Role Of Magnetic Resonance Enterography Research Articles

Colonic involvement in inflammatory bowel diseases: spotlight on the role of magnetic resonance enterography.

The large bowel can be affected by inflammatory bowel diseases, namely ulcerative colitis and Crohn's disease, with the latter occurring either as a unique localization or in conjunction with simultaneous ileal involvement. The differential diagnosis among these conditions is challenging and relies on clinical symptoms, laboratory tests and endoscopy with biopsy. However, as these features can overlap, a conclusive diagnosis is not always achievable, and the underlying cause remains indeterminate. Currently, endoscopy is the reference standard for colonic assessment, although its invasiveness limits its use and repetition within a short timeframe. Magnetic Resonance Enterography is a non-invasive, radiation-free technique that has been extensively and effectively employed in the intestinal evaluation of patients with Crohn's disease in recent years. Although the main goal of this technique is generally focused on evaluating small bowel loops, it can also provide important information about the large bowel if an adequate fulfillment by the oral contrast medium is achieved. The purpose of this work is, therefore, to put emphasis on the potential role of Magnetic Resonance Enterography in assessing the large bowel. In fact, this imaging modality is capable of providing valuable information for comprehensive staging and follow-up of inflammatory bowel diseases within the large bowel, thus complementing the clinical picture and the endoscopic features in the context of a differential diagnosis.

The Role of Magnetic Resonance Enterography in Crohn's Disease: A Review of Recent Literature.

Inflammatory bowel disease (IBD) is the term used to identify a form of chronic inflammation of the gastrointestinal tract that primarily contemplates two major entities: ulcerative colitis (UC) and Crohn’s disease (CD). The classic signs are abdominal pain and diarrhoea that correlate with the localization of gastro-enteric disease, although in this pathology extraintestinal symptoms may coexist. The diagnosis of CD relies on a synergistic combination of clinical, laboratory (stool and biochemical), cross-sectional imaging evaluation, as well as endoscopic and histologic assessments. The purpose of this paper is to prove the role of imaging in the diagnosis and follow-up of patients with CD with particular focus on recent innovations of magnetic resonance enterography (MRE) as a pivotal diagnostic tool, analysing the MRE study protocol and imaging features during the various phases of disease activity and its complications.

P212 Assessment of Crohn’s disease activity using global MaRIA score in patients with ileal and ileocolonic disease

Abstract Background Magnetic resonance index of activity (MaRIA) is composed of features independently associated with endoscopic disease activity and is surrogate marker of disease activity. The aim of this study was to evaluate correlation of global MaRIA (gMaRIA) with clinical and biochemical disease activity indices and diagnostic accuracy for active disease in patients with terminal ileum disease and ileocolonic disease. Methods This is a cross-sectional study which included 251 patients with diagnosed CD. Global MaRIA (gMaRIA) index was calculated on 6 bowel segments (the distal ileum, ascending, transverse, descending, sigmoid colon and rectum) using following parameters: bowel wall thickness, ulcers, edema and relative contrast enhancement. Disease activity was defined as combination of clinical and biochemical disease activity (CRP>5 or HBI≥5). Disease extension was classified using Montreal classification (L1 ileum, L2 colon, L3 ileum and colon). Results This study included 251 CD patients [age 35 (25–47), 55.3% males, BMI 21.8 (18–25) kg/m2, median disease duration 7 (2–15) years]. Ileal disease (L1) was present in 84 (33.5%) and ileocolonic disease (L3) in 151 (60.1%) patients. Correlation of gMARIA with biochemical indices of disease activity (CRP) was r=0.48, p<0.001 and with HBI r=0.33, p<0.001. Diagnostic accuracy of gMARIA in defining active disease in patients with L1 disease was considerably high [AUC 0.83 (95%CI 0.72–0.91)]. On the other hand, diagnostic accuracy in defining active disease in patients with L3 disease was good [AUC 0.71 (95%CI 0.62–0.79)], which is lower compared to L1 disease. In surgically naïve patients diagnostic accuracy of L1 disease was [AUC 0.88 (95%CI 0.72–0.96)], and for L3 disease [AUC 0.78 (95%CI 0.64–0.89)]. Conclusion Global MaRIA index showed higher diagnostic accuracy in detecting clinically and biochemically active disease in terminal ileum compared to ileocolic disease. These results emphasize the important role of magnetic resonance enterography in monitoring disease activity in patients with isolated ileal disease. Global MaRIA score correlates better with biochemical disease activity compared to clinical disease activity, which points out to the significance of biochemical remission.

The mutually complementary role of magnetic resonance enterography and conventional enteroclysis in patients with complicated and/or advanced stage of Crohn's disease.

To assess the diagnostic significance of magnetic resonance enterography (MRE) and conventional enteroclysis (CE) in patients with complicated and/or advanced stage of Crohn's disease. Patients with abnormal CE findings suggestive of mural and/or extramural involvement with the diagnosis or pre-diagnosis of CD are evaluated. After real-time bowel distension by enteroscopic examination, the patients with advanced or complicated stage were taken to the MRE examination in the same session. Mucosal-mural-extramural and activation findings, presence of stenosis/stricture, skip lesions and the mean duration of exams were evaluated with both CE and MRE. The superiority of one method over the other relative to these findings was evaluated. A total of 110 patients evaluated by CE had the findings of CD. Of these, 24 patients with abnormal CE findings suggestive of advanced mural and extramural involvements were subsequently evaluated with MRE. CE was superior to MRE in the depiction of early superficial mucosal changes (aphthous-linear ulcer), cobblestone pattern (p = 0.002, p < 0.01), obstruction (p = 0.004, p < 0.01), and differentiation between the string sign and stricture. MRE was superior to conventional enteroclysis in mural and perienteric findings of bowel thickening, fibro-fatty proliferation, abscess (p = 0.016, p 0.05). CE and MRE are mutually complementary imaging modalities in CD staging, evaluation of activation findings, and detection of complications (Tab. 3, Fig. 8, Ref. 23).

The Role of Magnetic Resonance Enterography in Pediatric IBD

Magnetic resonance (MR) enterography has become a popular diagnostic option for inflammatory bowel disease (IBD) in children due to its lack of

Magnetic resonance enterography: A stepwise interpretation approach and role of imaging in management of adult Crohn's disease.

Crohn's disease (CD) is a chronic inflammatory bowel disease that often requires frequent imaging of patients in order to detect active disease and other complications related to disease activity. While endoscopy is the gold standard for diagnosis, it may be contraindicated in some patients and has a limited role in detecting deep submucosal/mesenteric diseases and intra abdominal complications. In recent years, magnetic resonance enterography (MRE) has evolved as a noninvasive, radiation free imaging modality in the evaluation of patients with CD. This review article will focus on role of MRE in imaging patients with CD with emphasis on technical considerations, systematic image interpretation, differential diagnoses, and the role of imaging in deciding treatment options for patients.

The Diagnostic Role of Magnetic Resonance Enterography as a Complementary Test to Colonoscopy in Active Crohn's Disease.

BACKGROUND According to recent studies comparing magnetic resonance enterography (MRE) with ileocolonoscopy for assessing inflammation of small bowel and colonic segments in adults with active Crohn’s disease (CD), we aimed to compare the accuracy of these two diagnostic methods in Iranian population. METHODS During 2013-2014 a follow-up study was done on 30 patients with active CD in a gastroenterology clinic affiliated to Tehran University of Medical Sciences. MRE and ileocolonoscopy were performed for all the patients. All statistical analyses were performed using SPSS (version 18) and p-value<0.05 was considered as statistically significant. RESULTS Of the 30 patients with active CD, 11(36.7%) were men and 19 (63.3%) were women with mean age of 37.30±13.66 years (range: 19-67 years). MRE had sensitivity and specificity of 50% and 90% with positive predictive value (PPV) and negative predictive value (NPV) of 71.43 and 78.26, respectively for localizing sigmoid lesions and ileum had sensitivity and specificity of 84.21 and 45.45 with PPV and NPV of 72.73 and 62.50, respectively. CONCLUSION While moderate sensitivity and high specificity of MRE in localizing colonic lesions makes it an appropriate confirmatory test after colonoscopy, the reported high sensitivity and moderate specificity of MRE versus colonoscopy in detecting ileal lesions makes it a suitable screening test for ileal lesions. Finally we can conclude that MRE can be an important complementary test to colonoscopy in detecting active disease.

The Role of Magnetic Resonance Enterography in the Evaluation of Non-Crohn׳s Pathologies

In the young patient population, magnetic resonance enterography is fast becoming a preferred imaging tool for the investigation of patients with non-Crohn׳s small bowel and mesenteric pathologies. Its advantages include lack of ionizing radiation and high-contrast resolution. This review discusses the range of small bowel and mesenteric pathologies that can be easily demonstrated with this technique.

Magnetic resonance enterographic predictors of one-year outcome in ileal and ileocolonic Crohn's disease treated with anti-tumor necrosis factor antibodies.

The aim of the study was to assess the role of magnetic resonance enterography (MRE) in predicting one-year efficacy of anti-tumor necrosis factor antibodies - infliximab (IFX), adalimumab (ADA) in Crohn’s disease (CD) patients primarily responding to therapy. We performed retrospective analysis among 61 CD patients who had undergone a successful IFX/ADA induction therapy and were treated with maintenance doses. All patients underwent MRE at week 0. We assessed which MRE features were predictive for steroid-free remission at week 52, and which were associated with a secondary loss of response. 44 patients were in steroid-free remission at week 52, 17 - were secondary non-responders. The ROC curve showed that bowel thickening with contrast enhancement analyzed together at week 0 were associated with steroid-free remission at week 52 (p = 0.01; AUC 0.67). Bowel stenosis with or without prestenotic dilatation [OR 5.8 (95% CI 1.4 – 25) and 2.4 (95% CI 1.2 – 5) respectively; p = 0.01] and the presence of intra-abdominal fistulas [OR 1.4 (95% CI 1.1 – 2); p = 0.004] were related to secondary non-response. A high baseline inflammatory activity detected by MRE predicts one-year response in CD after IFX/ADA. In case of bowel stenosis, intra-abdominal fistulas, other therapeutic options should be considered.

Magnetic resonance enterography in post-operative inflammatory bowel disease.

To describe the role of magnetic resonance enterography (MRE) in patients with inflammatory bowel disease (IBD), and to review the expected post-operative appearance, as well as, potential surgical complications in this unique patient population. MRE compares favorably to CT Enterography (CTE) in terms of overall diagnostic accuracy and may provide better functional assessment of the small bowel through cine-MRI, diffusion-weighted imaging and dynamic contrast-enhancement. In the post-operative population, MRE provides critical information including: normal post-surgical anatomy, chronic strictures vs. active inflammation and disease/treatment-related complications. The post-operative IBD patient undergoes frequent repeated imaging and MRE may significantly reduce cumulative radiation dose while providing similar or improved diagnostic accuracy compared to CTE. MRE should be considered as an alternative imaging modality in this population.

The diagnostic role of magnetic resonance enterography in Crohn’s disease: An updated review of techniques, interpretation, and application

The diagnostic role of magnetic resonance enterography in Crohn’s disease: An updated review of techniques, interpretation, and application

PTH-108 Magnetic Resonance Enterography for the Assessment of Crohn’S Disease: Changing Imaging Paradigms?

IntroductionAdvances in therapy and definitions of inflammatory bowel disease (IBD) control have led to increasing reliance on imaging. Awareness of effects of ionising radiation has placed emphasis on radiation-free imaging....

Magnetic Resonance Enterography for the Assessment of Crohnʼs Disease: Changing Imaging Paradigms?

Purpose: Advances in the immunopathogenesis and therapy of inflammatory bowel disease (IBD) coupled with bolder definitions of disease control have led to increasing reliance on imaging. Increased awareness of the potential downstream effects of ionizing radiation has placed more emphasis on radiationfree imaging. We assessed the role of magnetic resonance enterography (MRE) in assessing small bowel Crohn's disease (CD). Methods: We conducted a retrospective review of 250 MRE studies performed between June 2009 and August 2011 at our institution. Clinical data including demographics, disease characteristics and therapy were obtained from electronic patient record review. Inflammatory markers, radiological investigations and ileocolonoscopy when performed within 90 days of MRE were recorded. MRE reports were recorded using accepted activity criteria - small bowel dilatation, stenosis, wall thickening, enhancement, mucosal irregularity, mesenteric inflammation, hypervascularity, lymph node enlargement, abscesses, fistulation and extraintestinal features. Results: Of 122 patients with IBD at time of MRE, 109 had CD. Seventy-one of 122 patients were female, mean age 34 (range 16-68) and median disease duration of 4 years (range 0-39). Abnormalities were noted in 77 MRE scans; 54 had active non-stricturing, 22 active stricturing and 1 fibrostenotic disease. Within the active groups, there were 7 fistulae and 4 abscesses in 7 patients. Ileo-colonoscopy was performed in 22 of these patients with 19/22 showing active colitis and raised CRP in 24/46 within 90 days of MRE. Treatment was increased in 61% of the active non-stricturing group, 9/33 to azathioprine, 11/33 to infliximab, 4/33 to surgery, 6/33 received 5-ASA with no change in the remaining 39%, of whom 4/9 had normal ileo-colonoscopy and 16/19 normal CRP. In 68% of active stricturing group, treatment was increased to azathioprine in 2, biologics (8) and 5 to surgery. Eight of 22 patients in this group had an elevated CRP and 5/8 had active colitis at ileo-colonoscopy. Of 31 normal MRE, treatment was not increased in 97%. Of these, CRP was normal in 25/29 and ileo-colonoscopy normal in 6/12. The fibrostenotic subject had normal CRP and mild colitis at colonoscopy, and proceeded to surgery. Of the abscess/fistula group 2 were referred for surgery, 3 started infliximab (fistula) and 2 were treated with antibiotics. Conclusion: The small bowel remains difficult to assess endoscopically. The choice of investigation will be driven by the clinical question, available expertise and economic factors. MRE adds to assessment of patients with CD, in addition to endoscopy and biological markers identifying patients with active disease where treatment escalation may result in meaningful benefit.

PWE-066 Magnetic resonance enterography for the assessment of Crohn's disease: changing imaging paradigms?

IntroductionRecent advances in the immunopathogenesis and therapy of inflammatory bowel disease (IBD) coupled with bolder definitions of disease control have led to increasing reliance on imaging. Increased awareness of the...

Magnetic resonance enterography findings of chronic radiation enteritis.

The diagnosis of chronic radiation enteritis (CRE) is considerably challenging both for clinicians and radiologists. The aim of this study was to evaluate the role of magnetic resonance enterography (MRE) in the diagnosis of CRE. To the best of our knowledge, there are no reports on the role of MRE in the diagnosis of CRE specifically. In this report, we present MRE findings of 4 patients with CRE. The most important factors in CRE diagnosis are the clinical findings and medical history, but focal abnormal bowel loop in the region of a known radiation field is the most important information. This abnormal loop is generally located in the distal ileum as present in our patients. Other associated findings helpful for the diagnosis are small bowel thickening, contrast material enhancement in a long segment, mesenteric stranding and luminal narrowing. MRE can be sufficient and useful in the diagnosis of CRE and for treatment planning, especially in patients with significant comorbidities who have had radiotherapy in the past. Adding MRE into the diagnostic algorithm can be helpful in post-radiotherapy patients with acute/subacute gastrointestinal symptoms.

Role of Magnetic Resonance Enterography in Differentiating between Fibrotic and Active Inflammatory Small Bowel Stenosis in Patients with Crohn's Disease

Objective:To assess the diagnostic accuracy of magnetic resonance imaging (MRI) in prospectively differentiating between fibrotic and active inflammatory small bowel stenosis in patients with Crohn's disease (CD).Materials and Methods:A total of 111 patients with histologically proven CD presenting with clinical and plain radiographic signs of small bowel obstruction underwent coronal and axial MRI scans after oral administration of polyethylene glycol solution. A stenosis was judged present if a small bowel segment had >80% lumen reduction as compared to an adjacent normal loop and mural thickening of >3 mm. At the level of the stenosis, both T2 signal intensity and post-gadolinium T1 enhancement were quantified using a 5-point scale (0: very low; 1: low; 2: moderate; 3: high; and 4: very high). A stenosis was considered fibrotic if the sum of the two values (activity score: AS) did not exceed 1.Results:A small bowel stenosis was identified in 48 out of 111 patients. Fibrosis was confirmed at histology in all of the 23 patients with AS of 0 or 1, who underwent surgery within 3 days of the MRI examination. In the remaining 25 patients (AS: 2–8), an active inflammatory stenosis was suspected and remission of the obstructive symptoms was obtained by means of medical treatment. One of these patients (AS: 2), however, underwent surgery after 14 days, due to recurrence. MRI had 95.8% sensitivity, 100% specificity, and 97.9% accuracy in the diagnosis of fibrotic stenosis.Conclusion:MRI is reliable in differentiating fibrotic from inflammatory small bowel stenosis in CD.

Role of Magnetic Resonance Enterography in the Management of Crohn Disease

To assess the impact of magnetic resonance enterography (MRE) on therapeutic decision making for patients with Crohn disease. Retrospective study. Tertiary care medical center. One hundred twenty patients who had either a history of or high suspicion for Crohn disease with onset of new symptoms underwent MRE over 18 months at our institution. All patients with Crohn disease were classified according to the Montreal system. Magnetic resonance enterography and medical vs surgical therapy. Changes in management after MRE findings. Magnetic resonance enterography demonstrated active Crohn disease in 57.5% of patients, chronic changes of Crohn disease without active inflammation (eg, stricture, fistula, or abscess) in 12.5% of cases, and no evidence of Crohn disease in 30% of cases. After MRE, 37 (31%) had no change in medical therapy, 64 (53%) had additional medical management for active inflammation, and 19 (16%) underwent an operation for complicated Crohn disease or medical intractability. In all surgical patients, the intraoperative findings were consistent with the MRE diagnosis. The mean (SD) MRE score was 1.6 (0.5) for patients who had no change in their treatment plans, 5.8 (1) for patients who underwent surgery, and 8 (0.4) for patients who had their drug regimen changed (P < .001). The MRE score independently correlated with need for intervention (P = .001). Magnetic resonance enterography shows promising ability to characterize the presence of active Crohn disease as well as chronic complications (eg, differentiate between stricture due to edema vs fibrotic scarring). Magnetic resonance enterography is fast becoming a useful adjunct in the management algorithm of patients with Crohn disease.