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DOI: 10.4103/0971-3026.184405
Magnetic resonance enterography: A stepwise interpretation approach and role of imaging in management of adult Crohn's disease
Financial support and sponsorship Nil.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.
Publication History
Article published online:
30 July 2021
© 2016. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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References
- 1 Mekhjian HS, Switz DM, Melnyk CS, Rankin GB, Brooks RK. Clinical features and natural history of Crohn's disease. Gastroenterology 1979;77:898-906.
- 2 O'Malley RB, Al-Hawary MM, Kaza RK, Wasnik AP, Liu PS, Hussain HK. Rectal imaging: Part 2, Perianal fistula evaluation on pelvic MRI--What the radiologist needs to know. AJR Am J Roentgenol 2012;199:W43-53.
- 3 Erbayrak M, Turkay C, Eraslan E, Cetinkaya H, Kasapoglu B, Bektas M. The role of fecal calprotectin in investigating inflammatory bowel diseases. Clinics 2009;64:421-5.
- 4 Huprich JE, Rosen MP, Fidler JL, Gay SB, Grant TH, Greene FL, et al. ACR Appropriateness Criteria on Crohn's disease. J Am Coll Radiol 2010;7 (2):94-102.
- 5 Desmond AN, O'Regan K, Curran C, McWilliams S, Fitzgerald T, Maher MM, et al. Crohn's disease: Factors associated with exposure to high levels of diagnostic radiation. Gut 2008;57:1524-9.
- 6 Shoenut JP, Semelka RC, Magro CM, Silverman R, Yaffe CS, Micflikier AB. Comparison of magnetic resonance imaging and endoscopy in distinguishing the type and severity of inflammatory bowel disease. J Clin Gastroenterol 1994;19:31-5.
- 7 Umschaden HW, Szolar D, Gasser J, Umschaden M, Haselbach H. Small-bowel disease: Comparison of MR enteroclysis images with conventional enteroclysis and surgical findings. Radiology 2000;215:717-25.
- 8 Schreyer AG, Geissler A, Albrich H, Scholmerich J, Feuerbach S, Rogler G, et al. Abdominal MRI after enteroclysis or with oral contrast in patients with suspected or proven Crohn's disease. Clin Gastroenterol Hepatol 2004;2:491-7.
- 9 Grand DJ, Kampalath V, Harris A, Patel A, Resnick MB, Machan J, et al. MR enterography correlates highly with colonoscopy and histology for both distal ileal and colonic Crohn's disease in 310 patients. Eur J Radiol 2012;81:e763-9.
- 10 Ordas I, Rimola J, Rodriguez S, Paredes JM, Martinez-Perez MJ, Blanc E, et al. Accuracy of magnetic resonance enterography in assessing response to therapy and mucosal healing in patients with Crohn's disease. Gastroenterology 2014;146:374-82.e1.
- 11 Siddiki HA, Fidler JL, Fletcher JG, Burton SS, Huprich JE, Hough DM, et al. Prospective comparison of state-of-the-art MR enterography and CT enterography in small-bowel Crohn's disease. AJR Am J Roentgenol 2009;193:113-21.
- 12 Gmerek L, Katulska K, Horbacka K, Krokowicz P. Usefulness of magnetic resonance enterography in diagnosis of Crohn's disease. Pol Przegl Chir 2011;83:244-9.
- 13 Schmidt S, Guibal A, Meuwly JY, Michetti P, Felley C, Meuli R, et al. Acute complications of Crohn's disease: Comparison of multidetector-row computed tomographic enterography with magnetic resonance enterography. Digestion 2010;82:229-38.
- 14 Lee SS, Kim AY, Yang SK, Chung JW, Kim SY, Park SH, et al. Crohn disease of the small bowel: Comparison of CT enterography, MR enterography, and small-bowel follow-through as diagnostic techniques. Radiology 2009;251:751-61.
- 15 Masselli G, Gualdi G. MR imaging of the small bowel. Radiology 2012;264:333-48.
- 16 Sinha R, Murphy P, Sanders S, Ramachandran I, Hawker P, Rawat S, et al. Diagnostic accuracy of high-resolution MR enterography in Crohn's disease: Comparison with surgical and pathological specimen. Clin Radiol 2013;68:917-27.
- 17 Friedrich C, Fajfar A, Pawlik M, Hoffstetter P, Rennert J, Agha A, et al. Magnetic resonance enterography with and without biphasic contrast agent enema compared to conventional ileocolonoscopy in patients with Crohn's disease. Inflamm Bowel Dis 2012;18:1842-8.
- 18 Amzallag-Bellenger E, Oudjit A, Ruiz A, Cadiot G, Soyer PA, Hoeffel CC. Effectiveness of MR enterography for the assessment of small-bowel diseases beyond Crohn disease. Radiographics 2012;32:1423-44.
- 19 Cronin CG, Lohan DG, Browne AM, Roche C, Murphy JM. Magnetic resonance enterography in the evaluation of the small bowel. Semin roentgenol 2009;44:237-43.
- 20 Gee MS, Harisinghani MG. MRI in patients with inflammatory bowel disease. J Mag Reson Imaging 2011;33:527-34.
- 21 Sinha R, Rawat S. MRI enterography with divided dose oral preparation: Effect on bowel distension and diagnostic quality. Indian J Radiol Imaging 2013;23: 86-91.
- 22 Morani AC, Smith EA, Ganeshan D, Dillman JR. Diffusion-weighted MRI in pediatric inflammatory bowel disease. AJR Am J Roentgenol 2015;204:1269-77.
- 23 Sinha R, Rajiah P, Ramachandran I, Sanders S, Murphy PD. Diffusion-weighted MR imaging of the gastrointestinal tract: Technique, indications, and imaging findings. Radiographics 2013;33:655-76.
- 24 Shenoy-Bhangle AS, Nimkin K, Aranson T, Gee MS. Value of diffusion-weighted imaging when added to magnetic resonance enterographic evaluation of Crohn disease in children. Pediatr Radiol 2016;46:34-42.
- 25 Cronin CG, Delappe E, Lohan DG, Roche C, Murphy JM. Normal small bowel wall characteristics on MR enterography. Eur J Radiol 2010;75:207-11.
- 26 Steward MJ, Punwani S, Proctor I, Adjei-Gyamfi Y, Chatterjee F, Bloom S, et al. Non-perforating small bowel Crohn's disease assessed by MRI enterography: Derivation and histopathological validation of an MR-based activity index. Eur J Radiol 2012;81:2080-8.
- 27 Ziech ML, Bipat S, Roelofs JJ, Nio CY, Mearadji B, van Doorn S, et al. Retrospective comparison of magnetic resonance imaging features and histopathology in Crohn's disease patients. Eur J Radiol 2011;80:e299-305.
- 28 Froehlich JM, Waldherr C, Stoupis C, Erturk SM, Patak MA. MR motility imaging in Crohn's disease improves lesion detection compared with standard MR imaging. Eur Radiol 2010;20:1945-51.
- 29 Cullmann JL, Bickelhaupt S, Froehlich JM, Szucs-Farkas Z, Tutuian R, Patuto N, et al. MR imaging in Crohn's disease: Correlation of MR motility measurement with histopathology in the terminal ileum. Neurogastroenterol Motil 2013;25:749-e577.
- 30 Menys A, Atkinson D, Odille F, Ahmed A, Novelli M, Rodriguez-Justo M, et al. Quantified terminal ileal motility during MR enterography as a potential biomarker of Crohn's disease activity: A preliminary study. Eur Radiol 2012;22:2494-501.
- 31 Bickelhaupt S, Pazahr S, Chuck N, Blume I, Froehlich JM, Cattin R, et al. Crohn's disease: Small bowel motility impairment correlates with inflammatory-related markers C-reactive protein and calprotectin. Neurogastroenterol Motil 2013;25:467-73.
- 32 Knuesel PR, Kubik RA, Crook DW, Eigenmann F, Froehlich JM. Assessment of dynamic contrast enhancement of the small bowel in active Crohn's disease using 3D MR enterography. Eur J Radiol 2010;73:607-13.
- 33 Horjus Talabur Horje CS, Bruijnen R, Roovers L, Groenen MJM, Joosten FBM, Wahab PJ. Contrast Enhanced Abdominal Ultrasound in the Assessment of Ileal Inflammation in Crohn's Disease: A Comparison with MR Enterography. PLoS One 2015;10:e0136105.
- 34 Sinha R, Verma R, Verma S, Rajesh A. MR enterography of Crohn disease: Part 2, imaging and pathologic findings. AJR Am J Roentgenol 2011;197:80-5.
- 35 Gourtsoyiannis N, Grammatikakis J, Papamastorakis G, Koutroumbakis J, Prassopoulos P, Rousomoustakaki M, et al. Imaging of small intestinal Crohn's disease: Comparison between MR enteroclysis and conventional enteroclysis. Eur Radiol 2006;16:1915-25.
- 36 Schmidt S, Chevallier P, Bessoud B, Meuwly JY, Felley C, Meuli R, et al. Diagnostic performance of MRI for detection of intestinal fistulas in patients with complicated inflammatory bowel conditions. Eur Radiol 2007;17:2957-63.
- 37 Negaard A, Paulsen V, Sandvik L, Berstad AE, Borthne A, Try K, et al. 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 2007;17:2294-301.
- 38 Herrmann KA, Michaely HJ, Seiderer J, Ochsenkuehn T, Reiser MF, Schoenberg SO. The “star-sign” in magnetic resonance enteroclysis: A characteristic finding of internal fistulae in Crohn's disease. Scand J Gastroenterol 2006 Feb; 41:239-41.
- 39 Fidler JL, Guimaraes L, Einstein DM. MR Imaging of the Small Bowel. Radiographics 2009;29:1811-25.
- 40 Fichera A, Michelassi F. Surgical treatment of Crohn's disease. J Gastrointest Surg 2007;11:791-803.
- 41 Tolan DJ, Greenhalgh R, Zealley IA, Halligan S, Taylor SA. MR enterographic manifestations of small bowel Crohn disease. Radiographics 2010;30:367-84.
- 42 Turkcapar N, Toruner M, Soykan I, Aydintug OT, Cetinkaya H, Duzgun N, et al. The prevalence of extraintestinal manifestations and HLA association in patients with inflammatory bowel disease. Rheumatol Int 2006;26:663-8.
- 43 Rodriguez-Reyna TS, Martinez-Reyes C, Yamamoto-Furusho JK. Rheumatic manifestations of inflammatory bowel disease. World J Gastroenterol 2009;15:5517-24.
- 44 Navallas M, Ares J, Beltran B, Lisbona MP, Maymo J, Solano A. Sacroiliitis associated with axial spondyloarthropathy: New concepts and latest trends. Radiographics 2013;33:933-56.
- 45 Friedrich C, Fajfar A, Pawlik M, Hoffstetter P, Rennert J, Agha A, et al. Magnetic resonance enterography with and without biphasic contrast agent enema compared to conventional ileocolonoscopy in patients with Crohn's disease. Inflamm Bowel Dis 2012;18:1842-8.
- 46 Pulimood AB, Amarapurkar DN, Ghoshal U, Phillip M, Pai CG, Reddy DN, et al. Differentiation of Crohn's disease from intestinal tuberculosis in India in 2010. World J Gastroenterol 2011;17:433-43.
- 47 I. Ordás, J. Rimola, S. Rodríguez, Paredes JM, Martínez-Pérez MJ, Blanc E, et al., Accuracy of magnetic resonance enterography in assessing response to therapy and mucosal healing in patients with Crohn's disease. Gastroenterology 2014;146:374-82.