Top

Published in:

Open Access 01-06-2012 | Pictorial Review

Small bowel MR enterography: problem solving in Crohn’s disease

Authors: Nyree Griffin, Lee Alexander Grant, Simon Anderson, Peter Irving, Jeremy Sanderson

Published in: Insights into Imaging | Issue 3/2012

Abstract

Magnetic resonance enterography (MRE) is fast becoming the first-line radiological investigation to evaluate the small bowel in patients with Crohn’s disease. It can demonstrate both mural and extramural complications. The lack of ionizing radiation, together with high-contrast resolution, multiplanar capability and cine-imaging make it an attractive imaging modality in such patients who need prolonged follow-up. A key question in the management of such patients is the assessment of disease activity. Clinical indices, endoscopic and histological findings have traditionally been used as surrogate markers but all have limitations. MRE can help address this question. The purpose of this pictorial review is to (1) detail the MRE protocol used at our institution; (2) describe the rationale for the MR sequences used and their limitations; (3) compare MRE with other small bowel imaging techniques; (4) discuss how MRE can help distinguish between inflammatory, stricturing and penetrating disease, and thus facilitate management of this difficult condition.

Main Messages

• MR enterography (MRE) is the preferred imaging investigation to assess Crohn’s disease. T2-weighted, post-contrast and diffusion-weighted imaging (DWI) can be used.

• MRE offers no radiation exposure, high-contrast resolution, multiplanar ability and cine imaging.

• MRE can help define disease activity, a key question in the management of Crohn’s disease.

• MRE can help distinguish between inflammatory, stricturing and penetrating disease.

• MRE can demonstrate both mural and extramural complications.

Loftus EV Jr (2004) Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences. Gastroenterology 126:1504–1517PubMedCrossRef

Van Assche G, Dignass A, Panes J, Beaugerie L, Karagiannis J, Allez M, Ochsenkühn T, Orchard T, Rogler G, Louis E, Kupcinskas L, Mantzaris G, Travis S, Stange E, European Crohn’s and Colitis Organisation (ECCO) (2010) The second European evidence-based Consensus on the diagnosis and management of Crohn’s disease: Definitions and diagnosis. J Crohns Colitis 4:7–27PubMedCrossRef

Hafeez R, Punwani S, Boulos P, Bloom S, McCartney S, Halligan S, Taylor SA (2011) Diagnostic and therapeutic impact of MR enterography in Crohn’s disease. Clin Radiol 66:1148–1158PubMedCrossRef

Cronin CG, Lohan DG, Mhuircheartaigh JN, McKenna D, Alhajeri N, Roche C, Murphy JM (2008) MRI small-bowel follow-through: prone versus supine patient positioning for best small-bowel distention and lesion detection. AJR Am J Roentgenol 191:502–506PubMedCrossRef

Lemberg DA, Issenman RM, Cawdron R, Green T, Mernagh J, Skehan SJ et al (2005) Positron emission tomography in the investigation of pediatric inflammatory bowel disease. Inflamm Bowel Dis 11:733–738PubMedCrossRef

Louis E, Ancion G, Colard A, Spote V, Belaiche J, Hustinx R (2007) Noninvasive assessment of Crohn’s disease intestinal lesions with (18)F-FDG PET/CT. J Nucl Med 48:1053–1059PubMedCrossRef

Löffler M, Weckesser M, Franzius C, Schober O, Zimmer KP (2006) High diagnostic value of 18F-FDG-PET in pediatric patients with chronic inflammatory bowel disease. Ann N Y Acad Sci 1072:379–385PubMedCrossRef

Horsthuis K, Bipat S, Bennink RJ, Stoker J (2008) Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta-analysis of prospective studies. Radiology 247:64–79PubMedCrossRef

Masselli G, Casciani E, Polettini E, Gualdi G (2008) Comparison of MR enteroclysis with MR enterography and conventional enteroclysis in patients with Crohn’s disease. Eur Radiol 18:438–447PubMedCrossRef

10.

Negaard A, Paulsen V, Sandvik L, Berstad AE, Borthne A, Try K, Lygren I, Storaas T, Klow NE (2007) A prospective randomized comparison between two MRI studies of the small bowel in Crohn’s disease, the oral contrast method and MR enteroclysis. Eur Radiol 17:2294–2301PubMedCrossRef

11.

Triester SL, Leighton JA, Leontiadis GI, Gurudu SR, Fleischer DE, Hara AK, Heigh RI, Shiff AD, Sharma VK (2006) A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with non-stricturing small bowel Crohn’s disease. Am J Gastroenterol 101:954–964PubMedCrossRef

12.

Triantafillidis JK, Merikas E, Georgopoulos F (2011) Current and emerging drugs for the treatment of inflammatory bowel disease. Drug Des Devel Ther 6:185–210CrossRef

13.

Horsthuis K, Bipat S, Stokkers PC, Stoker J (2009) Magnetic resonance imaging for evaluation of disease activity in Crohn’s disease: a systematic review. Eur Radiol 19:1450–1460PubMedCrossRef

14.

Rimola J, Ordás I, Rodriguez S, García-Bosch O, Aceituno M, Llach J, Ayuso C, Ricart E, Panés J (2011) Magnetic resonance imaging for evaluation of Crohn’s disease: validation of parameters of severity and quantitative index of activity. Inflamm Bowel Dis 17:1759–1768PubMedCrossRef

15.

Steward MJ, Punwani S, Proctor I, Adjei-Gyamfi Y, Chatterjee F, Bloom S, Novelli M, Halligan S, Rodriguez-Justo M, Taylor SA (2011) Non-perforating small bowel Crohn’s disease assessed by MRI enterography: derivation and histopathological validation of an MR-based activity index. Eur J Radiol Sep 14. [Epub ahead of print]

16.

Koh DM, Miao Y, Chinn RJ, Amin Z, Zeegen R, Westaby D, Healy JC (2001) MR imaging evaluation of the activity of Crohn’s disease. AJR Am J Roentgenol 177:1325–1332PubMedCrossRef

17.

Punwani S, Rodriguez-Justo M, Bainbridge A, Greenhalgh R, De Vita E, Bloom S, Cohen R, Windsor A, Obichere A, Hansmann A, Novelli M, Halligan S, Taylor SA (2009) Mural inflammation in Crohn disease: location-matched histologic validation of MR imaging features. Radiology 252:712–720PubMedCrossRef

18.

Maccioni F, Viscido A, Broglia L, Marrollo M, Masciangelo R, Caprilli R, Rossi P (2000) Evaluation of Crohn disease activity with magnetic resonance imaging. Abdom Imaging 25:219–228PubMedCrossRef

19.

Miao YM, Koh DM, Amin Z, Healy JC, Chinn RJ, Zeegen R, Westaby D (2002) Ultrasound and magnetic resonance imaging assessment of active bowel segments in Crohn’s disease. Clin Radiol 57:913–918PubMedCrossRef

20.

Florie J, Wasser MN, Arts-Cieslik K, Akkerman EM, Siersema PD, Stoker J (2006) Dynamic contrast-enhanced MRI of the bowel wall for assessment of disease activity in Crohn’s disease. AJR Am J Roentgenol 186:1384–1392PubMedCrossRef

21.

Pupillo VA, Di Cesare E, Frieri G, Limbucci N, Tanga M, Masciocchi C (2007) Assessment of inflammatory activity in Crohn’s disease by means of dynamic contrast-enhanced MRI. Radiol Med 112:798–809PubMedCrossRef

22.

Röttgen R, Grandke T, Grieser C, Lehmkuhl L, Hamm B, Lüdemann L (2010) Measurement of MRI enhancement kinetics for evaluation of inflammatory activity in Crohn’s disease. Clin Imaging 34:29–35PubMedCrossRef

23.

Oto A, Kayhan A, Williams JT, Fan X, Yun L, Arkani S, Rubin DT (2011) Active Crohn’s disease in the small bowel: evaluation by diffusion weighted imaging and quantitative dynamic contrast enhanced MR imaging. J Magn Reson Imaging 33:615–624PubMedCrossRef

24.

Del Vescovo R, Sansoni I, Caviglia R, Ribolsi M, Perrone G, Leoncini E, Grasso RF, Cicala M, Zobel BB (2008) Dynamic contrast enhanced magnetic resonance imaging of the terminal ileum:differentiation of activity of Crohn’s disease. Abdom Imaging 33:417–424PubMedCrossRef

25.

Oussalah A, Laurent V, Bruot O, Bressenot A, Bigard MA, Régent D, Peyrin-Biroulet L (2010) Diffusion-weighted magnetic resonance without bowel preparation for detecting colonic inflammation in inflammatory bowel disease. Gut 59:1056–1065PubMedCrossRef

26.

Kiryu S, Dodanuki K, Takao H, Watanabe M, Inoue Y, Takazoe M, Sahara R, Unuma K, Ohtomo K (2009) Free-breathing diffusion-weighted imaging for the assessment of inflammatory activity in Crohn’s disease. J Magn Reson Imaging 29:880–886PubMedCrossRef

27.

Oto A, Zhu F, Kulkarni K, Karczmar GS, Turner JR, Rubin D (2009) Evaluation of diffusion-weighted MR imaging for detection of bowel inflammation in patients with Crohn’s disease. Acad Radiol 16:597–603PubMedPubMedCentralCrossRef

28.

Sempere GA, Martinez Sanjuan V, Medina Chulia E, Benages A, Tome Toyosato A, Canelles P, Bulto A, Quiles F, Puchades I, Cuquerella J, Celma J, Orti E (2005) MRI evaluation of inflammatory activity in Crohn’s disease. AJR Am J Roentgenol 184:1829–1835PubMedCrossRef

29.

Rutgeerts P, Geboes K, Vantrappen G, Beyls J, Kerremans R, Hiele M (1990) Predictability of the postoperative course of Crohn’s disease. Gastroenterology 99:956–963PubMed

30.

Lee EC, Papaioannou N (1980) Recurrence following surgery for Crohn’s disease. Clin Gastroenterol 9:419–438PubMed

31.

Koilakou S, Sailer J, Peloschek P et al (2010) Endoscopy and MR enteroclysis: Equivalent tools in predicting clinical recurrence in patients with Crohn’s disease after ileocolic resection. Inflamm Bowel Dis 16:198–203PubMedCrossRef

32.

Gallego Ojea JC, Echarri Piudo AI, Porta Vila A (2011) Crohn’s disease: the usefulness of MR enterography in the detection of recurrence after surgery. Radiologia Mar 28 (Epub ahead of print)

Title: Small bowel MR enterography: problem solving in Crohn’s disease
Authors: Nyree Griffin
Lee Alexander Grant
Simon Anderson
Peter Irving
Jeremy Sanderson
Publication date: 01-06-2012
Publisher: Springer Berlin Heidelberg
Published in: Insights into Imaging / Issue 3/2012
Electronic ISSN: 1869-4101
DOI: https://doi.org/10.1007/s13244-012-0154-3

At a glance: The STEP trials

Springer Medicine

Small bowel MR enterography: problem solving in Crohn’s disease

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2012

Radiological appearances of gynaecological emergencies

Multimodality Imaging Training Curriculum — Parts II and III

Core curriculum for medical physicists in radiology. Recommendations from an EFOMP/ESR working group

Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis

MR imaging of the reconstructed breast: What the radiologist needs to know

A systematic approach for analysis, interpretation, and reporting of coronary CTA studies