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Panes J, Bouhnik Y, Reinisch W, Stoker J, Taylor SA, Baumgart DC, Danese S, Halligan S, Marincek B, Matos C, Peyrin-Biroulet L, Rimola J, Rogler G, van Assche G, Ardizzone S, Ba-Ssalamah A, Bali MA, Bellini D, Biancone L, Castiglione F, Ehehalt R, Grassi R, Kucharzik T, Maccioni F, Maconi G, Magro F, Martín-Comín J, Morana G, Pendsé D, Sebastian S, Signore A, Tolan D, Tielbeek JA, Weishaupt D, Wiarda B, Laghi A. Imaging techniques for assessment of inflammatory bowel disease: joint ECCO and ESGAR evidence-based consensus guidelines. J Crohns Colitis 2013; 7:556-85. [PMID: 23583097 DOI: 10.1016/j.crohns.2013.02.020] [Citation(s) in RCA: 446] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 02/20/2013] [Indexed: 12/12/2022]
Abstract
The management of patients with IBD requires evaluation with objective tools, both at the time of diagnosis and throughout the course of the disease, to determine the location, extension, activity and severity of inflammatory lesions, as well as, the potential existence of complications. Whereas endoscopy is a well-established and uniformly performed diagnostic examination, the implementation of radiologic techniques for assessment of IBD is still heterogeneous; variations in technical aspects and the degrees of experience and preferences exist across countries in Europe. ECCO and ESGAR scientific societies jointly elaborated a consensus to establish standards for imaging in IBD using magnetic resonance imaging, computed tomography, ultrasonography, and including also other radiologic procedures such as conventional radiology or nuclear medicine examinations for different clinical situations that include general principles, upper GI tract, colon and rectum, perineum, liver and biliary tract, emergency situation, and the postoperative setting. The statements and general recommendations of this consensus are based on the highest level of evidence available, but significant gaps remain in certain areas such as the comparison of diagnostic accuracy between different techniques, the value for therapeutic monitoring, and the prognostic implications of particular findings.
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Affiliation(s)
- J Panes
- Gastroenterology Department, Hospital Clinic Barcelona, CIBERehd, IDIBAPS, Barcelona, Spain.
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Zijta FM, Bipat S, Stoker J. Magnetic resonance (MR) colonography in the detection of colorectal lesions: a systematic review of prospective studies. Eur Radiol 2009; 20:1031-46. [PMID: 19936754 PMCID: PMC2850516 DOI: 10.1007/s00330-009-1663-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 08/26/2009] [Accepted: 09/17/2009] [Indexed: 12/16/2022]
Abstract
Objective To determine the diagnostic accuracy of MR-colonography for the detection of colorectal lesions. Methods A comprehensive literature search was performed for comparative MR-colonography studies, published between May 1997 and February 2009, using the MEDLINE, EMBASE and Cochrane databases. We included studies if MR-colonography findings were prospectively compared with conventional colonoscopy in (a)symptomatic patients. Two reviewers independently extracted study design characteristics and data for summarising sensitivity and specificity. Heterogeneity in findings between studies was tested using I2 test statistics. Sensitivity and specificity estimates with 95% confidence intervals (CI) were calculated on per patient basis and summary sensitivity on per polyp basis, using bivariate and univariate statistical models. Results Thirty-seven studies were found to be potentially relevant and 13 fulfilled the inclusion criteria. The study population comprised 1,285 patients with a mean disease prevalence of 44% (range 22–63%). Sensitivity for the detection of CRC was 100%. Significant heterogeneity was found for overall per patient sensitivity and specificity. For polyps with a size of 10 mm or larger, per patient sensitivity and specificity estimates were 88% (95% CI 63–97%; I2 = 37%) and 99% (95% CI 95–100%; I2 = 60%). On a per polyp basis, polyps of 10 mm or larger were detected with a sensitivity of 84% (95% CI 66–94%; I2 = 51%). The data were too heterogeneous for polyps smaller than 6 mm and 6–9 mm. Conclusion MR-colonography can accurately detect colorectal polyps more than 10 mm in size
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Affiliation(s)
- Frank M Zijta
- Department of Radiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Achiam MP, Løgager VB, Chabanova E, Eegholm B, Thomsen HS, Rosenberg J. Diagnostic accuracy of MR colonography with fecal tagging. ACTA ACUST UNITED AC 2009; 34:483-90. [PMID: 18452023 DOI: 10.1007/s00261-008-9402-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND MR colonography (MRC) is a non-invasive method of examining the colon, but it is still only used in a few specialized centers on a daily basis. The purpose of this study was to evaluate the performance of MRC with improved fecal tagging vs. conventional colonoscopy (CC). METHODS Between March 2006 and February 2007, consecutive patients who received first-time referrals to CC were asked to participate in the study. Two days prior to MRC, a new contrast mixture (barium/ferumoxsil) was ingested together with four meals each day. Standard bowel cleansing was performed before CC. MRC was evaluated by two blinded observers. MRC results were compared with CC. RESULTS A total of 56 patients were included. The per-polyp sensitivity was 85.7% for polyps 6-10 mm and 81.3% for polyps >10 mm. The per-patient sensitivity/specificity was 100%/80% for polyps >6 mm and 100%/91.4% for polyps >10 mm. CONCLUSION MRC showed acceptable per-patient sensitivities, but the per-polyp sensitivities are still compromised by the fecal tagging. MRC may be implemented, but at the present time MRC with fecal tagging is not ready for widespread use, although it remains a very promising diagnostic tool.
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Affiliation(s)
- Michael Patrick Achiam
- Department of Diagnostic Radiology, Copenhagen University Hospital Herlev, Herlev, Denmark.
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Achiam MP, Thomsen HS, Rosenberg J. Magnetic resonance colonography in clinical use: how far have we come? Scand J Gastroenterol 2009; 44:518-26. [PMID: 19107673 DOI: 10.1080/00365520802647418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Michael P Achiam
- Department of Surgical Gastroenterology D, Copenhagen University Hospital Herlev, Herlev, Denmark.
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Bakir B, Acunas B, Bugra D, Yamaner S, Asoglu O, Salmaslioglu A, Balik E. MR colonography after oral administration of polyethylene glycol-electrolyte solution. Radiology 2009; 251:901-9. [PMID: 19318587 DOI: 10.1148/radiol.2513081061] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This prospective study was approved by the local institutional ethics committee, and written informed consent was obtained from all patients. The aim of this study was to determine whether the oral administration of a polyethylene glycol (PEG)-electrolyte solution induces adequate luminal distention for magnetic resonance (MR) colonography to be performed and to assess patient acceptance of this procedure. Fifty-five patients (26 women, 29 men; mean age, 60.5 years +/- 14 [standard deviation]; age range, 40-75 years) who were referred for optical colonoscopy (OC) owing to symptoms and findings that included rectal bleeding, altered bowel habits, and positive fecal occult blood test results participated in this study. Standard bowel preparation was performed 1 day before the procedure. MR colonography was performed and followed by OC on the same day. Before undergoing MR colonography, the patients received 2.0-2.5 L of the PEG-electrolyte solution orally. Adequate distention of all colonic segments was achieved in 50-53 (91%-96%) of patients imaged in the supine position and in 51-53 (93%-96%) of patients imaged in the prone position. Oral administration of the solution yielded uniform luminal darkening and sufficient colonic distention for MR colonography in 91%-96% of patients.
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Affiliation(s)
- Baris Bakir
- Department of Radiology, Istanbul University, Istanbul Medical School, Capa, 34390 Istanbul, Turkey.
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Dark-lumen MR colonography with fecal tagging: a comparison of water enema and air methods of colonic distension for detecting colonic neoplasms. Eur Radiol 2008; 18:1396-405. [DOI: 10.1007/s00330-008-0900-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 02/05/2008] [Accepted: 02/08/2008] [Indexed: 01/22/2023]
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MR rectum imaging with ultra sound gel as instrumental contrast media in tubulovillous adenoma. Radiol Oncol 2008. [DOI: 10.2478/v10019-008-0012-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Combining the advantages of unsurpassed soft tissue contrast and lack of ionizing radiation, MR imaging of the gastrointestinal tract has become increasingly used clinically. Both bowel inflammation and tumor disease of the large bowel can be well visualized by means of MR colonography (MRC). This article describes current techniques of MRC and gives an overview of its clinical outcome. Special focus is directed toward the evaluation of patients' acceptance of MRC.
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Affiliation(s)
- Sonja Kinner
- Department of Radiology and Neuroradiology, University Hospital, Hufelandstrasse 55, 45122 Essen, Germany
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Kinner S, Kuehle CA, Langhorst J, Ladd SC, Nuefer M, Barkhausen J, Lauenstein TC. MR colonography with fecal tagging: do individual patient characteristics influence image quality? J Magn Reson Imaging 2007; 25:1007-12. [PMID: 17457810 DOI: 10.1002/jmri.20907] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To evaluate if different patient characteristics influence performance of fecal tagging (a new MR colonography (MRC) technique to label stool to avoid bowel cleansing) and, consecutively, MR image quality. MATERIALS AND METHODS A total of 333 patients (mean age = 61 years) underwent MRC with fecal tagging. Four segments of the large bowel (ascending, transverse, descending, and sigmoid colon) were assessed as for the presence of nontagged stool particles, which can impede an assessment of the colonic wall. Ratings were correlated with patients' characteristics including patient age (<55 vs. > or =55 years), body mass index (BMI) (<25 vs. > or =25), gender, and acceptance levels for fecal tagging. Statistical analysis was performed using a Mann-Whitney U-test. RESULTS A total of 1332 colonic segments were evaluated. Among them, 327 segments (25%) did not contain any visible stool particles. Considerably reduced image quality was found in 61 segments (5%). Best image quality was found in the sigmoid colon (mean value = 1.9), while image quality of the ascending colon turned out to be worst (mean value = 2.6). Fecal tagging effectiveness showed a reverse correlation with patient age. However, all other characteristics did not have a statistically significant influence on fecal tagging outcome. CONCLUSION MRC in conjunction with barium-based fecal tagging led to diagnostic image quality in 95% of all colonic segments. Since tagging results were significantly decreased in patients > or =55 years, tagging protocols should to be modified in this group, i.e., by increasing the time interval of tagging administration.
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Affiliation(s)
- Sonja Kinner
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, D-45122 Essen, Germany.
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Kinner S, Kuehle CA, Langhorst J, Ladd SC, Nuefer M, Zoepf T, Barkhausen J, Gerken G, Lauenstein TC. MR colonography vs. optical colonoscopy: comparison of patients’ acceptance in a screening population. Eur Radiol 2007; 17:2286-93. [PMID: 17522866 DOI: 10.1007/s00330-007-0643-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Revised: 02/28/2007] [Accepted: 03/22/2007] [Indexed: 12/01/2022]
Abstract
The aim of this study was to compare optical colonoscopy to fecal-tagging-based MR colonography in a screening population in terms of comfort and acceptance ratings as well as for future preferences as colorectal cancer screening examinations. Two hundred eighty-four asymptomatic patients (mean age 59 years) underwent MRC and OC within 4 weeks. While MRC was based on a fecal tagging technique, OC was performed after bowel cleansing. For OC, sedatives and analgesics were used. Patients evaluated both modalities and certain aspects of the examination according to a 10-point-scale with higher scores denoting a worse experience. Furthermore, preferences for future examinations were evaluated. No significant difference was noted for the overall acceptance of OC (mean value 3.0) and MRC (mean value 3.4). For MRC, the placement of the rectal tube was rated as the most unpleasant part, whereas bowel purgation was regarded most inconvenient for OC. Patients aged 55 years and older perceived most aspects less unpleasant than younger patients. Of the patients, 46% preferred MRC for future screening examinations (OC: 44%). OC and MRC have comparable general acceptance levels in a screening population. Especially for patients declining endoscopy as a screening method MRC may evolve as an attractive alternative.
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Affiliation(s)
- Sonja Kinner
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany.
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Ajaj W, Ruehm SG, Ladd SC, Gerken G, Goyen M. Utility of dark-lumen MR colonography for the assessment of extra-colonic organs. Eur Radiol 2007; 17:1574-83. [PMID: 17245582 DOI: 10.1007/s00330-006-0549-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Revised: 09/28/2006] [Accepted: 10/24/2006] [Indexed: 12/21/2022]
Abstract
The aim of the study was to evaluate the utility of dark-lumen MR colonography (MRC) for the assessment of extra-colonic organs. Three hundred seventy-five subjects with suspected colonic disease underwent a complete MRC examination. MRC data were evaluated by two radiologists in a blinded fashion. In addition to the large bowel, the extra-intestinal organs from the lung bases to the pelvis were assessed for the presence of pathologies. All findings were divided into known or unknown findings and therapeutically relevant or irrelevant findings. If deemed necessary, other diagnostic imaging tests to further assess those findings were performed. In total, 510 extra-colonic findings were found in 260 (69%) of the 375 subjects. Known extra-colonic findings were found in 140 subjects (54%) and unknown findings in 120 subjects (46%). Thirty-one (12%) of the 260 subjects had therapeutically relevant findings (45 findings); 229 patients (88%) had irrelevant findings (465 findings). Dark-lumen MRC is a useful tool not only for the assessment of the entire colon, but also for the evaluation of extra-colonic organs. Thus, intra- and extra-colonic pathologies can be diagnosed within the same examination.
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Affiliation(s)
- Waleed Ajaj
- Medical Center, University Hospital Hamburg-Eppendorf, Martini-Strasse 52, 22046 Hamburg, Germany.
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Ajaj W, Goyen M. MR imaging of the colon: "technique, indications, results and limitations". Eur J Radiol 2006; 61:415-23. [PMID: 17145153 DOI: 10.1016/j.ejrad.2006.07.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Accepted: 07/26/2006] [Indexed: 01/11/2023]
Abstract
In the last few years virtual colonography using MR imaging has shown a proceeding development regarding detection and quantification of colorectal pathologies. Dark-lumen MR colonography (MRC) has been a leading tool for the diagnosis of the entire colon and their pathologies. This review article describes some of the underlying techniques of MRC concerning data acquisition, the need for intravenously applied paramagnetic contrast agent, as well as indications, results and limitations of MRC for the detection of colorectal pathologies. In addition, new techniques to improve patient acceptance are discussed.
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Affiliation(s)
- Waleed Ajaj
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Lauenstein TC. MR colonography: current status. Eur Radiol 2006; 16:1519-26. [PMID: 16770654 DOI: 10.1007/s00330-006-0260-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Revised: 03/14/2006] [Accepted: 03/16/2006] [Indexed: 01/29/2023]
Abstract
Magnetic resonance colonography (MRC) has gained access into clinical routine as a means for the assessment of the large bowel. There are widely accepted indications for MRC, especially in patients with incomplete conventional colonoscopy. Furthermore, virtual MRC is more and more propagated as a screening tool, with advantages especially inherent to the non-invasive character of this procedure and the lack of ionizing radiation exposition. Beyond a sufficiently high diagnostic accuracy, outstanding patient acceptance is a major advantage of MRC as a diagnostic modality. This review article describes indications, techniques and clinical outcome of current MRC approaches. Furthermore, the impact of fecal tagging concepts is discussed.
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Affiliation(s)
- Thomas C Lauenstein
- Department of Radiology, The Emory Clinic, 1365 Clifton Road, Building A, Suite AT-627, Atlanta, GA 30322, USA.
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Lauenstein TC, Ajaj W, Kuehle CA. Virtual colonoscopy by MRI: state-of-the-art and future directions. Gastrointest Endosc Clin N Am 2005; 15:797-811. [PMID: 16278139 DOI: 10.1016/j.giec.2005.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
MR colonography has been shown to be an appropriate diagnostic tool for the detection of colorectal lesions. The technique is based on the acquisition of T1-weighted sequences after the administration of water enema and the intravenous administration of paramagnetic contrast. This article describes the technical requirements for MR colonoscopy and the procedures of data acquisition and image interpretation. The advantages and drawbacks of MR colonoscopy also are outlined.
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Affiliation(s)
- Thomas C Lauenstein
- Department of Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany.
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Abstract
MR colonography (MRC) is an accurate diagnostic tool for the detection of colorectal masses and inflammatory diseases. This article describes the underlying techniques of MRC that concern data acquisition and image interpretation. Indications for MRC are discussed, and technical developments are explained.
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Affiliation(s)
- Thomas C Lauenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany.
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