The mutually complementary role of magnetic resonance enterography and conventional enteroclysis in patients with complicated and/or advanced stage of Crohn's disease

Abstract

Aim: To assess the diagnostic significance of magnetic resonance enterography (MRE) and conventional enteroclysis (CE) in patients with complicated and/or advanced stage of Crohn's disease.

Methods: Patients with abnormal CE findings suggestive of mural and/or extramural involvement with the diagnosis or pre-diagnosis of CD are evaluated. After real-time bowel distension by enteroscopic examination, the patients with advanced or complicated stage were taken to the MRE examination in the same session. Mucosal-mural-extramural and activation findings, presence of stenosis/stricture, skip lesions and the mean duration of exams were evaluated with both CE and MRE. The superiority of one method over the other relative to these findings was evaluated.

Results: A total of 110 patients evaluated by CE had the findings of CD. Of these, 24 patients with abnormal CE findings suggestive of advanced mural and extramural involvements were subsequently evaluated with MRE. CE was superior to MRE in the depiction of early superficial mucosal changes (aphthous-linear ulcer), cobblestone pattern (p = 0.002, p < 0.01), obstruction (p = 0.004, p < 0.01), and differentiation between the string sign and stricture. MRE was superior to conventional enteroclysis in mural and perienteric findings of bowel thickening, fibro-fatty proliferation, abscess (p = 0.016, p 0.05).

Conclusion: CE and MRE are mutually complementary imaging modalities in CD staging, evaluation of activation findings, and detection of complications (Tab. 3, Fig. 8, Ref. 23).

Keywords: Crohn's disease; complicated; enteroclysis; magnetic resonance enterography; magnetic resonance imaging; mucosal; mural extramural..