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Pupulim LF, Hugot M, Stolz A. The creeping fat. Abdom Radiol (NY) 2024; 49:320-321. [PMID: 37863845 DOI: 10.1007/s00261-023-04077-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Lawrence F Pupulim
- Department of Radiology, Réseau Hospitalier Neuchâtelois, Rue de la Maladière, 45, 2000, Neuchâtel, Switzerland.
| | - Matthias Hugot
- Department of Radiology, Réseau Hospitalier Neuchâtelois, Rue de la Maladière, 45, 2000, Neuchâtel, Switzerland
| | - Alexandre Stolz
- Department of Radiology, Réseau Hospitalier Neuchâtelois, Rue de la Maladière, 45, 2000, Neuchâtel, Switzerland
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2
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Replacing Endoscopy with Magnetic Resonance Enterography for Mucosal Activity Assessment in Terminal Ileal Crohn’s Disease: Are We There Yet? Diagnostics (Basel) 2023; 13:diagnostics13061061. [PMID: 36980368 PMCID: PMC10046927 DOI: 10.3390/diagnostics13061061] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/18/2023] Open
Abstract
Crohn’s disease (CD) is a chronic immune mediated disorder that most commonly affects the small bowel and/or the large bowel. Treatment targets in CD include mucosal healing assessed via ileocolonoscopy and transmural healing assessed through cross-sectional imaging modalities such as magnetic resonance enterography (MRE). More recently, histological healing in CD has emerged as a treatment target, though it is made cumbersome given its reliance on frequent endoscopic examinations. With expert guidelines now recommending regular objective assessments as part of a treat-to-target approach, accurate non-invasive assessment will become increasingly critical. MRE has an established role in the assessment of small bowel CD, with growing data supportive of its ability in detecting disease activity at mucosal and histological levels. This could therefore potentially reduce the need for serial endoscopic assessment. Thus, this review will assess the capacity of individual MRE parameters and MRE indices for detecting mucosal and histological small bowel CD activity. Furthermore, challenging scenarios, such as CD activity detection in post-operative clinical scenarios and abnormal findings in the context of a normal ileocolonoscopy, will be explored.
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Ali RMM, El Salam AFA, Anwar I, Shehab H, Awadallah MY. Role of MR enterography versus ileo-colonoscopy in the assessment of inflammatory bowel diseases. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2023; 54:17. [DOI: 10.1186/s43055-023-00967-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/09/2023] [Indexed: 09/02/2023] Open
Abstract
Abstract
Background
Inflammatory bowel disease (IBD) is widespread and rapidly rising in developing countries. It remains a significant issue in Western culture with a prevalence of more than 0.3%. Symptom control has been the only focus of treatment before the discovery that many individuals with IBD continue to have disease activity even in the absence of clinical symptoms. Therefore, treatment goals now include establishing clinical remission, steroid-free remission, and mucosal healing, which may eventually be complemented by transmural healing in cross-sectional imaging modalities. Magnetic resonance enterography (MRE), computed tomography enterography, and small-bowel ultrasound are now reliable methods for staging intramural lesions and extramural consequences in CD and for determining disease activity and severity. Recently literature suggests the incorporation of (MRE) for periodic reevaluation of IBD patients, as it offers small-bowel, colonic, and extra-enteric assessment as well as monitors the response to the anti-inflammatory therapy. The purpose of the current study was to compare MRE with ileo-colonoscopy findings in the diagnosis of IBD features, specifically Crohn's disease, and ulcerative colitis, as well as in the detection of disease exacerbation (Activity).
Results
This study used MRE and ileo-colonoscopy to assess chronic inflammatory bowel disease patients; the patient population (n = 30) was made up of (14/30, 46.7%) females and (16/30, 53.3%) males, with a mean age of 32 ± SD 13 years. MRE alone detected lymphadenopathy in 73.3% of patients, and mural thickening with a mean of 4.1 ± SD 5.1 mm. It has detected mucosal enhancement with 80% sensitivity and 60% specificity. However, it was unable to detect mucosal erosions or ulceration.
Conclusions
MRE is sensitive, inexpensive, noninvasive, and radiation-free for inflammatory bowel disease detection, with 86.7% diagnostic accuracy for affected areas. Unlike ileo-colonoscopy, it could examine the entire small intestine, precisely measure the affected loop, and detect activity signs such as mural thickening and lymphadenopathy. Only ileo-colonoscopy could detect mucosal degradation and superficial ulcers. IBD treatment protocols should incorporate MRE for small-bowel, colonic, and extra-enteric assessment, monitoring of disease activity, and anti-inflammatory therapy response.
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The Role of Magnetic Resonance Enterography in Crohn’s Disease: A Review of Recent Literature. Diagnostics (Basel) 2022; 12:diagnostics12051236. [PMID: 35626391 PMCID: PMC9140029 DOI: 10.3390/diagnostics12051236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/06/2022] [Accepted: 05/13/2022] [Indexed: 11/17/2022] Open
Abstract
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.
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Vieujean S, Coibion C, Seidel L, Louis E, Meunier P. Magnetic resonance enterography perfusion parameters reveal complex changes in affected and unaffected segments in Crohn's disease. Scand J Gastroenterol 2020; 55:1041-1048. [PMID: 32757858 DOI: 10.1080/00365521.2020.1802773] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To compare dynamic contrast-enhanced (DCE)-MRI parameters in affected and unaffected segments of CD patients with those of a control group, and to assess the correlation between DCE-MRI parameters and clinical index of activity (HBI) as well as biomarkers (CRP and faecal calprotectin). METHODS We performed a single-center prospective study of CD patients and control subjects who underwent DCE-MRI. Regions of interest were drawn in segments and the program (Olea Medical - Canon) provided values for transfer constant (Ktrans), fractional volume of extravascular-extracellular space (Ve), slope of enhancement (SoE), time to maximum enhancement (TME), maximum enhancement (ME) and enhancement ratio (ER) which were determined and compared. RESULTS Fifteen CD patients (mean age 42 years; 10 women) and 7 healthy subjects (mean age 40.4 years; 6 women) were included. Paired comparisons of affected and unaffected segments in CD showed a significant increase of all parameters in affected segments, except for ER and TME. When comparing to controls, the affected segments did not show any significant difference, while a significant decrease in most of the parameters (except for ER and TME) was observed when comparing unaffected segments of CD patients to controls. In CD, significant correlations between DCE-MRI parameters and biomarkers (CRP, faecal calprotectin) were more frequent in unaffected segments than in affected segments. CONCLUSIONS Significant differences in perfusion parameters were observed between affected and unaffected segments of CD patients and between unaffected segments and those of control subjects. This suggests complex perfusion changes in both unaffected and affected intestinal segments in CD.
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Affiliation(s)
- Sophie Vieujean
- Department of Gastroenterology, CHU Sart-Tilman, University of Liège, Liege, Belgium
| | - Caroline Coibion
- Department of Radiology, CHU Sart-Tilman, University of Liège, Liege, Belgium
| | - Laurence Seidel
- Biostatistics and medico-economic information department, CHU Sart-Tilman, University of Liège, Liege, Belgium
| | - Edouard Louis
- Department of Gastroenterology, CHU Sart-Tilman, University of Liège, Liege, Belgium
| | - Paul Meunier
- Department of Radiology, CHU Sart-Tilman, University of Liège, Liege, Belgium
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Guglielmo FF, Anupindi SA, Fletcher JG, Al-Hawary MM, Dillman JR, Grand DJ, Bruining DH, Chatterji M, Darge K, Fidler JL, Gandhi NS, Gee MS, Grajo JR, Huang C, Jaffe TA, Park SH, Rimola J, Soto JA, Taouli B, Taylor SA, Baker ME. Small Bowel Crohn Disease at CT and MR Enterography: Imaging Atlas and Glossary of Terms. Radiographics 2020; 40:354-375. [DOI: 10.1148/rg.2020190091] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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7
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Gatti M, Allois L, Carisio A, Dianzani C, Garcia Martinez M, Ruggirello I, Varello S, Darvizeh F, Faletti R. Magnetic resonance enterography. MINERVA GASTROENTERO 2019; 65:319-334. [PMID: 31760740 DOI: 10.23736/s1121-421x.19.02639-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Crohn's disease is a condition of chronic inflammation that may involve any part of the gastrointestinal tract, although it more frequently affects the terminal ileum. Longstanding inflammation may lead to several bowel complications including obstruction, stricture, fistula and abscesses which often necessitate surgery. Cross-sectional imaging methods such as computed tomography and magnetic resonance imaging are being utilized more frequently to assess mural and extramural inflammatory bowel disease manifestations. Magnetic resonance enterography (MRE) for assessment of small bowel is optimal because of absence of ionizing radiation, better soft tissue contrast, development of motion-free sequences and high resolution images. A typical protocol includes pre and postcontrast sequences utilizing an enteric contrast agent for adequate bowel distention and an antiperistaltic agent. Overall, MRE allows the evaluation of disease activity, extraenteric complication and response to therapy with a great impact on patient management. In this review we discuss the features of MRE from patient's preparation and exam protocol to pathological findings.
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Affiliation(s)
- Marco Gatti
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy -
| | - Luca Allois
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Andrea Carisio
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Chiara Dianzani
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Maria Garcia Martinez
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Irene Ruggirello
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Sara Varello
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Fatemeh Darvizeh
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Riccardo Faletti
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
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8
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Varyani F, Samuel S. "Can Magnetic Resonance Enterography (MRE) replace ileo-colonoscopy for evaluating disease activity in Crohn's disease?". Best Pract Res Clin Gastroenterol 2019; 38-39:101621. [PMID: 31327407 DOI: 10.1016/j.bpg.2019.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/23/2019] [Indexed: 01/31/2023]
Abstract
Crohn's disease is a form of chronic inflammatory bowel disease that can lead to structural bowel damage due to transmural inflammation. Ileo-colonosocopy is currently essential for initial diagnosis. Reassessment of disease burden is frequently needed during episodes of active disease and when evaluating treatment efficacy. This review compares the role of Magnetic Resonance Enterography (MRE) and ileocolonoscopy in Crohn's disease management and whether cross-sectional imaging can replace invasive endoscopic tests. MRE can give information on the small bowel not visible at ileo-colonoscopy, and on extra-luminal complications. Evaluation of the bowel by MRE allows assessment of the submucosa and serosa, and thus transmural healing. MRE offers a well tolerated investigation and additional information on disease activity to better manage patients with Crohn's disease. Increasingly, there are a range of newer techniques such as diffusion weighted imaging, magnetisation transfer and motility MRI which provide greater information on fibrosis and predictors to treatment response which has been lacking despite the use of ileo-colonoscopy for several decades.
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Affiliation(s)
- Fumi Varyani
- NIHR Nottingham Biomedical Medical Centre, Nottingham University Hospitals NHS trust, Nottingham, United Kingdom
| | - Sunil Samuel
- NIHR Nottingham Biomedical Medical Centre, Nottingham University Hospitals NHS trust, Nottingham, United Kingdom.
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9
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MR Imaging Evaluation of Inflammatory Bowel Disease in Children:: Where Are We Now in 2019. Magn Reson Imaging Clin N Am 2019; 27:291-300. [PMID: 30910099 DOI: 10.1016/j.mric.2019.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel disease (IBD) is an important cause of abdominal pain in the pediatric population. Magnetic resonance enterography (MRE) plays a crucial role in assessment of disease severity, location, extent of disease, and assessment for associated complications. As MR imaging technology has advanced, new techniques have been brought into clinical practice. Recent research has expanded our understanding of how the inflammatory processes in IBD manifest on MRE and improved radiology's ability to accurately assess the disease and its associated complications. This article discusses up-to-date MR imaging techniques and imaging manifestations of IBD in pediatric patients.
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10
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Deepak P, Fowler KJ, Fletcher JG, Bruining DH. Novel Imaging Approaches in Inflammatory Bowel Diseases. Inflamm Bowel Dis 2019; 25:248-260. [PMID: 30010908 DOI: 10.1093/ibd/izy239] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Indexed: 12/12/2022]
Abstract
Inflammatory bowel diseases are chronic autoimmune conditions of the gastrointestinal tract, mainly grouped into ulcerative colitis or Crohn's disease. Traditionally, symptoms have been used to guide IBD management, but this approach is fatally flawed, as symptoms don't correlate with disease activity and often fail to predict disease complications, especially with Crohn's disease. Hence, there is increasing recognition of the need for treatment algorithms based on objective measures of bowel inflammation. In this review, we will focus on advancements in the endoscopic and radiological imaging armamentarium that allow detailed assessments from intestinal mucosa to mesentery.
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Affiliation(s)
- Parakkal Deepak
- Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Kathryn J Fowler
- Department of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Joel G Fletcher
- Division of Abdominal Imaging, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
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11
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Faletti R, Ribaldone DG, Gatti M, Perazzini C, Robella M, Angelino F, Saracco GM, Astegiano M, Pellicano R, Fonio P. Apparent diffusion coefficient and enhancement patterns in MR imaging as markers of severe or moderate ileum inflammation in Crohn's disease. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 111:28-33. [PMID: 30284909 DOI: 10.17235/reed.2018.5691/2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE magnetic resonance enterography has been increasingly used for the diagnosis and follow-up of Crohn's disease (CD). The purpose of the study was to compare the apparent diffusion coefficient (ADC) with wall enhancement for the differentiation of severe, moderate or no inflammation activity in the ileum. METHODS a prospective, blinded study was conducted of 46 CD patients with a clinical Crohn's disease activity index (CDAI) ≥ 220 and a simple endoscopic score for Crohn's disease (ES-CD) ≥ 7, which yielded 58 inflamed segments with CD. Twenty controls were also included. All segments were characterized by four ADC readings. The two different enhancement patterns observed in inflamed segments, transmural or mucosal, were associated with severely (23) or moderately (35) active CD. RESULTS the ADC value decreased from 2.79 ± 0.35 x 10-3 mm2/s for normal segments to 1.81 ± 0.39 x 10-3 mm2/s for the moderately inflamed segments and 1.15 ± 0.20 x 10-3 mm2/s for severely inflamed segments (p ≤ 0.0001). ROC curve analysis on the basis of the three ADC distributions showed a very good discrimination capability with an area under the curve of 0.95. Three groups were defined as follows: normal ileum ADC > 2.4 x 10-3 mm2/s, moderate stages of inflammation 1.5 x 10-3 mm2/s < ADC ≤ 2.4 x 10-3 mm2/s and severe stages of ADC ≤ 1.5 x 10-3 mm2/s. CONCLUSIONS the ADC value reliably discriminates between normal and inflamed ileum and also distinguishes between severe and moderate inflammation.
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Affiliation(s)
| | - Davide Giuseppe Ribaldone
- General and Specialistic Medicine/Gastroenterology, Città della Salute e della Scienza di Torino, Italy
| | - Marco Gatti
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Chiara Perazzini
- S.C. Radiologia Universitaria, Università di Torino, Azienda Ospedaliero-Universitaria Città della S
| | - Mattia Robella
- S.C. Radiologia Universitaria, Università di Torino, Azienda Ospedaliero-Universitaria Città della S
| | - Francesca Angelino
- S.C. Radiologia Universitaria, Università di Torino, Azienda Ospedaliero-Universitaria Città della S
| | | | - Marco Astegiano
- Gastroenterologia-U, Città della Salute e della Scienza di Torino, C.so Bramante 88, 10126 Turin, It
| | | | - Paolo Fonio
- S.C. Radiologia Universitaria, Università di Torino, Azienda Ospedaliero-Universitaria Città della S
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12
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Magnetic resonance enterography with oral mannitol solution: Diagnostic efficacy and image quality in Crohn disease. Diagn Interv Imaging 2017; 98:893-899. [DOI: 10.1016/j.diii.2017.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 05/06/2017] [Accepted: 06/01/2017] [Indexed: 12/18/2022]
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13
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Zhu J, Zhang F, Zhou J, Li H. Assessment of therapeutic response in Crohn's disease using quantitative dynamic contrast enhanced MRI (DCE-MRI) parameters: A preliminary study. Medicine (Baltimore) 2017; 96:e7759. [PMID: 28796069 PMCID: PMC5556235 DOI: 10.1097/md.0000000000007759] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The aim of the study was to investigate dynamic contrast enhanced MRI (DCE-MRI) as a potential marker to assess the therapeutic responses of fecal microbiota transplantation (FMT) in patients with Crohn's disease (CD) and to determine the parameter or combination of parameters most strongly associated with changes in clinical indicators after treatment.In 22 CD patients, DCE-MRI was performed with a 3.0T scanner. Parameters of DCE-MRI (vascular transfer constant [K] and blood volume [BV]) in the terminal ileum were compared between before and day 90 after FMT treatment. The differences of clinical indicators (C-reactive protein [CRP], Harvey-Bradshaw index [HBI]) and DCE-MRI parameters (K, BV) between pre- and post-treatment was calculated by Student's 2-tailed, paired t-test. The correlations between percent change of clinical indicators (ΔCRP, ΔHBI) with DCE-MRI parameters (ΔK, ΔBV) were analyzed by Pearson's correlation coefficients. A logistic regression model was used to identify the changes of DCE-MRI parameters related to the treatment outcomes. Receiver operating characteristic curves (ROCs) were generated to assess which DCE-MRI parameter showed the best accuracy for evaluation of therapeutic response.After treatment, mean values of clinical indicators decreased significantly (CRP: 62.68 ± 31.86 vs 43.55 ± 29.63 mg/L, P = .008; HBI: 7.18 ± 2.10 vs 5.73 ± 2.33, P = 0.012). Both DCE-MRI parameters showed prominent differences before and after treatment: K (1.86 ± 0.87 vs 1.39 ± 0.83 min, P = .017), BV (61.02 ± 28.49 vs 41.96 ± 22.75 mL/100 g, P = .005). There were significant correlations between ΔCRP or ΔHBI and percent change of CDE-MRI parameters (ΔK to ΔCRP: 0.659; ΔK to ΔHBI: 0.496; ΔBV to ΔCRP: 0.442; ΔBV to ΔHBI: 0.476). Compared to ΔK and ΔBV individually, the combination of both parameters performed best in assessment of therapeutic response with an area under the ROCs (AUC) of 0.948.K and BV parameters derived from DCE-MRI have the potential to assess for therapeutic response after FMT treatment for CD. The combination of K and BV measurements improved the predictive capability compared to the individual parameters.
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Affiliation(s)
| | - Faming Zhang
- Center of Intestinal Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
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14
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Naffaa L, Deshmukh T, Tumu S, Johnson C, Boyd KP, Meyers AB. Imaging of Acute Pelvic Pain in Girls: Ovarian Torsion and Beyond ☆. Curr Probl Diagn Radiol 2017; 46:317-329. [DOI: 10.1067/j.cpradiol.2016.12.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 12/19/2016] [Indexed: 12/24/2022]
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15
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Khater NH, Fahmy HS, Ali HI. Value of MR enterography in assessment of Crohn’s disease: Correlation with capsule endoscopy and colonoscopy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2016.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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16
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Mantarro A, Scalise P, Guidi E, Neri E. Magnetic resonance enterography in Crohn’s disease: How we do it and common imaging findings. World J Radiol 2017; 9:46-54. [PMID: 28298964 PMCID: PMC5334501 DOI: 10.4329/wjr.v9.i2.46] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 09/10/2016] [Accepted: 12/14/2016] [Indexed: 02/06/2023] Open
Abstract
Crohn’s disease (CD) is a chronic inflammatory disease of the gastrointestinal tract, with unpredictable clinical course by phases of relapses alternating with other of quiescence. The etiology is multifactorial and is still not completely known; globally the westernization of lifestyle is causing an increasing incidence of CD, with peak age of 20-30 years. The diagnostic workup begins with the evaluation of the clinical history, physical examination and laboratory tests. However, the clinical assessment is subjected interobserver variability and, occasionally, the symptoms of acute and chronic inflammation may be indistinguishable. In this regards, the role of magnetic resonance (MR) enterography is crucial to determine the extension, the disease activity and the presence of any complications without ionizing radiations, making this method very suitable for young population affected by CD. The purpose of this review article is to illustrate the MR enterography technique and the most relevant imaging findings of CD, allowing the detection of small bowel involvement and the assessment of disease activity.
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Radmard AR, Hashemi Taheri AP, Salehian Nik E, Kooraki S, Kolahdoozan S, Mirminachi B, Sotoudeh M, Ekhlasi G, Malekzadeh R, Shahbazkhani B. MR enterography in nonresponsive adult celiac disease: Correlation with endoscopic, pathologic, serologic, and genetic features. J Magn Reson Imaging 2017; 46:1096-1106. [DOI: 10.1002/jmri.25646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/10/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
- Amir Reza Radmard
- Department of Radiology, Shariati Hospital; Tehran University of Medical Sciences; Tehran Iran
| | | | - Elham Salehian Nik
- Department of Radiology, Shariati Hospital; Tehran University of Medical Sciences; Tehran Iran
| | - Soheil Kooraki
- Department of Radiology, Shariati Hospital; Tehran University of Medical Sciences; Tehran Iran
| | - Shadi Kolahdoozan
- Autoimmune and Motility Disorders of the Gastro-Intestinal Tract Research Center, Digestive Diseases Research Institute; Tehran University of Medical Sciences; Tehran Iran
| | - Babak Mirminachi
- Autoimmune and Motility Disorders of the Gastro-Intestinal Tract Research Center, Digestive Diseases Research Institute; Tehran University of Medical Sciences; Tehran Iran
| | - Masoud Sotoudeh
- Department of Pathology, Shariati Hospital; Tehran University of Medical Sciences; Tehran Iran
| | - Golnaz Ekhlasi
- Autoimmune and Motility Disorders of the Gastro-Intestinal Tract Research Center, Digestive Diseases Research Institute; Tehran University of Medical Sciences; Tehran Iran
| | - Reza Malekzadeh
- Autoimmune and Motility Disorders of the Gastro-Intestinal Tract Research Center, Digestive Diseases Research Institute; Tehran University of Medical Sciences; Tehran Iran
| | - Bijan Shahbazkhani
- Autoimmune and Motility Disorders of the Gastro-Intestinal Tract Research Center, Digestive Diseases Research Institute; Tehran University of Medical Sciences; Tehran Iran
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18
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Bhatnagar G, Von Stempel C, Halligan S, Taylor SA. Utility of MR enterography and ultrasound for the investigation of small bowel Crohn's disease. J Magn Reson Imaging 2016; 45:1573-1588. [PMID: 27943484 DOI: 10.1002/jmri.25569] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/11/2016] [Indexed: 12/18/2022] Open
Abstract
Cross sectional Imaging plays an increasingly important role the diagnosis and management of Crohn's disease. Particular emphasis is placed on MRI and Ultrasound as they do not impart ionising radiation. Both modalities have reported high sensitivity for disease detection, activity assessment and evaluation of extra-luminal complications, and have positive effects on clinical decision making. International Guidelines now recommend MRI and Ultrasound in the routine management of Crohn's disease patients. This article reviews the current evidence base supporting both modalities with an emphasis on the key clinical questions. We describe current protocols, basic imaging findings and highlight areas in need of further research. LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 4 J. MAGN. RESON. IMAGING 2017;45:1573-1588.
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Affiliation(s)
- Gauraang Bhatnagar
- Frimley Park Hospital NHS Foundation Trust, London, UK.,Centre for Medical Imaging, University College London, London, UK
| | | | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
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Horvat N, Tavares CC, Andrade AR, Cabral JCS, Leao-Filho HM, Caiado AHM, Ueda SKN, Leite AZA, Sipahi AM, Rocha MS. Inter- and intraobserver agreement in computed tomography enterography in inflammatory bowel disease. World J Gastroenterol 2016; 22:10002-10008. [PMID: 28018107 PMCID: PMC5143746 DOI: 10.3748/wjg.v22.i45.10002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 09/08/2016] [Accepted: 09/28/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate intra- and interobserver agreement in imaging features in inflammatory bowel disease and comparison with fecal calprotectin (FC) levels.
METHODS Our institutional computed tomography enterography (CTE) database was retrospectively queried to identify patients who underwent CTE from January 2014 to June 2015. Patient inclusion criteria were confirmed inflammatory bowel disease (IBD) and FC collected < 4 mo after CTE without any change in clinical treatment or surgical treatment during this interval. The exclusion criterion was poor image quality. Two blinded abdominal radiologists, with 12 and 3 years of experience analyzed the CTE regarding localization (small bowel, colonic, both, or no disease detected); type of IBD (inflammatory, stenosing, fistulizing, > 1 pattern, or normal); and signs of active disease (present or absent). In 42 of 44 patients evaluated, routine CTE reports were made by one of the readers who re-evaluated the CTEs ≥ 6 mo later, to determine the intraobserver agreement. FC was considered a sign of disease activity when it was higher than 250 μg/g.
RESULTS Forty-four patients with IBD (38 with Crohn’s disease and 6 with ulcerative colitis) were included. There was a moderate interobserver agreement regarding localization of IBD (κ = 0.540), type of disease (κ = 0.410) and the presence of active signs in CTE (κ = 0.419). There was almost perfect intraobserver agreement regarding localization, type and signs of active disease in IBD. The κ values were 0.902, 0.937 and 0.830, respectively. After a consensus between both radiologists regarding inflammatory activity in CTE, we found that 24 (85.7%) of 28 patients who were classified with active disease had elevated FC, and six (37.5%) of 16 patients without inflammatory activity in CTE had elevated FC (P = 0.003). The correlation between elevated FC and the presence of active disease in CTE was significant (κ = 0.495, P = 0.001).
CONCLUSION We found almost perfect intraobserver and moderate interobserver agreement in the signs of active disease in CTE with concurrence of high FC levels.
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Masselli G, Mastroiacovo I, De Marco E, Francione G, Casciani E, Polettini E, Gualdi G. Current tecniques and new perpectives research of magnetic resonance enterography in pediatric Crohn's disease. World J Radiol 2016; 8:668-82. [PMID: 27551337 PMCID: PMC4965351 DOI: 10.4329/wjr.v8.i7.668] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 03/24/2016] [Accepted: 04/07/2016] [Indexed: 02/06/2023] Open
Abstract
Crohn's disease affects more than 500000 individuals in the United States, and about 25% of cases are diagnosed during the pediatric period. Imaging of the bowel has undergone dramatic changes in the past two decades. The endoscopy with biopsy is generally considered the diagnostic reference standard, this combination can evaluates only the mucosa, not inflammation or fibrosis in the mucosa. Actually, the only modalities that can visualize submucosal tissues throughout the small bowel are the computed tomography (CT) enterography (CTE) with the magnetic resonance enterography (MRE). CT generally is highly utilized, but there is growing concern over ionizing radiation and cancer risk; it is a very important aspect to keep in consideration in pediatric patients. In contrast to CTE, MRE does not subject patients to ionizing radiation and can be used to detect detailed morphologic information and functional data of bowel disease, to monitor the effects of medical therapy more accurately, to detect residual active disease even in patients showing apparent clinical resolution and to guide treatment more accurately.
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21
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Ram R, Sarver D, Pandey T, Guidry CL, Jambhekar KR. Magnetic resonance enterography: A stepwise interpretation approach and role of imaging in management of adult Crohn's disease. Indian J Radiol Imaging 2016; 26:173-84. [PMID: 27413262 PMCID: PMC4931774 DOI: 10.4103/0971-3026.184405] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
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.
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Affiliation(s)
- Roopa Ram
- Department of Radiology, University of Arkansas for Medical Sciences, Arkansas, USA
| | - David Sarver
- Department of Radiology, University of Arkansas for Medical Sciences, Arkansas, USA
| | - Tarun Pandey
- Department of Radiology, University of Arkansas for Medical Sciences, Arkansas, USA
| | - Carey L Guidry
- Department of Radiology, University of Arkansas for Medical Sciences, Arkansas, USA
| | - Kedar R Jambhekar
- Department of Radiology, University of Arkansas for Medical Sciences, Arkansas, USA
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Schieda N, Isupov I, Chung A, Coffey N, Avruch L. Practical applications of balanced steady-state free-precession (bSSFP) imaging in the abdomen and pelvis. J Magn Reson Imaging 2016; 45:11-20. [DOI: 10.1002/jmri.25336] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 05/24/2016] [Indexed: 12/12/2022] Open
Affiliation(s)
- Nicola Schieda
- Ottawa Hospital, University of Ottawa, Department of Medical Imaging; Ottawa Ontario Canada
| | - Inga Isupov
- Ottawa Hospital, University of Ottawa, Department of Medical Imaging; Ottawa Ontario Canada
| | - Andrew Chung
- Ottawa Hospital, University of Ottawa, Department of Medical Imaging; Ottawa Ontario Canada
| | - Niamh Coffey
- Ottawa Hospital, University of Ottawa, Department of Medical Imaging; Ottawa Ontario Canada
| | - Leonard Avruch
- Ottawa Hospital, University of Ottawa, Department of Medical Imaging; Ottawa Ontario Canada
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Gupta MK, Khatri G, Bailey A, Pinho DF, Costa D, Pedrosa I. Endoluminal contrast for abdomen and pelvis magnetic resonance imaging. Abdom Radiol (NY) 2016; 41:1378-98. [PMID: 26907710 DOI: 10.1007/s00261-016-0668-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Magnetic resonance (MR) imaging of the abdomen and pelvis can be limited for assessment of different conditions when imaging inadequately distended hollow organs. Endoluminal contrast agents may provide improved anatomic definition and detection of subtle pathology in such scenarios. The available routes of administration for endoluminal contrast agents include oral, endorectal, endovaginal, intravesicular, and through non-physiologic accesses. Appropriate use of endoluminal contrast agents requires a thorough understanding of the clinical indications, available contrast agents, patient preparation, and interaction of the contrast agent with the desired MR imaging protocol. For example, biphasic oral enteric contrast agents are preferred in MR enterography as their signal properties on T1- and T2-weighted imaging allow for evaluation of both intraluminal and bowel wall pathology. In specific situations such as with MR enterography, MR defecography, and accurate local staging of certain pelvic tumors, the use of an endoluminal contrast agent is imperative in providing adequate diagnostic imaging. In other clinical scenarios, the use of an endoluminal contrast agent may serve as an indispensable problem-solving tool.
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Affiliation(s)
- Mohit K Gupta
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9085, USA
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9085, USA
| | - April Bailey
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9085, USA
| | - Daniella F Pinho
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9085, USA
| | - Daniel Costa
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9085, USA
| | - Ivan Pedrosa
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9085, USA.
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Zhu J, Zhang F, Luan Y, Cao P, Liu F, He W, Wang D. Can Dynamic Contrast-Enhanced MRI (DCE-MRI) and Diffusion-Weighted MRI (DW-MRI) Evaluate Inflammation Disease: A Preliminary Study of Crohn's Disease. Medicine (Baltimore) 2016; 95:e3239. [PMID: 27057860 PMCID: PMC4998776 DOI: 10.1097/md.0000000000003239] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The aim of the study was to investigate diagnosis efficacy of dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted MRI (DW-MRI) in Crohn's disease (CD). To find out the correlations between functional MRI parameters including K, Kep, Ve, Vp, and apparent diffusion coefficient (ADC) with a serologic biomarker. The relationships between pharmacokinetic parameters and ADC were also studied.Thirty-two patients with CD (22 men, 10 women; mean age: 30.5 years) and 18 healthy volunteers without any inflammatory disease (10 men, 8 women; mean age, 34.11 years) were enrolled into this approved prospective study. Pearson analysis was used to evaluate the correlation between K, Kep, Ve, Vp, and C-reactive protein (CRP), ADC, and CRP respectively. The diagnostic efficacy of the functional MRI parameters in terms of sensitivity and specificity were analyzed by receiver operating characteristic (ROC) curve analyses. Optimal cut-off values of each functional MRI parameters for differentiation of inflammatory from normal bowel were determined according to the Youden criterion.Mean value of K in the CD group was significantly higher than that of normal control group. Similar results were observed for Kep and Ve. On the contrary, the ADC value was lower in the CD group than that in the control group. K and Ve were shown to be correlated with CRP (r = 0.725, P < 0.001; r = 0.533, P = 0.002), meanwhile ADC showed negative correlation with CRP (r = -0.630, P < 0.001). There were negative correlations between the pharmacokinetic parameters and ADC, such as K to ADC (r = -0.856, P < 0.001), and Ve to ADC (r = -0.451, P = 0.01). The area under the curve (AUC) was 0.994 for K (P < 0.001), 0.905 for ADC (P < 0.001), 0.806 for Ve (P < 0.001), and 0.764 for Kep (P = 0.002). The cut-off point of the K was found to be 0.931 min. This value provided the best trade-off between sensitivity (93.8%) and specificity (100%). The best cut-off point of ADC was 1.11 × 10 mm/s. At this level, sensitivity was 100% and specificity was 68.8%.DCE-MRI and DW-MRI were helpful in the diagnosis of CD. Quantitative MRI parameters could be used to assess the severity of inflammation. The relationships between pharmacokinetic parameters (K and Ve) and ADC reflected microstructure and microcirculation of CD to some extent.
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Affiliation(s)
- Jianguo Zhu
- From the Department of Radiology (JZhu, DWang), The First Affiliated Hospital of Nanjing Medical University; Department of Gastroenterology (FZhang), The Second Affiliated Hospital of Nanjing Medical University; Department of Ultrasound (YLuan), Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing; GE HealthCare (China) (PCao), Shanghai; and Department of Radiology (JZhu, FLiu, WHe), The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
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25
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Pellino G, Nicolai E, Catalano OA, Campione S, D'Armiento FP, Salvatore M, Cuocolo A, Selvaggi F. PET/MR Versus PET/CT Imaging: Impact on the Clinical Management of Small-Bowel Crohn's Disease. J Crohns Colitis 2016; 10:277-85. [PMID: 26574490 PMCID: PMC4957472 DOI: 10.1093/ecco-jcc/jjv207] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/03/2015] [Accepted: 11/06/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The aim of this study was to compare the accuracy and clinical impact of hybrid positron emission tomography [PET]/magnetic resonance-enterography [MR-E] and PET/computed tomography-enterography [CT-E] in patients with Crohn's disease [CD]. METHODS A total of 35 patients with symptomatic small-bowel CD who were scheduled to undergo operation were evaluated before operation by same-day PET/CT-E and PET/MR-E. PET/MR-E was also compared with MR-E alone. Imaging accuracy for detecting pathological sites and discriminating between fibrotic and inflammatory strictures was assessed. Treatment was adjusted according to imaging findings and change in medical/surgical strategy was also evaluated. RESULTS PET/CT-E, PET/MR-E, and MR-E were equally accurate in detecting CD sites. PET/MR-E was more accurate in assessing extra-luminal disease [p = 0.002], which was associated with higher need for stoma [p = 0.022] and distant localisation [p = 0.002]. When the latter was observed, laparoscopy was started with hand-assisted device, reducing operative time [p = 0.022]. PET/MR-E was also more accurate in detecting a fibrotic component compared with PET/CT-E [p = 0.043] and with MR-E [p = 0.024]. Fibrosis was more frequently classified as inflammation with MR-E compared with PET/MR-E [p = 0.019]. Out of 8 patients with predominantly inflammatory CD who received medical treatment, 6 [75%] remained surgery free. Overall, 29 patients received surgery. At median follow-up of 9 [6-22] months, no recurrences occurred in either the medical or the surgical group. CONCLUSIONS Preoperative PET/MR-E imaging is highly accurate for assessing CD lesions before operation and contributed to clinical management of patients with small-bowel CD more often than PET/CT-E.
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Affiliation(s)
- Gianluca Pellino
- Unit of Colorectal Surgery, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy
| | | | - Onofrio A Catalano
- Department of Radiology, Harvard medical school, Massachusetts General Hospital, Boston, MA
| | - Severo Campione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Francesco P D'Armiento
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Francesco Selvaggi
- Unit of Colorectal Surgery, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy
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26
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Abstract
Over the past decade, magnetic resonance (MR) enterography has become established as the first-line imaging test for patients with Crohn׳s disease. This article reviews the role of MR enterography in assessing the extent and activity of Crohn׳s disease at baseline and on treatment follow-up. It discusses the role of diffusion-weighted imaging, and the recent introduction of MR scoring systems to facilitate noninvasive objective assessment of disease activity and cumulative bowel damage.
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Affiliation(s)
- Olwen Westerland
- Department of Radiology, Guy׳s and St Thomas׳ NHS Foundation Trust, London, UK
| | - Nyree Griffin
- Department of Radiology, Guy׳s and St Thomas׳ NHS Foundation Trust, London, UK.
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27
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Das CJ, Manchanda S, Panda A, Sharma A, Gupta AK. Recent Advances in Imaging of Small and Large Bowel. PET Clin 2016; 11:21-37. [DOI: 10.1016/j.cpet.2015.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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28
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Mansoori B, Delaney CP, Willis JE, Paspulati RM, Ros PR, Schmid-Tannwald C, Herrmann KA. Magnetic resonance enterography/enteroclysis in acquired small bowel diverticulitis and small bowel diverticulosis. Eur Radiol 2015; 26:2881-91. [PMID: 26597545 DOI: 10.1007/s00330-015-4098-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 08/10/2015] [Accepted: 10/28/2015] [Indexed: 12/27/2022]
Abstract
PURPOSE Small bowel (SB) diverticulosis is a rare disorder that may entail serious complications, including SB diverticulitis. Both are often missed in imaging. Magnetic resonance enterography/enteroclysis (MRE) is increasingly used to assess SB disease; awareness of the appearance of SB diverticulitis is essential to ensure appropriate management. Our aim was to systematically describe imaging characteristics of SB diverticulosis and diverticulitis in MRE. METHODS This retrospective, HIPAA-compliant study identified 186 patients with suspected SB diverticulosis/diverticulitis in medical databases of two tertiary medical centres between 2005 and 2011. Patients with surgically confirmed diagnoses of SB diverticulosis/diverticulitis were included. Two observers analyzed MR images for the presence, location, number, and size of diverticula, wall thickness, and mural and extramural patterns of inflammation. RESULTS Seven patients were recruited. MRI analysis showed multiple diverticula in all (100 %). Diverticular size ranged from 0.5 to 6 cm. Prevalence of diverticula was higher in the proximal than the distal SB (jejunum 86 %, ileum 57 %, distal ileum43%). Diverticulitis occurred in 3/7 patients (43 %) showing asymmetric bowel wall thickening and focal mesenteric inflammation. CONCLUSION SB diverticulitis demonstrates characteristic MRE imaging features to distinguish this rare disorder from more common diseases. Asymmetric, focal mesenteric and mural inflammation and presence of multiple diverticula are keys to diagnosis. KEY POINTS • Small bowel diverticulosis and diverticulitis is rare and often missed in imaging • Acquired small bowel diverticula are variable in size and number • Small bowel diverticulitis demonstrates characteristic features on MR enterography/enteroclysis • A focal or segmental asymmetric small bowel inflammation should prompt the search for diverticula.
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Affiliation(s)
- Bahar Mansoori
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Conor P Delaney
- Department of Surgery, Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Joseph E Willis
- Department of Pathology, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Raj M Paspulati
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH, USA.,Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Pablo R Ros
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH, USA.,Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | | | - Karin A Herrmann
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH, USA. .,Department of Radiology, Case Western Reserve University, Cleveland, OH, USA. .,University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
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29
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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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Ravindran S, Barlow N, Dunk A, Howlett D. Magnetic resonance enterography: a pictorial review of Crohn's disease. Br J Hosp Med (Lond) 2015; 76:444-9. [PMID: 26255913 DOI: 10.12968/hmed.2015.76.8.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Use of magnetic resonance enterography has significantly increased and its role as an adjunct to ileocolonoscopy is best practice, particularly in the evaluation of Crohn's disease. This article reviews magnetic resonance enterography, and describes common findings related to Crohn's disease and unexpected extra-intestinal findings.
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Affiliation(s)
- Srivathsan Ravindran
- Gastroenterology Specialist Registrar in the Department of Gastroenterology, Royal Sussex County Hospital, Brighton BN2 5BE
| | | | - Arthur Dunk
- Gastroenterologist in the Department of Gastroenterology
| | - David Howlett
- Radiologist in the Department of Radiology, Eastbourne District General Hospital, Eastbourne
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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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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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Qi F, Jun S, Qi QY, Chen PJ, Chuan GX, Jiong Z, Rong XJ. Utility of the diffusion-weighted imaging for activity evaluation in Crohn's disease patients underwent magnetic resonance enterography. BMC Gastroenterol 2015; 15:12. [PMID: 25653007 PMCID: PMC4323053 DOI: 10.1186/s12876-015-0235-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 01/19/2015] [Indexed: 02/07/2023] Open
Abstract
Background Cross-sectional imaging techniques as magnetic resonance enterography (MRE) may offer additional information on transmural inflammation, stricturing and fistulising complications in Crohn’s disease (CD). The purpose of our study was to evaluate the diagnostic accuracy of Magnetic Resonance Imaging (MRI) combined with Diffusion-weighted Imaging (DWI) and MRE for determination of inflammation in small bowel CD. Methods MR imaging examination was performed with a GE Signa EXCITE 3.0 T MRI scanner. The optimal b value in DWI with a learning cohort of patients was determined. The diagnostic accuracy for active lesions and disease activity were accessed by MRE combined with DWI. Results The b value 800 s/mm2 group showed the highest diagnostic sensitivity (74.19%) for diagnostic assessment of active Crohn’s lesions on DWI. MRE combined with DWI showed the highest sensitivity (93.55%), specificity (89.47%) and diagnostic accuracy (92%) compared with MRE or DWI alone. The segmental MR score (MR-score-S) showed a significantly positive correlation with the Capsule Endoscopy Crohn’s Disease Activity Index Score (CECDAI-S) (r = 0.717, p < 0.01). The total MR score (MR-score-T) showed significant association with C-reactive protein (CRP) (r = 0.445, p = 0.019) and erythrocyte sedimentation rate (ESR) (r = 0.688, p < 0.01). Conclusions MRE combined with DWI improves the diagnostic accuracy for active lesions and correlates the endoscopic disease activity. MRE with DWI could represent a non-invasive tool in assessing active inflammation in CD.
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Affiliation(s)
- Feng Qi
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Shen Jun
- Shanghai Institute of Digestive Disease, Shanghai Inflammatory Bowel Disease Research Center, Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Qiao Yu Qi
- Shanghai Institute of Digestive Disease, Shanghai Inflammatory Bowel Disease Research Center, Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Peng Jiang Chen
- Shanghai Institute of Digestive Disease, Shanghai Inflammatory Bowel Disease Research Center, Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Geng Xiao Chuan
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Zhu Jiong
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Xu Jian Rong
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Al-Hawary MM, Zimmermann EM, Hussain HK. MR imaging of the small bowel in Crohn disease. Magn Reson Imaging Clin N Am 2014; 22:13-22. [PMID: 24238129 DOI: 10.1016/j.mric.2013.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
MR enterography has an established role in evaluating patients with Crohn disease providing essential complementary information to clinical assessment, and as an indispensible adjunct to clinical tools such as colonoscopy. MR enterography examinations can establish the diagnosis of Crohn disease, evaluate disease activity and complications, and assess treatment response, thus providing support for clinical decision-making. Currently, MR imaging findings are highly predictive of tissue inflammation and can be used clinically to guide clinical care.
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Affiliation(s)
- Mahmoud M Al-Hawary
- Department of Radiology, University of Michigan Hospitals, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Smolinski S, George M, Dredar A, Hayes C, Rakita D. Magnetic resonance enterography in evaluation and management of children with Crohn's disease. Semin Ultrasound CT MR 2014; 35:331-48. [PMID: 25129211 DOI: 10.1053/j.sult.2014.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The role of radiologic evaluation in Crohn's disease (CD) has undergone a recent paradigm shift in which the radiologist adds value to the multidisciplinary team by longitudinally assessing therapeutic response and identifying treatment-modifying subtypes, such as fibrostenotic or fistulizing disease. Magnetic resonance enterography (MRE) has become the primary imaging modality used. The combination of multiplanar, multiparametric, and multiphasic contrast-enhanced imaging with the high spatial resolution and very high tissue contrast of MR imaging allows for detailed evaluation of intra-abdominal pathology, without the risk of cumulative radiation exposure. MRE provides the benefit of a complete evaluation of mural, extramural, and even extraintestinal manifestations and complications of CD in a single examination. Cine motility sequences and diffusion-weighted imaging may further increase sensitivity and specificity. MRE represents an ideal imaging modality for initial evaluation, assessment of therapeutic response, and evaluation of complications in patients with CD.
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Affiliation(s)
- Sara Smolinski
- Department of Radiology, Baystate Medical Center, Springfield, MA.
| | - Michael George
- Department of Radiology, Baystate Medical Center, Springfield, MA
| | | | - Christopher Hayes
- Department of Pediatric Gastroenterology and Nutrition, Baystate Medical Center, Springfield, MA
| | - Dmitry Rakita
- Department of Radiology, Baystate Medical Center, Springfield, MA
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Outcomes of computed tomography and magnetic resonance enterography in clinical practice of inflammatory bowel disease. Dig Dis Sci 2014; 59:838-49. [PMID: 24323180 DOI: 10.1007/s10620-013-2964-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 11/15/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Computed tomography (CT) and magnetic resonance (MR) enterography are now widely used to diagnose and monitor Crohn's disease. AIM We sought to assess the use of enterography for management of inflammatory bowel disease (IBD) in our medical center. METHODS We performed a retrospective review of all patients diagnosed with IBD who underwent MR or CT enterography from November 1, 2010 to October 25, 2012 at our institution. We assessed disease complications identified by enterography, agreement between disease activity determined by endoscopy and enterography, association between inflammatory markers and enterography-determined disease activity and recommended changes in medical and surgical management following enterography. RESULTS A total of 311 enterography studies (291 MR and 20 CT enterographies) were performed on 270 patients, including 258 (83.0 %) on patients with presumed Crohn's disease and 53 (17.0 %) with presumed ulcerative colitis. Active small bowel (SB) disease was noted in 73/311 (23.5 %) studies. Complications including strictures, perianal fistulas, abscesses and SB fistulas were noted in 108/311 (34.7 %) studies. Endoscopic and enterography defined active disease had an agreement of κ = 0.36 in the ileum (n = 179). A total of 142/311 (45.7 %) enterographies were associated with recommended medication changes within 90 days while surgery or endoscopic dilation of stricture was recommended following 41/311 (13.2 %) enterographies. Enterography resulted in a change in diagnosis from ulcerative colitis to Crohn's in 5/311 (1.6 %) studies. CONCLUSION Enterography reveals active disease and complications not evident on endoscopy and should be considered in the initial diagnosis, assessment of disease activity, and monitoring of therapy in patients with IBD.
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Grading Crohn disease activity with MRI: interobserver variability of MRI features, MRI scoring of severity, and correlation with Crohn disease endoscopic index of severity. AJR Am J Roentgenol 2014; 201:1220-8. [PMID: 24261360 DOI: 10.2214/ajr.12.10341] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this article is to assess the interobserver variability for scoring MRI features of Crohn disease activity and to correlate two MRI scoring systems to the Crohn disease endoscopic index of severity (CDEIS). MATERIALS AND METHODS Thirty-three consecutive patients with Crohn disease undergoing 3-T MRI examinations (T1-weighted with IV contrast medium administration and T2-weighted sequences) and ileocolonoscopy within 1 month were independently evaluated by four readers. Seventeen MRI features were recorded in 143 bowel segments and were used to calculate the MR index of activity and the Crohn disease MRI index (CDMI) score. Multirater analysis was performed for all features and scoring systems using intraclass correlation coefficient (icc) and kappa statistic. Scoring systems were compared with ileocolonoscopy with CDEIS using Spearman rank correlation. RESULTS Thirty patients (median age, 32 years; 21 women and nine men) were included. MRI features showed fair-to-good interobserver variability (intraclass correlation coefficient or kappa varied from 0.30 to 0.69). Wall thickness in millimeters, presence of edema, enhancement pattern, and length of the disease in each segment showed a good interobserver variability between all readers (icc = 0.69, κ = 0.66, κ = 0.62, and κ = 0.62, respectively). The MR index of activity and CDMI scores showed good reproducibility (icc = 0.74 and icc = 0.78, respectively) and moderate CDEIS correlation (r = 0.51 and r = 0.59, respectively). CONCLUSION The reproducibility of individual MRI features overall is fair to good, with good reproducibility for the most commonly used features. When combined into the MR index of activity and CDMI score, overall reproducibility is good. Both scores show moderate agreement with CDEIS.
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Sinha R, Rajiah P, Ramachandran I, Sanders S, Murphy PD. Diffusion-weighted MR imaging of the gastrointestinal tract: technique, indications, and imaging findings. Radiographics 2014; 33:655-76; discussion 676-80. [PMID: 23674768 DOI: 10.1148/rg.333125042] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Diffusion-weighted magnetic resonance (MR) imaging has emerged as an important tool in the diagnostic work-up of patients with bowel cancer and inflammatory conditions of the gastrointestinal tract. It functions on the basis of the microscopic motion of water molecules in a cellular environment and provides functional information about the water in body tissues. Diffusion-weighted imaging serves to complement conventional MR imaging, and its use may improve the accuracy of tumor detection and staging. It does not rely on the use of intravenous contrast material and may be performed in patients with renal impairment. Because it provides quantitative information about tissue cellularity, diffusion-weighted imaging may be used to distinguish between tissues with altered cellularity (eg, tumors and metastases) and normal tissues. Data from diffusion-weighted MR images enable the calculation of apparent diffusion coefficient (ADC) values, which provide useful information about response to treatment. Malignant gastrointestinal tract tumors have low ADC values, which increase after successful therapy. Diffusion-weighted imaging also plays a role in the evaluation of patients with inflammatory bowel disease and may help assess inflammation and complications, such as abscesses and fistulas. Quantitative measurements of signal intensity at diffusion-weighted imaging may help differentiate actively inflamed bowel from normal bowel, and ADC values provide useful information about disease activity and response to treatment.
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Affiliation(s)
- Rakesh Sinha
- Departments of Clinical Radiology, GI Unit, Warwick Hospital, South Warwickshire NHS Foundation Trust, Warwick, England CV34 5BW. rakslide@ gmail.com
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Yacoub JH, Obara P, Oto A. Evolving role of MRI in Crohn's disease. J Magn Reson Imaging 2014; 37:1277-89. [PMID: 23712842 DOI: 10.1002/jmri.24081] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 01/22/2013] [Indexed: 12/18/2022] Open
Abstract
MR enterography is playing an evolving role in the evaluation of small bowel Crohn's disease (CD). Standard MR enterography includes a combination of rapidly acquired T2 sequence, balanced steady-state acquisition, and contrast enhanced T1-weighted gradient echo sequence. The diagnostic performance of these sequences has been shown to be comparable, and in some respects superior, to other small bowel imaging modalities. The findings of CD on MR enterography have been well described in the literature. New and emerging techniques such as diffusion-weighted imaging (DWI), dynamic contrast enhanced MRI (DCE-MRI), cinematography, and magnetization transfer, may lead to improved accuracy in characterizing the disease. These advanced techniques can provide quantitative parameters that may prove to be useful in assessing disease activity, severity, and response to treatment. In the future, MR enterography may play an increasing role in management decisions for patients with small bowel CD; however, larger studies are needed to validate these emerging MRI parameters as imaging biomarkers.
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Affiliation(s)
- Joseph H Yacoub
- Department of Radiology, University of Chicago, Chicago, Illinois 60637, USA
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Diagnostic accuracy of high-resolution MR enterography in Crohn's disease: Comparison with surgical and pathological specimen. Clin Radiol 2013; 68:917-27. [DOI: 10.1016/j.crad.2013.02.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 02/13/2013] [Accepted: 02/27/2013] [Indexed: 12/18/2022]
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Abstract
This article addresses the current technique and protocols for magnetic resonance (MR) enterography, with a primary focus on inflammatory bowel disease (IBD) and a secondary detailed discussion of other diseases of the small bowel beyond IBD. A brief discussion of MR imaging for appendicitis is included, but the evaluation of appendicitis does not require an enterographic protocol. The focused key points and approach presented in this article are intended to enhance the reader's understanding to help improve patient compliance with the MR enterographic studies, overcome challenges, and improve interpretation.
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Nonneoplastic Diseases of the Small Intestine: Differential Diagnosis and Crohn Disease. AJR Am J Roentgenol 2013; 201:W174-82. [DOI: 10.2214/ajr.12.8495] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
The occurrence of strictures as a complication of Crohn's disease is a significant clinical problem. No specific antifibrotic therapies are available. This systematic review comprehensively addresses the pathogenesis, epidemiology, prediction, diagnosis and therapy of this disease complication. We also provide specific recommendations for clinical practice and summarise areas that require future investigation.
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Affiliation(s)
- Florian Rieder
- Department of Pathobiology, Lerner Research Institute, NC22, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Ellen M Zimmermann
- Division of Gastroenterology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Feza H Remzi
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
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Pesce Lamas Constantino C, Souza Rodrigues R, Araujo Oliveira Neto J, Marchiori E, Eiras Araujo AL, Perez RDM, Braz Parente D. Computed tomography and magnetic resonance enterography findings in Crohn's disease: what does the clinician need to know from the radiologist? Can Assoc Radiol J 2013; 65:42-51. [PMID: 23706867 DOI: 10.1016/j.carj.2012.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 10/24/2012] [Accepted: 11/02/2012] [Indexed: 12/22/2022] Open
Abstract
The purpose of this pictorial essay was to discuss and illustrate computed tomography and magnetic resonance enterography findings in patients with Crohn's disease. These noninvasive and easily performed methods for the evaluation of Crohn's disease are useful for differentiating between active and fibrotic bowel disease, and can help to guide treatment (medical vs surgical). Although inflammatory and fibrostenotic findings of Crohn's disease may overlap, computed tomography and magnetic resonance enterography can help to identify the presence, extent, and severity of active inflammation that may respond to medical therapy, and the existence of fistulas and fibrostenosis that may benefit from surgical management.
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Affiliation(s)
- Carolina Pesce Lamas Constantino
- Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Abdominal Imaging, Dimagem diagnostico por imagem, Rio de Janeiro, Brazil.
| | - Rosana Souza Rodrigues
- Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Radiology, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | | | - Edson Marchiori
- Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Antonio Luis Eiras Araujo
- Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Radiology, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Renata de Mello Perez
- Department of Clinic and Hepatology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Daniella Braz Parente
- Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Radiology, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
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Small Bowel Imaging: Clinical Applications of the Different Imaging Modalities—A Comprehensive Review. ACTA ACUST UNITED AC 2013. [DOI: 10.1155/2013/419542] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In the last years, MR and CT techniques have been optimized for small bowel imaging and are playing an increasing role in the evaluation of small bowel disorders. In comparison to traditional barium fluoroscopic examinations, spatial and temporal resolution is now much more improved partially thanks to modern bowel distending agents. However, there is a global interest in implementing techniques that either reduce or eliminate radiation exposure. This is especially important in patients with chronic diseases such as inflammatory bowel disease who may require multiple studies over a lifetime. Owing to the excellent soft tissue contrast, direct multiplanar imaging capabilities, new ultrafast breath-holding pulse sequences, lack of ionizing radiation, and availability of a variety of oral contrast agents, MR is well suited to play a critical role in the imaging of small bowel disorders.
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Lai C, Zhou HC, Ma M, Zhang HX, Jia X. Comparison of magnetic resonance enterography, capsule endoscopy and gastrointestinal radiography of children with small bowel Crohn's disease. Exp Ther Med 2013; 6:115-120. [PMID: 23935731 PMCID: PMC3735909 DOI: 10.3892/etm.2013.1113] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 04/22/2013] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to compare magnetic resonance enterography (MRE) findings with those of video capsule endoscopy (VCE) or conventional gastrointestinal radiography (CGR) in pediatric patients with small bowel Crohn's disease. A total of 55 cases of small bowel Crohn's disease that were diagnosed through clinical, laboratory, surgical and histopathological findings were reviewed. Prior to the examination, children suspected of having other types of diseases of the small intestinal were identified. The pulse sequences included coronal T2-true-fast imaging with steady-state precession (TrueFISP) images, navigation axial and coronal T1-weighted images, T2-weighted fat-suppressed images and coronal fat-suppressed three-dimensional gradient-echo images, immediately followed by contrast-enhanced axial and coronal T1-weighted fat-suppressed images. Findings from MRE were compared with those of VCE (n=39) and CGR (n=37). MRE results exhibited a number of features characteristic to small bowel Crohn's disease, including wall thickening, mesenteric fibrofatty changes and mesenteric vasculature changes. VCE, MRE and CGR demonstrated sensitivities of 94.6, 85.7 and 71.1% with specificities of 72.7, 70 and 40%; accuracies of 89.6, 82.2 and 61.1%; positive predictive values of 92.1, 90.9 and 59.6%; and negative predictive values of 80, 58.3 and 40%, respectively. VCE depicted mucosal pathologies missed by MRE in three patients. MRE revealed 83 extraenteric findings in 55 patients and CGR was able to show the dynamic evolution of the gastrointestinal function. MRE is a simple, safe, non-invasive and effective method for evaluating small bowel Crohn's disease. VCE allows visualization and readily characterizes subtle mucosal lesions missed by MRE, whereas MRE yields additional mural, perienteric and extraenteric information. However, oral barium CGR utilizes radiation, which is not suitable for repeated use in children.
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Affiliation(s)
- Can Lai
- Departments of Radiology, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, P.R. China
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Abstract
PURPOSE To compare the efficacy and patients' tolerance of a new mixed biphasic oral contrast solution with routine biphasic oral contrast agent in magnetic resonance (MR) enterography (MRE). MATERIALS AND METHODS Thirty-seven patients (group 1) had MRE with the new mixture, whereas 14 patients (group 2) had MRE with biphasic oral contrast agent (lactulose). Magnetic resonance enterography images were evaluated by 2 experienced radiologists. Each intestinal segment was evaluated for luminal distension (LD), distinction from the surrounding tissue (wall conspicuity), and the confidence of radiologist for evaluation of the specified segment (radiological evaluation confidence). Comparisons between the 2 groups were performed using the Mann-Whitney U test. Interrater and intrarater agreement values were obtained. In addition, patients' acceptability and tolerance were assessed. RESULTS The new mixture was more effective than the oral contrast agent used in group 2 for LD, wall conspicuity, and radiological confidence. The values of interrater and intrarater agreement in scoring LD, wall conspicuity, and radiological confidence were generally moderate. CONCLUSION Our new mixture allowed good-quality enterographic images, and this solution was well tolerated by patients. In addition, this mixture is useful for evaluation of small bowels and colonic segments. We suggest the use of it for enterographic examinations.
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Amzallag-Bellenger E, Soyer P, Barbe C, Diebold MD, Cadiot G, Hoeffel C. Prospective evaluation of magnetic resonance enterography for the detection of mesenteric small bowel tumours. Eur Radiol 2013; 23:1901-10. [PMID: 23479221 DOI: 10.1007/s00330-013-2800-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 01/25/2013] [Indexed: 01/03/2023]
Abstract
PURPOSE To prospectively evaluate magnetic resonance (MR) enterography for detecting mesenteric small-bowel tumours (MSBTs) and assess the added value of gadolinium-chelate injection. MATERIAL AND METHODS Over a 2-year period MR enterography examinations of 75 patients (33 men, 42 women; mean age, 53.8 years; range, 19-85) with suspected MSBT were blindly analysed by two readers for the presence of MSBT. Sensitivities, specificities, predictive positive values (PPVs), negative predictive values (NPVs) and accuracies of MR enterography for the detection of MSBT were calculated on per-patient and per-lesion bases. The McNemar test was used to compare sensitivities and specificities of the unenhanced and gadolinium-enhanced sets of MR enterographies. RESULTS Thirty-seven MSBTs were pathologically confirmed in 26 patients. The mean tolerance score of the examinations was 0.7. On a per-patient basis, sensitivity, specificity, PPV, NPV and accuracy for detection of MSBT were 96 % [95 % CI, 89-100 %], 96 % [90-100 %], 93 % [83-100 %], 98 % [94-100 %] and 96 % [92-100 %], respectively. On a per-lesion basis, sensitivity and PPV were 70 % [56-85 %] and 93 % [83-100 %], respectively. Gadolinium injection yielded higher sensitivities on both bases (P = 0.008). CONCLUSION MR enterography is an accurate and well-tolerated imaging modality for detecting MSBT. Intravenous administration of gadolinium-chelate improves sensitivity for MSBT detection. KEY POINTS • MR enterography accurately detects mesenteric small bowel tumours. • MR enterography is a well-tolerated imaging technique. • Intravenous administration of gadolinium chelate improves sensitivity for detecting small-bowel tumours.
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Affiliation(s)
- Elisa Amzallag-Bellenger
- Department of Radiology, Hôpital Robert Debré, Avenue du Général Koenig, 51092 Reims Cedex, France.
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