Strukturierte Befundung der intestinalen MRT bei Morbus Crohn

Beim Morbus Crohn kommt der MRT bei Diagnose, Verlauf und Therapie eine große Bedeutung zu. Dabei sind gemeinsame Befundungsstandards für die MRT (und den Darmultraschall) eine wichtige Voraussetzung für die Zusammenarbeit von Gastroenterologen, Radiologen und Chirurgen. Die wesentlichen Standards sind in diesem Beitrag zusammengefasst.

Kernaussagen

• Eine Nahrungskarenz von mindestens 4 Stunden vor der MRT ist ausreichend.

• Die MRT kann ohne Sondenapplikation als MR-Enterografie mit oraler Gabe von Mannitol oder Methylcellulose sicher durchgeführt werden.

• Befundungs- und Bildkriterien werden systematisch und strukturiert erhoben:

  • mural (Lokalisation, Länge, Wanddicke, Stenose, Wandödem, Ulzera, Diffusionsrestriktion, Enhancement, Wandmuster)

  • extramural („creeping fat“, mesenteriales Ödem, „comb sign“, Lymphadenopathie einschließlich Komplikationen wie Sinus Tracts, Fisteln, Konglomerattumoren, Abszesse)

  • extraintestinal (Sakroiliitis, avaskuläre Knochennekrose, primär sklerosierende Cholangitis, Pankreatitis, mesenteriale Venenthrombose sowie Cholelithiasis und Nephrolithiasis)

• In der Beurteilung bewertet man im klinischen Kontext den Entzündungs-, den Stenose-, den Penetrations-, den Perianal- und den extraintestinalen Komplikationsstatus.

  • Vermutete Stenosen werden als sichere oder wahrscheinliche Stenose kategorisiert und systematisch in Hinblick auf ihre Entzündungsaktivität charakterisiert (prädominant entzündlich vs. prädominant fibrotisch).

  • Vorrangige Kriterien der Entzündungsaktivität sind Darmwandödem, Darmwandschichtung, Ulzera, Sinus Tract, Fistel und Abszess.

• Eine Verbesserung der Erhebung wie auch der Dokumentation der Befunde einer MR-Enterografie bei chronisch entzündlichen Darmerkrankungen kann zur besseren Kommunikation und damit Versorgung der Patienten beitragen.

Schlüsselwörter

MR-Enterografie - Morbus Crohn

Key words

magnetic resonance enterography - Crohnʼs Disease

Publication History

Article published online:
01 September 2023

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