA, Arranz JC, Alonso RC, de Vega Fernández VM. Magnetic resonance enterography: review of the technique for the study of Crohn's disease. Radiología (English Edition). 2011;53(5):421-33.
• 21. Low RN, Sebrechts CP, Politoske DA, Bennett MT, Flores S, Snyder RJ, et al. Crohn disease with endoscopic correlation: single-shot fast spin-echo and gadolinium-enhanced fat-suppressed spoiled gradient-echo MR imaging. Radiology. 2002;222(3):652-60.
• 22. Menys A, Atkinson D, Odille F, Ahmed A, Novelli M, Rodriguez-Justo M, et al. Quantified terminal ileal motility during MR enterography as a potential biomarker of Crohn’s disease activity: a preliminary study. European radiology. 2012;22(11):2494-501.
• 23. Rimola J, Rodríguez S, García-Bosch O, Ordás I, Ayala E, Aceituno M, et al. Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn’s disease. Gut. 2009;58(8):1113-20.
• 24. Goei R, Nix M, Kessels A, Ten Tusscher M. Use of antispasmodic drugs in double contrast barium enema examination: glucagon or buscopan? Clinical radiology. 1995;50(8):553-7.
• 25. Pomeroy A, Rand M. Anticholinergic effects and passage through the intestinal wall of N‐butylhyoscine bromide. Journal of Pharmacy and Pharmacology. 1969;21(3):180-7.
• 26. Ahualli J. The target sign: bowel wall. Radiology. 2005;234(2):549-50.
• 27. Onay M, Erden A, Binboğa AB, Altay ÇM, Törüner M. Assessment of Imaging Features of Crohn’s Disease with MR Enterography. The Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology. 2021;32(8):631-9.
• 28. Hoeffel C, Crema MD, Belkacem A, Azizi L, Lewin M, Arrivé L, et al. Multi–detector row CT: spectrum of diseases involving the ileocecal area. Radiographics. 2006;26(5):1373-90.
• 29. Bickelhaupt S, Froehlich J, Cattin R, Patuto N, Tutuian R, Wentz K, et al. Differentiation between active and chronic Crohn's disease using MRI small-bowel motility examinations—Initial experience. Clinical radiology. 2013;68(12):1247-53.
• 30. Macarini L, Stoppino L, Centola A, Muscarella S, Fortunato F, Coppolino F, et al. Assessment of activity of Crohn’s disease of the ileum and large bowel: proposal for a new multiparameter MR enterography score. La radiologia medica. 2013;118(2):181-95.
• 31. Sinha R, Verma R, Verma S, Rajesh A. MR enterography of Crohn disease: part 2, imaging and pathologic findings. American Journal of Roentgenology. 2011;197(1):80-5.
• 32. Kitazume Y, Satoh S, Hosoi H, Noguchi O, Shibuya H. Cine magnetic resonance imaging evaluation of peristalsis of small bowel with longitudinal ulcer in Crohn disease: preliminary results. Journal of computer assisted tomography. 2007;31(6):876-83.
• 33. Rimola J, Planell N, Rodríguez S, Delgado S, Ordás I, Ramírez-Morros A, et al. Characterization of inflammation and fibrosis in Crohn’s disease lesions by magnetic resonance imaging. The American journal of gastroenterology. 2015;110(3):432.