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Rimola J, Beek KJ, Ordás I, Gecse KB, Cuatrecasas M, Stoker J. Contemporary Imaging Assessment of Strictures and Fibrosis in Crohn Disease, With Focus on Quantitative Biomarkers: From the AJR Special Series on Imaging of Fibrosis. AJR Am J Roentgenol 2024; 222:e2329693. [PMID: 37530400 DOI: 10.2214/ajr.23.29693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
Patients with Crohn disease commonly have bowel strictures develop, which exhibit varying degrees of inflammation and fibrosis. Differentiation of the distinct inflammatory and fibrotic components of strictures is key for the optimization of therapeutic management and for the development of antifibrotic drugs. Cross-sectional imaging techniques, including ultrasound, CT, and MRI, allow evaluation of the full thickness of the bowel wall as well as extramural complications and associated mesenteric abnormalities. Although promising data have been reported for a range of novel imaging biomarkers for detection of fibrosis and quantification of the degree of fibrosis, these biomarkers lack sufficient validation and standardization for clinical use. Additional methods, including PET with emerging radiotracers, artificial intelligence, and radiomics, are also under investigation for stricture characterization. In this review, we highlight the clinical relevance of identifying fibrosis in Crohn disease, review the histopathologic aspects of strictures in Crohn disease, summarize the morphologic imaging findings of strictures, and explore contemporary developments in the use of cross-sectional imaging techniques for detecting and characterizing intestinal strictures, with attention given to emerging quantitative biomarkers.
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Affiliation(s)
- Jordi Rimola
- Radiology Department, IBD Unit, Hospital Clínic de Barcelona, Villarroel 170, Escala 3, Planta 1, Barcelona 08036, Spain
- Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Kim J Beek
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ingrid Ordás
- Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Gastroenterology Department, IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Krisztina B Gecse
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Míriam Cuatrecasas
- Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Pathology Department, IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Carvello M, Danese S, Spinelli A. Surgery versus Medical Therapy in Luminal Ileocecal Crohn's Disease. Clin Colon Rectal Surg 2022; 35:72-77. [PMID: 35069033 PMCID: PMC8763452 DOI: 10.1055/s-0041-1740031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The deeper understanding of the inflammatory process which gradually evolves into irreversible fibrosis and tissue damage has provided a precise picture of the disease course of luminal ileocecal Crohn's disease. According to the model of progressive structural damage, ideal time windows for medical and surgical treatment have been identified. While complicated disease clearly profits from surgical treatment, uncomplicated disease has become, in the last years, the most debatable setting in terms of different approaches including early surgery. On one hand, the rationale of traditional escalating medical therapy (step-up approach) has been undermined by the top-down medical approach. Indeed, the step-up approach has the possible drawback of delaying, up to a later disease stage, the use of more effective agents such as anti-tumor necrosis factors. Conversely, the top-down approach might expose patients to an overtreatment along with side effects including hypersensitivity to biologic agents. More recently, it has been shown how early surgery could be a valid option in this subset of patients being more cost-effective than medical therapy. Involving the surgeon at an early stage is considered now a good clinical practice and, in this scenario full of possibilities, the surgeon should be included into the decision-making process from the very beginning of patient management.
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Affiliation(s)
- Michele Carvello
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy,Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy,Department of Gastroenterology, IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy,Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy,Address for correspondence Antonino Spinelli, MD, PhD Via Alessandro Manzoni, 56, Rozzano, 20089, MilanItaly
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Alahdab YO, Demirtas CO, Kani HT, Tuney D, Seker L, Tolu T, Atug O. Clinical significance of isolated abnormal intestinal findings in magnetic resonance enterography in patients with suspected small bowel disease. Abdom Radiol (NY) 2020; 45:1036-1043. [PMID: 31686178 DOI: 10.1007/s00261-019-02297-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Magnetic resonance imaging (MRE) is a well-established adjunct diagnostic tool for the diagnosis of Crohn's Disease (CD), as ileocolonoscopy can sometimes be falsely reassuring when CD skips distal terminal ileum. We aimed to determine the frequency and clinical significance of isolated abnormal small bowel findings in MRE with normal ileal view in ileoscopy. METHODS We retrospectively reviewed findings from 1611 MRE studies that were conducted between 2012 and 2018 to detect patients bearing abnormal intestinal findings and having full ileocolonoscopy. After exclusion of normal or repetitive MRE scans and previously known CD, 147 patients with abnormal MRE detected. MRE scans were categorized as suspicious of CD and non-specific findings. RESULTS Out of 147 patients with abnormal MRE, 122 (83%) had terminal ileum involvement in MRE consistent with ileoscopy findings. Twenty-five (17%) patients were found to have solitarily abnormal intestinal findings in MRE with normal ileoscopy. Only 3 (12%) were diagnosed with CD initially, and all had MRE findings suspicious of CD. The remainder 40% (n = 10) were diagnosed with non-Crohn's small bowel disease after further investigation, while in the other 48% (n = 12) abnormal MRE findings could not be explained with any organic disease in the follow-up. CONCLUSION The present study demonstrated that only a small portion of patients with isolated abnormal intestinal findings in MRE is CD, and more than that are non-crohn's small bowel diseases. These findings, even if they carry the suspicion of CD, do not transform to CD in the long-term follow-up.
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Affiliation(s)
- Yesim Ozen Alahdab
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Coskun Ozer Demirtas
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey.
| | - Haluk Tarik Kani
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Davut Tuney
- Department of Radiology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Lamia Seker
- Department of Internal Medicine, Marmara University, School of Medicine, Istanbul, Turkey
| | - Tugba Tolu
- Department of Internal Medicine, Marmara University, School of Medicine, Istanbul, Turkey
| | - Ozlen Atug
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey
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Assessment of the usefulness of imaging studies and biomarkers in the activity of Crohn's disease. GASTROENTEROLOGY REVIEW 2020; 16:15-22. [PMID: 33986883 PMCID: PMC8112266 DOI: 10.5114/pg.2020.93539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/16/2020] [Indexed: 11/17/2022]
Abstract
Aim The aim of the study was to determine the suitability of available diagnostic methods, by means of comparison, for predicting disease activity, based on cost efficiency and sensitivity criteria. Material and methods In this study, we conducted analyses of 37 patients with Crohn’s disease (CD). CD was graded as “active” or “inactive” by adopting certain cut-off values for every marker. The main assumption was that methods used to grade CD severity do not give false positive results. The authors decided to measure the agreement between the methods by applying Cohen’s κ coefficient. Results Endoscopy shows the highest sensitivity, negative predictive value, and accuracy in detecting CD. In the case of both intestines, the sensitivity of endoscopy reached 93.9% and the accuracy 94.6%, while the sensitivity and accuracy of enterography and calprotectin were 51.5% vs. 71,9% and 56.8% vs. 72.2%, respectively. For the large intestine, the sensitivity and accuracy of endoscopy reached 100%. For the small intestine, endoscopy had 55% sensitivity and 75% accuracy, while enterography showed only 66.7% and 81.1%, respectively. The best agreement (77.1%, p = 0.005) was seen between endoscopy and calprotectin for full intestines. However, the value of Cohen’s κ suggests that this agreement is moderate. The optimal cut-off value for calprotectin was 43 µg/g, and the ROC curve (AUC = 0.871) was large enough to conclude that calprotectin is a statistically significant (p < 0.001) indicator of CD activity. Conclusions Statistically significant compliance was shown only between colonoscopy and faecal calprotectin.
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Ippolito D, Lombardi S, Talei Franzesi C, Drago SG, Querques G, Casiraghi A, Pecorelli A, Riva L, Sironi S. Dynamic Contrast-Enhanced MR with Quantitative Perfusion Analysis of Small Bowel in Vascular Assessment between Inflammatory and Fibrotic Lesions in Crohn's Disease: A Feasibility Study. CONTRAST MEDIA & MOLECULAR IMAGING 2019; 2019:1767620. [PMID: 30863218 PMCID: PMC6378774 DOI: 10.1155/2019/1767620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 09/26/2018] [Accepted: 12/10/2018] [Indexed: 02/08/2023]
Abstract
AIM To assess the feasibility of dynamic contrast-enhanced perfusion-MRI in characterization of active small-bowel inflammation and chronic mural fibrosis in patients with Crohn's disease (CD). METHODS We analyzed a total of 37 (11 women; 23-69 years) patients with known biopsy proven CD, who underwent MR-enterography (MRE) study, performed on a 1.5 T MRI system (Achieva, Philips), using a phased array sense body multicoil, after oral administration of 1.5-2 L of PEG solution. MRE protocol included T1 weighted, SSh T2, sBTFE, and gadolinium-enhanced THRIVE sequences acquired on coronal and axial planes. A dedicated workstation was used to generate perfusion color maps, on which we drown ROI on normal bowel and on pathological segment, thus obtaining related perfusion parameters: relative arterial, venous, and late enhancement (RAE, RVE, and RLE), maximum enhancement (ME), and time to peak (TTP). RESULTS Quantitative perfusion analysis showed a good correlation with local degree of Crohn's inflammation activity. Twenty-nine out of 37 patients showed active inflammatory disease (reference standard of active disease: wall bowel thickness and layered enhancement) with following perfusion parameters: REA (%) = 116.1, RVE (%) = 125.3, RLE (%) = 127.1, ME (%) = 1054.7, TTP (sec) = 157. The same parameters calculated in patients with mural fibrosis were as follows: RAE (%): median = 56.4; RVE (%): 81.2; RLE (%): 85.4; ME (%):809.6; TTP (sec): 203.4. A significant difference (p < 0.001) between inflamed and fibrotic bowel wall vascularity, regarding all perfusion parameters evaluated, was found, with higher values in active CD localizations. CONCLUSION Vascular assessment of perfusion kinetics of bowel wall by dynamic contrast perfusion-MR analysis may represent a complementary diagnostic tool that enables a quantitative evaluation of local inflammation activity in CD patients.
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Affiliation(s)
- Davide Ippolito
- 1School of Medicine, University of Milano-Bicocca, Milan, Italy
- 2Department of Diagnostic Radiology, San Gerardo Hospital H. S. Gerardo Monza, Via Pergolesi 33, 20900-Monza, MB, Italy
| | - Sophie Lombardi
- 1School of Medicine, University of Milano-Bicocca, Milan, Italy
- 2Department of Diagnostic Radiology, San Gerardo Hospital H. S. Gerardo Monza, Via Pergolesi 33, 20900-Monza, MB, Italy
| | - Cammillo Talei Franzesi
- 1School of Medicine, University of Milano-Bicocca, Milan, Italy
- 2Department of Diagnostic Radiology, San Gerardo Hospital H. S. Gerardo Monza, Via Pergolesi 33, 20900-Monza, MB, Italy
| | - Silvia Girolama Drago
- 1School of Medicine, University of Milano-Bicocca, Milan, Italy
- 2Department of Diagnostic Radiology, San Gerardo Hospital H. S. Gerardo Monza, Via Pergolesi 33, 20900-Monza, MB, Italy
| | - Giulia Querques
- 1School of Medicine, University of Milano-Bicocca, Milan, Italy
- 2Department of Diagnostic Radiology, San Gerardo Hospital H. S. Gerardo Monza, Via Pergolesi 33, 20900-Monza, MB, Italy
| | - Alessandra Casiraghi
- 1School of Medicine, University of Milano-Bicocca, Milan, Italy
- 2Department of Diagnostic Radiology, San Gerardo Hospital H. S. Gerardo Monza, Via Pergolesi 33, 20900-Monza, MB, Italy
| | - Anna Pecorelli
- 1School of Medicine, University of Milano-Bicocca, Milan, Italy
- 2Department of Diagnostic Radiology, San Gerardo Hospital H. S. Gerardo Monza, Via Pergolesi 33, 20900-Monza, MB, Italy
| | - Luca Riva
- 1School of Medicine, University of Milano-Bicocca, Milan, Italy
- 2Department of Diagnostic Radiology, San Gerardo Hospital H. S. Gerardo Monza, Via Pergolesi 33, 20900-Monza, MB, Italy
| | - Sandro Sironi
- 1School of Medicine, University of Milano-Bicocca, Milan, Italy
- 3Department of Diagnostic Radiology, Papa Giovanni XXIII Hospital H. Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
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Pouillon L, Laurent V, Pouillon M, Bossuyt P, Bonifacio C, Danese S, Deepak P, Loftus EV, Bruining DH, Peyrin-Biroulet L. Diffusion-weighted MRI in inflammatory bowel disease. Lancet Gastroenterol Hepatol 2018; 3:433-443. [DOI: 10.1016/s2468-1253(18)30054-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 12/17/2022]
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Aryan A, Azizi Z, Teimouri A, Ebrahimi Daryani N, Aletaha N, Jahanbakhsh A, Nouritaromlou MK, Alborzi F, Mami M, Basirat V, Javid Anbardan S. The Diagnostic Role of Magnetic Resonance Enterography as a Complementary Test to Colonoscopy in Active Crohn's Disease. Middle East J Dig Dis 2016; 8:93-101. [PMID: 27252815 PMCID: PMC4885618 DOI: 10.15171/mejdd.2016.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
- Arvin Aryan
- Assistant Professor of Radiology, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Zahra Azizi
- Researcher, Iran University of Medical Sciences, Tehran, Iran
| | - Azam Teimouri
- Fellow of Gastroenterology, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Nasser Ebrahimi Daryani
- Professor of Gastroenterology, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Najme Aletaha
- Assistant Professor of Gastroenterology, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Ali Jahanbakhsh
- Researcher, Tehran University of Medical Science, Tehran, Iran
| | | | - Forough Alborzi
- Fellow of Gastroenterology, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Masoud Mami
- Fellow of Gastroenterology, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Vahid Basirat
- Resident of Internal Medicine, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran
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Dohan A, Taylor S, Hoeffel C, Barret M, Allez M, Dautry R, Zappa M, Savoye-Collet C, Dray X, Boudiaf M, Reinhold C, Soyer P. Diffusion-weighted MRI in Crohn's disease: Current status and recommendations. J Magn Reson Imaging 2016; 44:1381-1396. [PMID: 27249184 DOI: 10.1002/jmri.25325] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/12/2016] [Indexed: 12/19/2022] Open
Abstract
Over the past years, technological improvements and refinements in magnetic resonance imaging (MRI) hardware have made high-quality diffusion-weighted imaging (DWI) routinely possible for the bowel. DWI is promising for the detection and characterization of lesions in Crohn's disease (CD) and has been advocated as an alternative to intravenous gadolinium-based contrast agents. Furthermore, quantification using the apparent diffusion coefficient may have value as a biomarker of CD activity and has shown promise. In this article we critically review the literature pertaining to the value of DWI in CD for detection, characterization, and quantification of disease activity and complications. Although the body of supportive evidence is growing, it is clear that well-designed, multicenter studies are required before the role of DWI in clinical practice can be fully established. J. Magn. Reson. Imaging 2016;44:1381-1396.
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Affiliation(s)
- Anthony Dohan
- McGill University Health Center, Department of Radiology, McGill University Health Center, Montreal, QC, Canada
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
- INSERM UMR 965, Paris, France
| | - Stuart Taylor
- Centre for Medical Imaging, University College London, Podium Level 2, University College Hospital, London, UK
| | | | - Maximilien Barret
- Department of Gastroenterology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Matthieu Allez
- Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
- Department of Gastroenterology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Raphael Dautry
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Magaly Zappa
- Department of Radiology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | | | - Xavier Dray
- Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
- Department of Gastroenterology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mourad Boudiaf
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Caroline Reinhold
- McGill University Health Center, Department of Radiology, McGill University Health Center, Montreal, QC, Canada
| | - Philippe Soyer
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
- INSERM UMR 965, Paris, France
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Noninvasive Longitudinal Study of a Magnetic Resonance Imaging Biomarker for the Quantification of Colon Inflammation in a Mouse Model of Colitis. Inflamm Bowel Dis 2016; 22:1286-95. [PMID: 27104818 DOI: 10.1097/mib.0000000000000755] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Colonoscopy is the gold standard to diagnose and follow up the evolution of inflammatory bowel diseases. However, this technique can still present a risk of severe complications, a general discomfort in patients, and its diagnostic value is limited to the visualization of the colon mucosal changes. Magnetic resonance imaging (MRI) is emerging as a noninvasive imaging technique of choice to overcome these limitations. The aim of this work was to evaluate the potential of colon wall thickness measured using MRI as an in vivo imaging biomarker of inflammation for inflammatory bowel disease in an animal model of this disease. METHODS On day 0, 2% or 3% Dextran sodium sulfate was added to the drinking water of mice (n = 10/group) for 5 days. Six mice were left as controls. Animals were imaged with colonoscopy and MRI on days 7, 11, and 21 to study the colitis progression. Histology was performed at the end of the protocol. RESULTS The colon wall thickness measured in Dextran sodium sulfate-treated animals was shown to be significantly and dose dependently increased compared to controls. Colonoscopy showed similar results and excellently correlated with MRI measurements and histology. The proposed protocol showed high robustness, with negligible interoperator and intraoperator variability. CONCLUSIONS The findings of this investigation suggest the feasibility of using MRI for the noninvasive assessment of colon wall thickness as a robust surrogate biomarker for colon inflammation detection and follow-up. The data presented show the potential of MRI in in vivo preclinical longitudinal studies, including testing of new drugs or investigation of inflammatory bowel disease development mechanisms.
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Abstract
Accurately measuring the complex motor behaviors of the gastrointestinal tract has tremendous value for the understanding, diagnosis and treatment of digestive diseases. This review synthesizes the literature regarding current tests that are used in both humans and animals. There remains further opportunity to enhance such tests, especially when such tests are able to provide value in both the preclinical and the clinical settings.
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Key Words
- acute pancreatitis
- biliary pancreatitis
- necroptosis
- apoptosis
- pancreatic cell death
- ac, ascending colon
- cf6, filling the colon at 6 hours
- ct, computed tomography
- gebt, gastric emptying breath test
- hdam, high-definition anorectal pressure manometry/topography
- hram, high-resolution anorectal manometry
- ht, hydroxytryptophan
- iqr, interquartile range
- mmc, migrating motor complex
- mri, magnetic resonance imaging
- 99mtc, technetium-99m
- spect, single-photon emission computed tomography
- 13c, carbon-13
- 3-d, 3-dimensional
- wmc, wireless motility capsule
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Hahnemann ML, Kraff O, Maderwald S, Johst S, Orzada S, Umutlu L, Ladd ME, Quick HH, Lauenstein TC. Non-enhanced magnetic resonance imaging of the small bowel at 7 Tesla in comparison to 1.5 Tesla: First steps towards clinical application. Magn Reson Imaging 2015; 34:668-73. [PMID: 26747410 DOI: 10.1016/j.mri.2015.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/29/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To perform non-enhanced (NE) magnetic resonance imaging (MRI) of the small bowel at 7 Tesla (7T) and to compare it with 1.5 Tesla (1.5T). MATERIAL AND METHODS Twelve healthy subjects were prospectively examined using a 1.5T and 7T MRI system. Coronal and axial true fast imaging with steady-state precession (TrueFISP) imaging and a coronal T2-weighted (T2w) half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequence were acquired. Image analysis was performed by 1) visual evaluation of tissue contrast and detail detectability, 2) measurement and calculation of contrast ratios and 3) assessment of artifacts. RESULTS NE MRI of the small bowel at 7T was technically feasible. In the vast majority of the cases, tissue contrast and image details were equivalent at both field strengths. At 7T, two cases revealed better detail detectability in the TrueFISP, and better contrast in the HASTE. Susceptibility artifacts and B1 inhomogeneities were significantly increased at 7T. CONCLUSION This study provides first insights into NE ultra-high field MRI of the small bowel and may be considered an important step towards high quality T2w abdominal imaging at 7T MRI.
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Affiliation(s)
- Maria L Hahnemann
- Institute of Clinical Radiology, University Hospital Muenster, University of Muenster, Muenster, Germany; Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany; Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany.
| | - Oliver Kraff
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Stefan Maderwald
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Soeren Johst
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Stephan Orzada
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany; Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Mark E Ladd
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany; Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Harald H Quick
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany; High Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Thomas C Lauenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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12
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The Role of MR Enterography in Assessing Crohn's Disease Activity and Treatment Response. Gastroenterol Res Pract 2015; 2016:8168695. [PMID: 26819611 PMCID: PMC4706951 DOI: 10.1155/2016/8168695] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/23/2015] [Accepted: 08/27/2015] [Indexed: 12/17/2022] Open
Abstract
MR enterography (MRE) has become the primary imaging modality in the assessment of Crohn's disease (CD) in both children and adults at many institutions in the United States and worldwide, primarily due to its noninvasiveness, superior soft tissue contrast, and lack of ionizing radiation. MRE technique includes distention of the small bowel with oral contrast media with the acquisition of T2-weighted, balanced steady-state free precession, and multiphase T1-weighted fat suppressed gadolinium contrast-enhanced sequences. With the introduction of molecule-targeted biologic agents into the clinical setting for CD and their potential to reverse the inflammatory process, MRE is increasingly utilized to evaluate disease activity and response to therapy as an imaging complement to clinical indices or optical endoscopy. New and emerging MRE techniques, such as diffusion-weighted imaging (DWI), magnetization transfer, ultrasmall superparamagnetic iron oxide- (USPIO-) enhanced MRI, and PET-MR, offer the potential for an expanded role of MRI in detecting occult disease activity, evaluating early treatment response/resistance, and differentiating inflammatory from fibrotic strictures. Familiarity with MR enterography is essential for radiologists and gastroenterologists as the technique evolves and is further incorporated into the clinical management of CD.
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Improved detection of inflammatory bowel disease by additional automated motility analysis in magnetic resonance imaging. Invest Radiol 2015; 50:67-72. [PMID: 25260093 DOI: 10.1097/rli.0000000000000097] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate whether the use of automatically generated maps of bowel motility (motility mapping) in magnetic resonance imaging (MRI) leads to an increased detection rate of inflammatory bowel disease. MATERIALS AND METHODS Fifty consecutive patients with suspected or known inflammatory bowel disease who underwent bowel MRI using a 1.5-T scanner were analyzed retrospectively. In addition to standard small bowel magnetic resonance protocol, a dynamic coronal T2-weighted sequence (dynamic MRI) was acquired. Dynamic sequences were used to automatically generate a parametric map depicting bowel motility. Two readings of the MRI were performed: first, evaluation of static MRI alone and second, evaluation of static MRI combined with dynamic MRI (motility mapping). Static MRI was analyzed on parameters defining inflammation (morphology, enhancement). Dynamic MRI (motility mapping) was evaluated on the basis of a color-coded scheme displaying hypomotility and hypermotility. RESULTS Using motility maps, additional inflammatory lesions were found in 13 (26%) of the 50 patients, resulting in a significantly higher detection rate using static MRI together with motility mapping compared with static MRI alone (P = 0.0002). Overall, 66 inflammatory lesions of the bowel were detected in a total of 38 patients (static MRI + motility mapping) versus 51 lesions in 34 patients (sole evaluation of static MRI). CONCLUSIONS Motility assessment of the bowel provides additional information and improves the detection of inflammatory lesions in MRI.
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Lee SM, Kim WS, Choi YH. Pediatric Magnetic Resonance Enterography: Focused on Crohn's Disease. Pediatr Gastroenterol Hepatol Nutr 2015; 18:149-59. [PMID: 26473134 PMCID: PMC4600698 DOI: 10.5223/pghn.2015.18.3.149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 09/08/2015] [Indexed: 12/22/2022] Open
Abstract
Crohn's disease is a chronic idiopathic inflammatory disease of the intestines characterized by frequent relapse and remission. It often develops in children and adolescents, who are vulnerable to repeated exposure to ionizing radiations. Magnetic resonance enterography (MRE) is an increasingly important radiation-free imaging modality that is used to evaluate pediatric patients with Crohn's disease. MRE can evaluate extraluminal and extraintestinal abnormalities as well as the status of the bowel wall. In addition, MRE has an advantage in the evaluation of the small bowel involvement. MRE can be used for the initial diagnosis of Crohn's disease, and can aid in the assessment of disease activity and complications such as penetrating and fibrostenotic diseases. The aims of this article are to review the MRE technique for obtaining diagnostic and high-quality images and to discuss interpretations of imaging findings in patients with Crohn's disease.
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Affiliation(s)
- So Mi Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea. ; Department of Radiology, Kyungpook National University Medical Center, Daegu, Korea
| | - Woo Sun Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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Quaia E, Sozzi M, Gennari AG, Pontello M, Angileri R, Cova MA. Impact of gadolinium-based contrast agent in the assessment of Crohn's disease activity: Is contrast agent injection necessary? J Magn Reson Imaging 2015; 43:688-97. [DOI: 10.1002/jmri.25024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/22/2015] [Indexed: 12/15/2022] Open
Affiliation(s)
- Emilio Quaia
- Department of Radiology; Cattinara Hospital, University of Trieste; Trieste Italy
| | - Michele Sozzi
- Department of Gastroenterology; Cattinara Hospital; Trieste Italy
| | | | - Michele Pontello
- Department of Radiology; Cattinara Hospital, University of Trieste; Trieste Italy
| | - Roberta Angileri
- Department of Radiology; Cattinara Hospital, University of Trieste; Trieste Italy
| | - Maria Assunta Cova
- Department of Radiology; Cattinara Hospital, University of Trieste; Trieste Italy
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High Spatiotemporal Resolution Dynamic Contrast-Enhanced MR Enterography in Crohn Disease Terminal Ileitis Using Continuous Golden-Angle Radial Sampling, Compressed Sensing, and Parallel Imaging. AJR Am J Roentgenol 2015; 204:W663-9. [PMID: 26001254 DOI: 10.2214/ajr.14.13674] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this article was to assess the feasibility of golden-angle radial acquisition with compress sensing reconstruction (Golden-angle RAdial Sparse Parallel [GRASP]) for acquiring high temporal resolution data for pharmacokinetic modeling while maintaining high image quality in patients with Crohn disease terminal ileitis. MATERIALS AND METHODS Fourteen patients with biopsy-proven Crohn terminal ileitis were scanned using both contrast-enhanced GRASP and Cartesian breath-hold (volume-interpolated breath-hold examination [VIBE]) acquisitions. GRASP data were reconstructed with 2.4-second temporal resolution and fitted to the generalized kinetic model using an individualized arterial input function to derive the volume transfer coefficient (K(trans)) and interstitial volume (v(e)). Reconstructions, including data from the entire GRASP acquisition and Cartesian VIBE acquisitions, were rated for image quality, artifact, and detection of typical Crohn ileitis features. RESULTS Inflamed loops of ileum had significantly higher K(trans) (3.36 ± 2.49 vs 0.86 ± 0.49 min(-1), p < 0.005) and v(e) (0.53 ± 0.15 vs 0.20 ± 0.11, p < 0.005) compared with normal bowel loops. There were no significant differences between GRASP and Cartesian VIBE for overall image quality (p = 0.180) or detection of Crohn ileitis features, although streak artifact was worse with the GRASP acquisition (p = 0.001). CONCLUSION High temporal resolution data for pharmacokinetic modeling and high spatial resolution data for morphologic image analysis can be achieved in the same acquisition using GRASP.
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Li Y, Hauenstein K. New Imaging Techniques in the Diagnosis of Inflammatory Bowel Diseases. VISZERALMEDIZIN 2015; 31:227-34. [PMID: 26557830 PMCID: PMC4608604 DOI: 10.1159/000435864] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Cross-sectional imaging modalities are fundamental in the management of patients with inflammatory bowel disease (IBD) from the first diagnosis and throughout the entire course of the disease. Over the past few years, the use of magnetic resonance (MR) imaging (MRI) has considerably increased, and no other imaging modality has experienced as advanced a development as MRI. Methods A comprehensive literature search (PubMed/Medline) using keywords such as ‘MR enterography’, ‘imaging modalities’, ‘IBD’, and ‘Crohn's disease’ was performed. 48 articles published between 1999 and 2015 were systematically reviewed. In this article, besides the current standard MRI techniques, we review novel and implementable for routine use MR techniques. The use of positron emission tomography/computed tomography (PET/CT) and hybrid imaging such as PET/MRI with enormous potential will also be briefly discussed. Results New imaging techniques such as diffusion-weighted imaging, dynamic contrast-enhanced MR perfusion, and MR motility imaging yield advanced findings about changes in the microenvironment and alterations in motility of the affected bowel segment, and are proven to improve the diagnostic accuracy in assessing the scale, activity level, and severity of the IBD. Novel magnetization transfer imaging allows direct visualization of fibrosis in the bowel wall. Conclusion Diffusion-weighted imaging can be easily implemented in standard MRI for routine use to further enhance the diagnostic accuracy in disease assessment. For validation of magnetization transfer imaging, larger studies are warranted.
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Affiliation(s)
- Yan Li
- Institute of Diagnostic and Interventional Radiology, University Medicine Rostock, Rostock, Germany
| | - Karlheinz Hauenstein
- Institute of Diagnostic and Interventional Radiology, University Medicine Rostock, Rostock, Germany
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Abstract
The duodenum is a unique segment of intestine, occupying both intra and extra-peritoneal locations. There is a wide spectrum of abnormalities of the duodenum that range from congenital anomalies to traumatic, inflammatory, and neoplastic entities. The duodenum may be overlooked on cross-sectional imaging due to its location and small size. Duodenal pathologies may, therefore, be missed or wrongly diagnosed. Knowledge about duodenal pathologies and optimal imaging techniques can increase diagnostic yield and permit optimal patient management. Conventionally, the duodenum was evaluated with upper GI studies on fluoroscopy; however, endoluminal evaluation is better performed with endoscopy. Additionally, a broad array of cross-sectional imaging modalities permits comprehensive assessment of the duodenum and surrounding viscera. While endoscopic sonography is increasingly used to locally stage duodenal malignancies, MDCT remains the primary modality widely used in the detection and characterization of duodenal abnormalities. MRI is used as a "problem solving" modality in select conditions. We present a comprehensive review of duodenal abnormalities with an emphasis on accurate diagnosis and management.
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Hahnemann ML, Nensa F, Kinner S, Köhler J, Gerken G, Umutlu L, Lauenstein TC. Quantitative assessment of small bowel motility in patients with Crohn's disease using dynamic MRI. Neurogastroenterol Motil 2015; 27:841-8. [PMID: 25808321 DOI: 10.1111/nmo.12558] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 02/28/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Assessment of motility alterations by functional magnetic resonance imaging (MRI) contributes to improved evaluation of inflammatory bowel disease. The aim of the study was to quantify motility in inflammatory bowel segments and to compare motility alterations with MR-based parameters for activity of inflammation in Crohn's disease (CD). METHODS Thirty consecutive patients with CD underwent bowel MRI which included a dynamic sequence for automatic generation of parametric maps facilitating quantification of bowel motility. Mean motility score (MMS) of small bowel segments with signs of inflammation was measured and compared with MMS of the whole gastrointestinal tract (GI tract). MRI-based score of inflammatory activity and lesion length were correlated with the MMS ratio of inflammatory small bowel lesion and whole GI tract. KEY RESULTS Inflammatory bowel segments showed a mean value of MMSs of 1080, whereas the whole GI tract showed a mean value of MMSs of 2839 (p < 0.0001). Decrease in motility ranged between 20 and 87% in inflammatory bowel segments compared to the MMS of the whole GI tract. The MMS ratio of an inflammatory small bowel segment and whole GI tract showed negative correlation with MR activity score (r = -0.5921, p = 0.0003) and length of the lesion (r = -0.3495, p = 0.0462). CONCLUSIONS & INFERENCES Quantitative assessment of motility alterations by means of motility scoring in small bowel segments affected by CD provides additional information on inflammatory activity.
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Affiliation(s)
- M L Hahnemann
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - F Nensa
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - S Kinner
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - J Köhler
- Department of Medical Oncology, University Hospital Essen, Essen, Germany
| | - G Gerken
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - L Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - T C Lauenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Indications and selection of MR enterography vs. MR enteroclysis with emphasis on patients who need small bowel MRI and general anaesthesia: results of a survey. Insights Imaging 2015; 6:339-46. [PMID: 25855563 PMCID: PMC4444793 DOI: 10.1007/s13244-015-0384-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 01/01/2015] [Accepted: 01/13/2015] [Indexed: 12/17/2022] Open
Abstract
Aims To survey the perceived indications for magnetic resonance imaging of the small bowel (MRE) by experts, when MR enteroclysis (MREc) or MR enterography (MREg) may be chosen, and to determine how the approach to MRE is modified when general anaesthesia (GA) is required. Materials and methods Selected opinion leaders in MRE completed a questionnaire that included clinical indications (MREg or MREc), specifics regarding administration of enteral contrast, and how the technique is altered to accommodate GA. Results Fourteen responded. Only the diagnosis and follow-up of Crohn’s disease were considered by over 80 % as a valid MRE indication. The remaining indications ranged between 35.7 % for diagnosis of caeliac disease and unknown sources of gastrointestinal bleeding to 78.6 % for motility disorders. The majority chose MREg over MREc for all indications (from 100 % for follow-up of caeliac disease to 57.7 % for tumour diagnosis). Fifty per cent of responders had needed to consider MRE under GA. The most commonly recommended procedural change was MRI without enteral distention. Three had experience with intubation under GA (MREc modification). Conclusion Views were variable. Requests for MRE under GA are not uncommon. Presently most opinion leaders suggest standard abdominal MRI when GA is required. Main messages • Experts are using MRE for various indications. • Requests for MRE under general anaesthesia are not uncommon. • Some radiologists employ MREc under general anaesthesia; others do not distend the small bowel.
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Dulai PS, Singh S, Cesarini M, Bouguen G, Nelson SA, Peyrin-Biroulet L, Feagan BG, Ordas I, Sandborn WJ, Santillan C, Rimola J, Panes J, D'Haens G, Zou GY, Stoker J, MacDonald JK, Levesque BG. MRI scoring indices for evaluation of disease activity and severity in Crohn’s disease. Hippokratia 2015. [DOI: 10.1002/14651858.cd011630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Monica Cesarini
- University of Rome; Dipartimento di Medicina Interna e Specialità Mediche; Viale del Policlinico, 155 Rome Italy 00161
| | | | | | - Laurent Peyrin-Biroulet
- CHU de Nancy; Service d'Hepatogastroenterologie; Allee du Morvan Vandoeuvre-les-Nancy France F-54511
| | - Brian G Feagan
- Robarts Research Institute; Robarts Clinical Trials; P.O. Box 5015 100 Perth Drive London ON Canada N6A 5K8
| | - Ingrid Ordas
- University of Barcelona; Hospital Clinic; Villaroel 170 Barcelona Spain 08036
| | - William J Sandborn
- University of California San Diego; Division of Gastroenterology; La Jolla California USA
| | - Cynthia Santillan
- University of California San Diego; 200 West Arbor Dr, #8756 San Diego CA USA 92103
| | - Jordi Rimola
- University of Barcelona; Hospital Clinic; Villaroel 170 Barcelona Spain 08036
| | - Julian Panes
- University of Barcelona; Hospital Clinic; Villaroel 170 Barcelona Spain 08036
| | - Geert D'Haens
- Academic Medical Center; Meibergdreef 9 - C2-112 Amsterdam Netherlands 1105 AZ
| | - GY Zou
- Robarts Research Institute; Robarts Clinical Trials; P.O. Box 5015 100 Perth Drive London ON Canada N6A 5K8
| | | | - John K MacDonald
- Robarts Research Institute; Robarts Clinical Trials; P.O. Box 5015 100 Perth Drive London ON Canada N6A 5K8
| | - Barrett G Levesque
- University of California San Diego; Division of Gastroenterology; La Jolla California USA
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Quon JS, Quon PR, Lim CS, Abdeen N, Schieda N. Magnetic resonance enterography in post-operative inflammatory bowel disease. ACTA ACUST UNITED AC 2015; 40:1034-49. [PMID: 25776203 DOI: 10.1007/s00261-015-0392-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE 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. CONCLUSION 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.
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Affiliation(s)
- Jeffrey S Quon
- Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada,
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Stoddard PB, Ghazi LJ, Wong-You-Cheong J, Cross RK, Vandermeer FQ. Magnetic resonance enterography: state of the art. Inflamm Bowel Dis 2015; 21:229-39. [PMID: 25222657 DOI: 10.1097/mib.0000000000000186] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Crohn's disease is a chronic inflammatory bowel disease of the gastrointestinal tract manifested by frequent periods of relapses and remissions of symptoms. The small bowel is most frequently affected. Progression of transmural inflammation can lead to stricturing or penetrating complications. At the time of diagnosis, approximately 10% of patients have disease beyond the reach of the colonoscope. Imaging can aid in clinical evaluation by depicting small bowel involvement and extraenteric disease. Magnetic resonance enterography (MRE) has emerged as a valuable tool and is being used with increasing frequency for the diagnosis and management of Crohn's disease. This article will discuss the current state of the art in MRE. In addition to reviewing the literature reporting its utility, we will present case examples illustrating how MRE best depicts the various findings of Crohn's disease within 4 imaging categories of disease: active inflammatory, fibrostenotic, fistulizing/perforating, and reparative or regenerative. We will present additional important clinical considerations in routine use of MRE, including implications for monitoring disease activity and response to treatment, cost-effectiveness, and appropriate use in the context of the American College of Radiology Appropriateness Criteria.
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Affiliation(s)
- Paul B Stoddard
- *Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland; †Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland; and ‡University of Maryland Medical Center, Baltimore, Maryland
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Quaia E, Cabibbo B, Sozzi M, Gennari AG, Pontello M, Degrassi F, Cova MA. Biochemical markers and MR imaging findings as predictors of crohn disease activity in patients scanned by contrast-enhanced MR enterography. Acad Radiol 2014; 21:1225-32. [PMID: 24998692 DOI: 10.1016/j.acra.2014.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/14/2014] [Accepted: 05/09/2014] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVES To define the best independent predictors for active inflammation in patients with Crohn disease (CD) examined by contrast-enhanced magnetic resonance (MR) enterography. MATERIALS AND METHODS Ninety-one patients (47 men and 44 women; aged 39.58 ± 17.1 years) with a diagnosis of CD; CD activity index (CDAI) ≥ 150 (n = 19 patients) or <150 (n = 72) underwent MR enterography including T2-weighted half-Fourier acquisition single-shot turbo spin-echo, T2-weighted spectral fat presaturation with inversion recovery, T1-weighted balanced steady-state free precession, and T1-weighted breath-hold resolution isotropic high volume three-dimensional MR imaging sequences before and after administration of gadobenate dimeglumine during arterial (30 seconds), portal venous (70 seconds), and delayed phase (3 and 5 minutes from contrast injection). Two readers analyzed the MR images in consensus. Reference standard was the Crohn's Disease Endoscopic Index of Severity (CDEIS) with deep mucosal biopsy or the histologic analysis of the surgical specimen in those patients (n = 30) who underwent elective small-bowel resection. Univariate and multivariate logistic regression analyses were performed to assess CDAI, biochemical markers (C-reactive protein and fecal calprotectin levels) and MR imaging findings as potential predictors of inflammatory CD activity. RESULTS Patients revealed prevalently active (n = 47 patients) or quiescent CD with mural fibrosis (n = 44 patients). The bowel wall T2 hyperintensity (odds ratio [OR], 9.20; 95% confidence interval [CI], 2.71-31.19) and total length of disease (OR, 1.29; 95% CI, 1.11-1.49) were found as the best independent predictors of active CD. CDAI, C-reactive protein, and fecal calprotectin were not found independent predictors of active CD. CONCLUSIONS The bowel wall T2 hyperintensity and the length of the involved bowel tract were predictors of active inflammation in patients with CD examined by contrast-enhanced MR enterography.
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Pola S, Santillan C, Levesque BG, Feagan BG, Sandborn WJ. An overview of magnetic resonance enterography for Crohn's disease. Dig Dis Sci 2014; 59:2040-9. [PMID: 24659238 DOI: 10.1007/s10620-014-3116-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 03/12/2014] [Indexed: 12/27/2022]
Abstract
Magnetic resonance enterography (MRE) is a relatively new imaging modality that has shown promise for diagnosing, staging, and monitoring Crohn's disease (CD) and its complications while avoiding exposure to ionizing radiation. In addition to clinical implications, MRE has the potential to be used as an objective measure of disease activity for clinical trials. We provide the rationale for MRE, indications for its use, and an overview of the typical procedure and common findings for institutions who want to begin or refine the use of MRE for CD.
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Menys A, Plumb A, Atkinson D, Taylor SA. The challenge of segmental small bowel motility quantitation using MR enterography. Br J Radiol 2014; 87:20140330. [PMID: 24919500 PMCID: PMC4112392 DOI: 10.1259/bjr.20140330] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE Analysis of "cine" MRI using segmental regions of interest (ROIs) has become increasingly popular for investigating bowel motility; however, variation in motility in healthy subjects both within and between scans remains poorly described. METHODS 20 healthy individuals (mean age, 28 years; 14, males) underwent MR enterography to acquire dynamic motility scans in both breath hold (BH) and free breathing (FB) on 2 occasions. Motility data were quantitatively assessed by placing four ROIs per subject in different small bowel segments and applying two measures: (1) contractions per minute (CPM) and (2) Jacobian standard deviation (SD) motility score. Within-scan (between segment) variation was assessed using intraclass correlation (ICC), and repeatability was assessed using Bland-Altman limits of agreement (BA LoA). RESULTS Within-scan segmental variation: BH CPM and Jacobian SD metrics between the four segments demonstrated ICC R = 0.06, p = 0.100 and R = 0.20, p = 0.027 and in FB, the CPM and Jacobian SD metrics demonstrated ICC R = -0.26, p = 0.050 and R = 0.19, p = 0.030. Repeatability: BH CPM for matched segments ranged between 0 and 14 contractions with BA LoA of ±8.36 and Jacobian SD ranged between 0.09 and 0.51 with LoA of ±0.33. In FB data, CPM ranged between 0 and 10 contractions with BA LoA of ±7.25 and Jacobian SD ranged between 0.16 and 0.63 with LoA = ±0.28. CONCLUSION The MRI-quantified small bowel motility in normal subjects demonstrates wide intersegmental variation and relatively poor repeatability over time. ADVANCES IN KNOWLEDGE This article presents baseline values for healthy individuals of within- and between-scan motility that are essential for understanding how this process changes in disease.
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Affiliation(s)
- A Menys
- Centre for Medical Imaging, University College London, UK
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