Skip to main content
Top

03-02-2025 | Crohn's Disease | Review

MR enterography in Crohns disease and beyond: a pictorial review

Beyond Crohn’s: a pictorial guide to MR enterography in small bowel disease

Authors: Chandan Kakkar, Pietro Andrea Bonaffini, Arshdeep Singh, Vikram Narang, Ramit Mahajan, Shruti Verma, Saurabh Singla, Ajit Sood

Published in: Abdominal Radiology

Login to get access

Abstract

Magnetic resonance enterography (MRE) has become an essential imaging modality for evaluating small bowel disorders, particularly Crohn’s disease (CD), due to its superior soft-tissue contrast, multiplanar capabilities, and lack of ionizing radiation. While radiologists are generally familiar with the MRE findings of CD, several other small bowel entities can present with similar imaging features, potentially leading to diagnostic challenges. This pictorial review comprehensively illustrates the MRE findings of CD and its various mimickers, including Ulcerative colitis (UC), intestinal tuberculosis (ITB), Non-steroidal anti-inflammatory drug (NSAID) induced enteropathy, cryptogenic multifocal ulcerating and stenosing enteropathy (CMUSE), celiac disease, gastrointestinal endometriosis, intestinal lipomatosis, lymphangiectasia, eosinophilic enteritis, encapsulating peritoneal sclerosis, adhesions, radiation enteropathy, and intestinal angioedema etc. We discuss the key imaging features that can help a radiologist differentiate these conditions, highlight specific MRE sequences useful for diagnosis, and provide clinically relevant context for each entity. This review serves as a practical guide for radiologists and clinicians in recognizing and distinguishing various small bowel pathologies that may simulate CD on MRE, ultimately aiding in appropriate patient management.

Graphical abstract

Literature
5.
go back to reference Bruining DH, Zimmermann EM, Loftus EV Jr, Sandborn WJ, Sauer CG, Strong SA; Society of Abdominal Radiology Crohn’s Disease-Focused Panel. Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn’s Disease. Radiology. 2018;286(3):776–799. doi: https://doi.org/10.1148/radiol.2018171737. Epub 2018 Jan 10. PMID: 29319414. Bruining DH, Zimmermann EM, Loftus EV Jr, Sandborn WJ, Sauer CG, Strong SA; Society of Abdominal Radiology Crohn’s Disease-Focused Panel. Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn’s Disease. Radiology. 2018;286(3):776–799. doi: https://​doi.​org/​10.​1148/​radiol.​2018171737. Epub 2018 Jan 10. PMID: 29319414.
6.
go back to reference Ordás I, Rimola J, Rodríguez S, Paredes JM, Martínez-Pérez MJ, Blanc E, Arévalo JA, Aduna M, Andreu M, Radosevic A, Ramírez-Morros AM, Pinó S, Gallego M, Jauregui-Amezaga A, Ricart E, Panés J. Accuracy of magnetic resonance enterography in assessing response to therapy and mucosal healing in patients with Crohn’s disease. Gastroenterology. 2014;146(2):374– 82.e1. doi: https://doi.org/10.1053/j.gastro.2013.10.055. Epub 2013 Oct 29. PMID: 24177375. Ordás I, Rimola J, Rodríguez S, Paredes JM, Martínez-Pérez MJ, Blanc E, Arévalo JA, Aduna M, Andreu M, Radosevic A, Ramírez-Morros AM, Pinó S, Gallego M, Jauregui-Amezaga A, Ricart E, Panés J. Accuracy of magnetic resonance enterography in assessing response to therapy and mucosal healing in patients with Crohn’s disease. Gastroenterology. 2014;146(2):374– 82.e1. doi: https://​doi.​org/​10.​1053/​j.​gastro.​2013.​10.​055. Epub 2013 Oct 29. PMID: 24177375.
7.
go back to reference Sinha R, Murphy P, Sanders S, Ramachandran I, Hawker P, Rawat S, Roberts S. Diagnostic accuracy of high-resolution MR enterography in Crohn’s disease: comparison with surgical and pathological specimen. Clin Radiol. 2013;68(9):917–27. doi: 10.1016/j.crad.2013.02.012. Epub 2013 Apr 25. PMID: 23622798.CrossRefPubMed Sinha R, Murphy P, Sanders S, Ramachandran I, Hawker P, Rawat S, Roberts S. Diagnostic accuracy of high-resolution MR enterography in Crohn’s disease: comparison with surgical and pathological specimen. Clin Radiol. 2013;68(9):917–27. doi: 10.1016/j.crad.2013.02.012. Epub 2013 Apr 25. PMID: 23622798.CrossRefPubMed
8.
go back to reference Bettenworth D, Bokemeyer A, Baker M, Mao R, Parker CE, Nguyen T, Ma C, Panés J, Rimola J, Fletcher JG, Jairath V, Feagan BG, Rieder F; Stenosis Therapy and Anti-Fibrotic Research (STAR) Consortium. Assessment of Crohn’s disease-associated small bowel strictures and fibrosis on cross-sectional imaging: a systematic review. Gut. 2019;68(6):1115–1126. doi: https://doi.org/10.1136/gutjnl-2018-318081. Epub 2019 Apr 3. PMID: 30944110; PMCID: PMC6580870.CrossRefPubMed Bettenworth D, Bokemeyer A, Baker M, Mao R, Parker CE, Nguyen T, Ma C, Panés J, Rimola J, Fletcher JG, Jairath V, Feagan BG, Rieder F; Stenosis Therapy and Anti-Fibrotic Research (STAR) Consortium. Assessment of Crohn’s disease-associated small bowel strictures and fibrosis on cross-sectional imaging: a systematic review. Gut. 2019;68(6):1115–1126. doi: https://​doi.​org/​10.​1136/​gutjnl-2018-318081. Epub 2019 Apr 3. PMID: 30944110; PMCID: PMC6580870.CrossRefPubMed
9.
go back to reference Lambrou T, Chaudhry NA, Grajo JR, Moser P, Riverso M, Mramba LK, Zimmermann EM. Small bowel stricture is associated with abnormal motility on the cine MRI sequence in patients with Crohn’s disease. Eur J Radiol. 2019;118:264–270. doi: 10.1016/j.ejrad.2019.08.001. Epub 2019 Aug 2. PMID: 31439253.CrossRefPubMed Lambrou T, Chaudhry NA, Grajo JR, Moser P, Riverso M, Mramba LK, Zimmermann EM. Small bowel stricture is associated with abnormal motility on the cine MRI sequence in patients with Crohn’s disease. Eur J Radiol. 2019;118:264–270. doi: 10.1016/j.ejrad.2019.08.001. Epub 2019 Aug 2. PMID: 31439253.CrossRefPubMed
10.
go back to reference Dohan A, Taylor S, Hoeffel C, Barret M, Allez M, Dautry R, Zappa M, Savoye-Collet C, Dray X, Boudiaf M, Reinhold C, Soyer P. Diffusion-weighted MRI in Crohn’s disease: Current status and recommendations. J Magn Reson Imaging. 2016;44(6):1381–1396. doi: https://doi.org/10.1002/jmri.25325. Epub 2016 Jun 1. PMID: 27249184.CrossRefPubMed Dohan A, Taylor S, Hoeffel C, Barret M, Allez M, Dautry R, Zappa M, Savoye-Collet C, Dray X, Boudiaf M, Reinhold C, Soyer P. Diffusion-weighted MRI in Crohn’s disease: Current status and recommendations. J Magn Reson Imaging. 2016;44(6):1381–1396. doi: https://​doi.​org/​10.​1002/​jmri.​25325. Epub 2016 Jun 1. PMID: 27249184.CrossRefPubMed
12.
go back to reference Khosravi B, Salehnia A, Pak N, Montazeri SA, Sima AR, Vahedi H, Malekzadeh R, Radmard AR. A Practical Index to Distinguish Backwash Ileitis From Crohn’s Terminal Ileitis in MR Enterography. Inflamm Bowel Dis. 2023;29(1):42–50. doi: https://doi.org/10.1093/ibd/izac040. PMID: 35259254. Khosravi B, Salehnia A, Pak N, Montazeri SA, Sima AR, Vahedi H, Malekzadeh R, Radmard AR. A Practical Index to Distinguish Backwash Ileitis From Crohn’s Terminal Ileitis in MR Enterography. Inflamm Bowel Dis. 2023;29(1):42–50. doi: https://​doi.​org/​10.​1093/​ibd/​izac040. PMID: 35259254.
13.
15.
19.
go back to reference Frye JM, Hansel SL, Dolan SG, Fidler JL, Song LM, Barlow JM, Smyrk TC, Flicek KT, Hara AK, Bruining DH, Fletcher JG. NSAID enteropathy: appearance at CT and MR enterography in the age of multi-modality imaging and treatment. Abdom Imaging. 2015;40(5):1011-25. doi: https://doi.org/10.1007/s00261-015-0367-2. PMID: 25666969. Frye JM, Hansel SL, Dolan SG, Fidler JL, Song LM, Barlow JM, Smyrk TC, Flicek KT, Hara AK, Bruining DH, Fletcher JG. NSAID enteropathy: appearance at CT and MR enterography in the age of multi-modality imaging and treatment. Abdom Imaging. 2015;40(5):1011-25. doi: https://​doi.​org/​10.​1007/​s00261-015-0367-2. PMID: 25666969.
26.
go back to reference 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(4):1096–1106. doi: https://doi.org/10.1002/jmri.25646. Epub 2017 Feb 9. PMID: 28182308.CrossRefPubMed 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(4):1096–1106. doi: https://​doi.​org/​10.​1002/​jmri.​25646. Epub 2017 Feb 9. PMID: 28182308.CrossRefPubMed
28.
go back to reference Rousset P, Peyron N, Charlot M, Chateau F, Golfier F, Raudrant D, Cotte E, Isaac S, Réty F, Valette PJ. Bowel endometriosis: preoperative diagnostic accuracy of 3.0-T MR enterography–initial results. Radiology. 2014;273(1):117– 24. doi: https://doi.org/10.1148/radiol.14132803. Epub 2014 May 12. PMID: 24828001. Rousset P, Peyron N, Charlot M, Chateau F, Golfier F, Raudrant D, Cotte E, Isaac S, Réty F, Valette PJ. Bowel endometriosis: preoperative diagnostic accuracy of 3.0-T MR enterography–initial results. Radiology. 2014;273(1):117– 24. doi: https://​doi.​org/​10.​1148/​radiol.​14132803. Epub 2014 May 12. PMID: 24828001.
32.
go back to reference Jasti R, Carucci LR. Small Bowel Neoplasms: A Pictorial Review. Radiographics. 2020 Jul-Aug;40(4):1020–1038. doi: 10.1148/rg.2020200011. Epub 2020 Jun 19. PMID: 32559148. Jasti R, Carucci LR. Small Bowel Neoplasms: A Pictorial Review. Radiographics. 2020 Jul-Aug;40(4):1020–1038. doi: 10.1148/rg.2020200011. Epub 2020 Jun 19. PMID: 32559148.
35.
go back to reference Yalon M, Tahboub Amawi AD, Kelm ZS, Wells ML, Teo LLS, Heiken JP, Sheedy SP, Torbenson MS, Fidler JL, Venkatesh SK. Eosinophilic Disorders of the Gastrointestinal Tract and Associated Abdominal Viscera: Imaging Findings and Diagnosis. Radiographics. 2022 Jul-Aug;42(4):1081–1102. doi: https://doi.org/10.1148/rg.220004. Epub 2022 Jun 24. PMID: 35749291. Yalon M, Tahboub Amawi AD, Kelm ZS, Wells ML, Teo LLS, Heiken JP, Sheedy SP, Torbenson MS, Fidler JL, Venkatesh SK. Eosinophilic Disorders of the Gastrointestinal Tract and Associated Abdominal Viscera: Imaging Findings and Diagnosis. Radiographics. 2022 Jul-Aug;42(4):1081–1102. doi: https://​doi.​org/​10.​1148/​rg.​220004. Epub 2022 Jun 24. PMID: 35749291.
36.
go back to reference Lopes Vendrami C, Kelahan L, Escobar DJ, Goodhartz L, Hammond N, Nikolaidis P, Yang GY, Hirano I, Miller FH. “Imaging Findings of Eosinophilic Gastrointestinal Diseases in Adults”. Curr Probl Diagn Radiol. 2023 Mar-Apr;52(2):139–147. doi: 10.1067/j.cpradiol.2022.11.010. Epub 2022 Nov 22. PMID: 36517296.CrossRefPubMed Lopes Vendrami C, Kelahan L, Escobar DJ, Goodhartz L, Hammond N, Nikolaidis P, Yang GY, Hirano I, Miller FH. “Imaging Findings of Eosinophilic Gastrointestinal Diseases in Adults”. Curr Probl Diagn Radiol. 2023 Mar-Apr;52(2):139–147. doi: 10.1067/j.cpradiol.2022.11.010. Epub 2022 Nov 22. PMID: 36517296.CrossRefPubMed
38.
go back to reference Singhal M, Krishna S, Lal A, Narayanasamy S, Bal A, Yadav TD, Kochhar R, Sinha SK, Khandelwal N, Sheikh AM. Encapsulating Peritoneal Sclerosis: The Abdominal Cocoon. Radiographics. 2019 Jan-Feb;39(1):62–77. doi: https://doi.org/10.1148/rg.2019180108. Epub 2018 Dec 7. PMID: 30526331. Singhal M, Krishna S, Lal A, Narayanasamy S, Bal A, Yadav TD, Kochhar R, Sinha SK, Khandelwal N, Sheikh AM. Encapsulating Peritoneal Sclerosis: The Abdominal Cocoon. Radiographics. 2019 Jan-Feb;39(1):62–77. doi: https://​doi.​org/​10.​1148/​rg.​2019180108. Epub 2018 Dec 7. PMID: 30526331.
39.
43.
go back to reference Ishigami K, Averill SL, Pollard JH, McDonald JM, Sato Y. Radiologic manifestations of angioedema. Insights Imaging. 2014;5(3):365– 74. doi: 10.1007/s13244-014-0329-1. Epub 2014 May 3. PMID: 24792779; PMCID: PMC4035492. Ishigami K, Averill SL, Pollard JH, McDonald JM, Sato Y. Radiologic manifestations of angioedema. Insights Imaging. 2014;5(3):365– 74. doi: 10.1007/s13244-014-0329-1. Epub 2014 May 3. PMID: 24792779; PMCID: PMC4035492.
Metadata
Title
MR enterography in Crohns disease and beyond: a pictorial review
Beyond Crohn’s: a pictorial guide to MR enterography in small bowel disease
Authors
Chandan Kakkar
Pietro Andrea Bonaffini
Arshdeep Singh
Vikram Narang
Ramit Mahajan
Shruti Verma
Saurabh Singla
Ajit Sood
Publication date
03-02-2025
Publisher
Springer US
Published in
Abdominal Radiology
Print ISSN: 2366-004X
Electronic ISSN: 2366-0058
DOI
https://doi.org/10.1007/s00261-025-04824-z

Keynote series | Spotlight on menopause

Menopause can have a significant impact on the body, with effects ranging beyond the endocrine and reproductive systems. Learn about the systemic effects of menopause, so you can help patients in your clinics through the transition.   

Prof. Martha Hickey
Dr. Claudia Barth
Dr. Samar El Khoudary
Developed by: Springer Medicine
Watch now

Keynote webinar | Spotlight on adolescent vaping

Growing numbers of young people are using e-cigarettes, despite warnings of respiratory effects and addiction. How can doctors tackle the epidemic, and what health effects should you prepare to manage in your clinics?

Prof. Ann McNeill
Dr. Debbie Robson
Benji Horwell
Developed by: Springer Medicine
Watch now

Keynote webinar | Spotlight on modern management of frailty

Frailty has a significant impact on health and wellbeing, especially in older adults. Our experts explain the factors that contribute to the development of frailty and how you can manage the condition and reduce the risk of disability, dependency, and mortality in your patients.

Prof. Alfonso Cruz-Jentoft
Prof. Barbara C. van Munster
Prof. Mirko Petrovic
Developed by: Springer Medicine
Watch now

A quick guide to ECGs

Improve your ECG interpretation skills with this comprehensive, rapid, interactive course. Expert advice provides detailed feedback as you work through 50 ECGs covering the most common cardiac presentations to ensure your practice stays up to date. 

PD Dr. Carsten W. Israel
Developed by: Springer Medizin
Start the cases

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Read more