Reply to: enteroclysis vs enterography: the unsettled issue

Abstract

Dear Drs Torkzad and Lauenstein, Thank you for your interest in our article, “Comparison of MR enteroclysis with MR enterography and conventional enteroclysis in patients with Crohn’s disease”, published in European Radiology [1]. We would like to respond briefly to some of your questions and comments. Statistical analysis: We have not compared MR enteroclysis (MREc) and MR enterography (MREg) directly, but MREc and MREg findings were compared directly with those of conventional enteroclysis (CE) as the ‘gold standard’. The results of this analysis were correlated. The two groups of patients that underwent to MREc and CE (n=22) and MREg and CE (n=18) were not statistically different, because the procedure for alternate assignment involved random basing of the CDAI score. The two populations were homogeneous, and the analysis of the results was not on a patient basis but on a segment basis. We agree with you that a larger number of patients would be useful in evaluating the grade of the diagnostic difference between the MREc and MREg examinations. MRI technique and interpretation: We agree that cine MR imaging is useful in assessing the peristalsis of the small bowel [2], but we do not think that this procedure could improve the diagnostic accuracy of MREg in detecting affected segments, because the main limitation of this procedure is that it is difficult to visualise all the small bowel loops in one acquisition. In our opinion, the main application of cine MR is in evaluating the grade and the changing of a segment of stenosis, in differentiating the fibrotic from inflammatory stricture.