Abstract
Crohn's disease (CD) is a chronic inflammatory condition with relapsing-remitting behavior, often causing strictures or penetrating bowel damage. Its lifelong clinical course necessitates frequent assessment of disease activity and complications. Computed tomography (CT) enterography has been used as primary imaging modality; however, the concern for radiation hazard limits its use especially in younger population. Magnetic resonance (MR) imaging has advantages of avoiding radiation exposure, lower incidence of adverse events, ability to obtain dynamic information, and good soft-tissue resolution. MR enterography (MRE) with oral contrast agent has been used as primary MR imaging modality of CD with high sensitivity, specificity, and interobserver agreement. The extent of inflammation as well as transmural ulcers and fibrostenotic diseases can be detected with MRE. Novel MR techniques such as diffusion-weighted MRI (DWI), motility study, PET-MRI, and molecular imaging are currently investigated for further improvement of diagnosis and management of CD. MR spectroscopy is a remarkable molecular imaging tool to analyze metabolic profile of CD with human samples such as plasma, urine, or feces, as well as colonic mucosa itself.
Highlights
Inflammatory bowel disease (IBD) includes two major forms of chronic intestinal disorder: Crohn’s disease (CD) and ulcerative colitis (UC) [1, 2]
Differentiation between the subtypes is clinically important because active inflammation is usually treated medically unless there are extramural complications, while fibrostenotic disease characterised by obstructive symptoms often requires surgery [50]
A study using in vitro 1H NMR reported that patients with IBD showed similar metabolic profile in macroscopically involved and uninvolved colonic mucosa compared with that of controls [76]
Summary
Inflammatory bowel disease (IBD) includes two major forms of chronic intestinal disorder: Crohn’s disease (CD) and ulcerative colitis (UC) [1, 2]. CD is a chronic inflammatory condition characterized by relapsing-remitting clinical behavior, potentially affecting any portion of the gastrointestinal tract from mouth to anus. It can occur at any age but most often in second or third decade [3]. Most clinical trials in patients with active Crohn’s disease recruit patients with a Crohn’s Disease Activity Index (CDAI) of >220 [6] This index is a point score and comprises eight items (stool frequency, abdominal pain, subjective general wellbeing, presence of complications and abdominal mass, use of antidiarrheal medications, hematocrit, and weight deviation) [7]. Treatment of Crohn’s disease aims to achieve sustained clinical and endoscopic remission and to interrupt the disease course that ends in intestinal failure and complications [8]
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