Usefulness of Magnetic Resonance Enterography in Diagnosis of Crohn's Disease
The numbers of patients with diagnosed Crohn's disease in Poland continue to be on the rise. It may be assumed that it is associated not with an increased incidence but with significant advancements in diagnostic techniques which in an increasingly better manner solve problems of abdominal pain. One of such methods is magnetic resonance enterography, which gives high hope in the diagnostics of Crohn's disease.
The aim of the study was the evaluation of the results of magnetic resonance enterography (MREG) and their comparison with the results of histopathological examination o perioperative specimens.
Material and methods. The clinical material comprised 48 patients with suspected Crohn's disease. Colonoscopy was performed in all the patients, followed by magnetic resonance enterography, which evaluated the lesion localisation, large intestine wall thickening, small intestine stenosis, mesenteric vessel proliferation, infiltration of surrounding adipose tissue, lymph node enlargement, presence of enteroenteral, enterovesical and enterocutaneous fistulas. Next, a surgical procedure was performed, with collection of specimen for histopathology. The examination results were compared with those of magnetic resonance enterography.
Results. MREG was performed in 48 individuals. Suspected Crohn's disease based on the above examination was diagnosed in 35 cases, isolated small intestine inflammation - in 5, and fibrosis in the remaining 5 patients. No significant differences were found between the lesion localisation done by MREG or perioperativelly. Crohn's disease was confirmed by histopathology in 36 cases. The sensitivity of MREG with histopathology was 91.6%, and the specificity - 77.8%.
Conclusions. Magnetic resonance enterography is a highly effective and sensitice method in the diagnostics of Crohn's disease, free of adverse effects and possible to be performed even in pregnant female patients.
Saibeni S et al.: Imaging of the small bowel in Crohn's disease: A review of old and new techniques. World J Gastroenterol 2007 June 28; 13(24): 3279-87.
Cieszanowski A, Wojciechowski K, Pacho R et al.: Computed tomografhy of the whole bowel in patients suspected of Crohn's disease. Preliminary report - assessment of examination technique and image quality. Pol J Radiol 2004; 69(4): 12-18.
Albert JG, Martiny F, Krummenerl A et al.: Diagnosis of small bowel Crohn's disease: a prospective comparsion of capsule endoscopy with magnetic resonace imaging and fluoroscopic enteroclysis. Gut 2005; 54: 1721-27.
Swain P: Wireless capsule endoscopy and Crohn's disease. Gut 2005 54: 323-26.
Nakase H, Matsuura M, Mikami S et al.: Diagnosis and treatment of obscure GI bleeding with double balloon endoscopy. Gastroinest Endosc 2007; 66(3 Suppl): S78-81.
Rottgen R, Herzog H, Lopez-Hanninen E et al.: Combination of dynamic MR enteroclysis (Sellink) and MR colonography to diagnose Crohn's disease. Rofo 2005; 177: 1131-38.
Masseli G, Brizi MG, Menchini L i wsp.: Magnetic Resonace Enteroclysis imaging of Crohn's. Radiol Med (Torino) 2005; 110: 221-33.
Gil J, Jałocha Ł, Wojtuń S: Metody obrazowania w nieswoistych chorobach zapalnych jelit. Pol Merk Lek 2007; XXII(131): 442.
Parente F, Greco S, Molteni M et al.: Imaging inflammatory bowel disease using bowel ultrasound. Eur J Gastroentrol Hepatol 2005; 17: 283-91.
Fukumoto A, Tanaka S, Yamamoto H et al.: Diagnosis and treatment of small-bowel stricture by double ballon endoscopy. Gastrointest Endosc 2007 66 (3 Supply): S108-12.
Umschaden HW, Szolar D, Gasser J et al.: Small-bowel disease: comparsion of MR enteroclysis with conventional enteroclysis and surgical findings. Radiology 2000; 215: 717-25.
Prassopoulos P, Papanikolaou N, Grammatikakis J et al.: MR enteroclysisi imaging of Crohn disease. Radiographics 2001; 21 Spec No: S161-72.
Laghi A, Passariello R: Magnetic Resonance in the study of the small bowel. Radiol Med (Torino) 2003; 106 1-15; quiz 16-17.