Go Back
This abstract was viewed 52 times

Original research article


Role of Magnetic Resonance Enterography in Differentiating between Fibrotic and Active Inflammatory Small Bowel Stenosis in Patients with Crohn's Disease

Francesca FornasaChiara BenassutiLuca Benazzato
Departments of Radiology, Surgery and Gastroenterology, San Bonifacio Hospital, 37042 San Bonifacio (Verona), Italy
Date of Submission: 09-May-2011, Date of Acceptance: 08-Jun-2011, Date of Web Publication: 25-Jun-2011.
Corresponding Author:
Corresponding Author

Francesca Fornasa

Department of Radiology, San Bonifacio Hospital, 1, Via Fontanelle, 37042 San Bonifacio (Verona), Italy.
E-mail: francescafornasa@libero.it

Corresponding Author:
Corresponding Author

Francesca Fornasa

Department of Radiology, San Bonifacio Hospital, 1, Via Fontanelle, 37042 San Bonifacio (Verona), Italy.
E-mail: francescafornasa@libero.it

DOI: 10.4103/2156-7514.82339 Facebook Twitter Google Linkedin

ABSTRACT



Objective: To assess the diagnostic accuracy of magnetic resonance imaging (MRI) in prospectively differentiating between fibrotic and active inflammatory small bowel stenosis in patients with Crohn’s disease (CD).
Materials and Methods: A total of 111 patients with histologically proven CD presenting with clinical and plain radiographic signs of small bowel obstruction underwent coronal and axial MRI scans after oral administration of polyethylene glycol solution. A stenosis was judged present if a small bowel segment had >80% lumen reduction as compared to an adjacent normal loop and mural thickening of >3 mm. At the level of the stenosis, both T2 signal intensity and post-gadolinium T1 enhancement were quantified using a 5-point scale (0: very low; 1: low; 2: moderate; 3: high; and 4: very high). A stenosis was considered fibrotic if the sum of the two values (activity score: AS) did not exceed 1.
Results: A small bowel stenosis was identified in 48 out of 111 patients. Fibrosis was confirmed at histology in all of the 23 patients with AS of 0 or 1, who underwent surgery within 3 days of the MRI examination. In the remaining 25 patients (AS: 2–8), an active inflammatory stenosis was suspected and remission of the obstructive symptoms was obtained by means of medical treatment. One of these patients (AS: 2), however, underwent surgery after 14 days, due to recurrence. MRI had 95.8% sensitivity, 100% specificity, and 97.9% accuracy in the diagnosis of fibrotic stenosis.
Conclusion: MRI is reliable in differentiating fibrotic from inflammatory small bowel stenosis in CD.
Keywords: Crohn's Disease, MR Enteroclysis, Intestinal Stenosis, Small Bowel Imaging

Cited in 27 Documents

  1. E. Giles, A. R. Barclay, S. Chippington and D. C. Wilson (2013) Systematic review: MRI enterography for assessment of small bowel involvement in paediatric Crohn's disease. Aliment Pharmacol Ther 37(12):1121. doi: 10.1111/apt.12323
  2. Sara Keihanian and Alan C. Moss (2016) Crohn’s disease stricture evaluation and management. Techniques in Gastrointestinal Endoscopy 18(3):136. doi: 10.1016/j.tgie.2016.08.004
  3. Saurabh Kedia, Raju Sharma, Govind K. Makharia, Vineet Ahuja, Devendra Desai, Devasenathipathy Kandasamy, Anu Eapen, Karthik Ganesan, Uday C. Ghoshal, Naveen Kalra, D. Karthikeyan, Kumble Seetharama Madhusudhan, Mathew Philip, Amarender Singh Puri, Sunil Puri, Saroj K. Sinha, Rupa Banerjee, Shobna Bhatia, Naresh Bhat, Sunil Dadhich, G. K. Dhali, B. D. Goswami, S. K. Issar, V. Jayanthi, S. P. Misra, Sandeep Nijhawan, Pankaj Puri, Avik Sarkar, S. P. Singh, Anshu Srivastava, Philip Abraham and B. S. Ramakrishna (2017) Imaging of the small intestine in Crohn’s disease: Joint position statement of the Indian Society of Gastroenterology and Indian Radiological and Imaging Association. Indian J Gastroenterol 36(6):487. doi: 10.1007/s12664-017-0804-y
  4. Matthew P. Moy, Jenny Sauk and Michael S. Gee (2016) The Role of MR Enterography in Assessing Crohn’s Disease Activity and Treatment Response. Gastroenterology Research and Practice 2016:1. doi: 10.1155/2016/8168695
  5. Dana M. H. Dykes, Alexander J. Towbin, Erin Bonkowski, Claudia Chalk, Ramona Bezold, Kathleen Lake, Mi-Ok Kim, James E. Heubi, Bruce C. Trapnell, Daniel J. Podberesky and Lee A. Denson (2013) Increased Prevalence of Luminal Narrowing and Stricturing Identified by Enterography in Pediatric Crohn’s Disease Patients With Elevated Granulocyte–Macrophage Colony Stimulating Factor Autoantibodies. Inflammatory Bowel Diseases 19(10):2146. doi: 10.1097/MIB.0b013e31829706e0
  6. Astrid-Jane Greenup, Brian Bressler and Greg Rosenfeld (2016) Medical Imaging in Small Bowel Crohnʼs Disease—Computer Tomography Enterography, Magnetic Resonance Enterography, and Ultrasound. Inflammatory Bowel Diseases 22(5):1246. doi: 10.1097/MIB.0000000000000727
  7. F. Maccioni, I. Staltari, A. R. Pino and A. Tiberti (2012) Value of T2-weighted magnetic resonance imaging in the assessment of wall inflammation and fibrosis in Crohn’s disease. Abdom Imaging 37(6):944. doi: 10.1007/s00261-012-9853-y
  8. Marianne M. Amitai, Shomron Ben-Horin, Rami Eliakim and Uri Kopylov (2013) Magnetic resonance enterography in Crohn's disease: A guide to common imaging manifestations for the IBD physician. Journal of Crohn's and Colitis 7(8):603. doi: 10.1016/j.crohns.2012.10.005
  9. Brice Malgras, Karine Pautrat, Xavier Dray, Pierre Pasquier, Patrice Valleur, Marc Pocard and Philippe Soyer (2015) Multidisciplinary Management of Gastrointestinal Fibrotic Stenosis in Crohn’s Disease. Dig Dis Sci 60(5):1152. doi: 10.1007/s10620-014-3421-y
  10. Pablo Rodriguez, Ramiro Mendez, Fatima Matute, Paula Hernandez and Juan Luis Mendoza (2014) Imaging Crohn Disease. Journal of Computer Assisted Tomography 38(2):219. doi: 10.1097/RCT.0000000000000020
  11. Florian Rieder, Jessica R. de Bruyn, Bao Tung Pham, Konstantinos Katsanos, Vito Annese, Peter D.R. Higgins, Fernando Magro and Iris Dotan (2014) Results of the 4th Scientific Workshop of the ECCO (Group II): Markers of intestinal fibrosis in inflammatory bowel disease. 8(10):1166. doi: 10.1016/j.crohns.2014.03.009
  12. Christian Maaser, Andreas Sturm, Stephan R Vavricka, Torsten Kucharzik, Gionata Fiorino, Vito Annese, Emma Calabrese, Daniel C Baumgart, Dominik Bettenworth, Paula Borralho Nunes, Johan Burisch, Fabiana Castiglione, Rami Eliakim, Pierre Ellul, Yago González-Lama, Hannah Gordon, Steve Halligan, Konstantinos Katsanos, Uri Kopylov, Paulo G Kotze, Eduards Krustiņš, Andrea Laghi, Jimmy K Limdi, Florian Rieder, Jordi Rimola, Stuart A Taylor, Damian Tolan, Patrick van Rheenen, Bram Verstockt and Jaap Stoker (2019) ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: Initial diagnosis, monitoring of known IBD, detection of complications. 13(2):144. doi: 10.1093/ecco-jcc/jjy113
  13. Min Dai, Ting Zhang, Qianqian Li, Bota Cui, Liyuan Xiang, Xiao Ding, Rong Rong, Jianling Bai, Jianguo Zhu and Faming Zhang (2019) The bowel preparation for magnetic resonance enterography in patients with Crohn’s disease: study protocol for a randomized controlled trial. Trials 20(1):. doi: 10.1186/s13063-018-3101-x
  14. Federica Branchi, Flavio Caprioli, Stefania Orlando, Dario Conte and Mirella Fraquelli (2017) Non-invasive evaluation of intestinal disorders: The role of elastographic techniques. WJG 23(16):2832. doi: 10.3748/wjg.v23.i16.2832
  15. David H. Bruining, Ellen M. Zimmermann, Edward V. Loftus, William J. Sandborn, Cary G. Sauer and Scott A. Strong (2018) Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn’s Disease. Radiology 286(3):776. doi: 10.1148/radiol.2018171737
  16. Aida Kapic Lunder, Linda Tøften Bakstad, Jørgen Jahnsen, Arne Borthne, Johannes Roksund Hov, Morten Vatn and Anne Negård (2019) Assessment of Bowel Inflammation and Strictures by Magnetic Resonance Enterography in Long-term Crohn’s Disease. 13(5):607. doi: 10.1093/ecco-jcc/jjy208
  17. Noriko Okazaki, Toshihiro Inokuchi, Sakiko Hiraoka, Masayasu Ohmori, Shiho Takashima, Daisuke Takei, Yuusaku Sugihara, Masahiro Takahara, Keita Harada, Seiji Kawano, Hiroyuki Okada and Jun Kato (2017) Findings of Retrograde Contrast Study Through Double-balloon Enteroscopy Predict the Risk of Bowel Resections in Patients with Crohnʼs Disease with Small Bowel Stenosis. Inflammatory Bowel Diseases 23(12):2097. doi: 10.1097/MIB.0000000000001175
  18. Gabriele Bislenghi and Andre D’Hoore (2018) Fibrostenotic Inflammatory Bowel Disease. (Chapter 19):267. doi: 10.1007/978-3-319-90578-5_19
  19. Jordi Rimola, Núria Planell, Sonia Rodríguez, Salvadora Delgado, Ingrid Ordás, Anna Ramírez-Morros, Carmen Ayuso, Montse Aceituno, Elena Ricart, Aranzazu Jauregui-Amezaga, Julián Panés and Míriam Cuatrecasas (2015) Characterization of Inflammation and Fibrosis in Crohn’s Disease Lesions by Magnetic Resonance Imaging. American Journal of Gastroenterology 110(3):432. doi: 10.1038/ajg.2014.424
  20. Uri Kopylov, Doron Yablecovitch, Adi Lahat, Sandra Neuman, Nina Levhar, Tomer Greener, Eyal Klang, Noa Rozendorn, Marianne M Amitai, Shomron Ben-Horin and Rami Eliakim (2015) Detection of Small Bowel Mucosal Healing and Deep Remission in Patients With Known Small Bowel Crohn’s Disease Using Biomarkers, Capsule Endoscopy, and Imaging. American Journal of Gastroenterology 110(9):1316. doi: 10.1038/ajg.2015.221
  21. Noa Rozendorn, Eyal Klang, Adi Lahat, Doron Yablecovitch, Uri Kopylov, Abraham Eliakim, Shomron Ben-Horin and Michal Marianne Amitai (2016) Prediction of patency capsule retention in known Crohn's disease patients by using magnetic resonance imaging. Gastrointestinal Endoscopy 83(1):182. doi: 10.1016/j.gie.2015.05.048
  22. Mariangela Allocca, Gionata Fiorino, Cristiana Bonifacio, Laurent Peyrin-Biroulet and Silvio Danese (2019) Noninvasive Multimodal Methods to Differentiate Inflamed vs Fibrotic Strictures in Patients With Crohn's Disease. Clinical Gastroenterology and Hepatology :. doi: 10.1016/j.cgh.2019.04.025
  23. Ji Hoon Lee, Yong Eun Park, Nieun Seo, Hyun Jung Lee, Soo Jung Park, Tae Il Kim, Won Ho Kim, Joon Seok Lim and Jae Hee Cheon (2018) Magnetic resonance enterography predicts the prognosis of Crohn's disease. Intest Res 16(3):445. doi: 10.5217/ir.2018.16.3.445
  24. Paul B. Stoddard, Leyla J. Ghazi, Jade Wong-You-Cheong, Raymond K. Cross and Fauzia Q. Vandermeer (2015) Magnetic Resonance Enterography. Inflammatory Bowel Diseases 21(1):229. doi: 10.1097/MIB.0000000000000186
  25. David H. Bruining, Ellen M. Zimmermann, Edward V. Loftus, William J. Sandborn, Cary G. Sauer, Scott A. Strong, Mahmoud Al-Hawary, Sudha Anupindi, Mark E. Baker, David Bruining, Kassa Darge, Jonathan Dillman, David Einstein, Jeff L. Fidler, Joel G. Fletcher, Michael S. Gee, David Grand, Falvius Guglielmo, Amy K. Hara, Tracy A. Jaffe, Dean Maglinte, Alec Megibow, Seong Ho Park, Joel Platt, Daniel Podberesky, Jordi Rimola, Dushyant V. Sahani, Jorge Soto and Stuart A. Taylor (2018) Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn’s Disease. Gastroenterology 154(4):1172. doi: 10.1053/j.gastro.2017.11.274
  26. Andrea Magarotto, Stefania Orlando, Marina Coletta, Dario Conte, Mirella Fraquelli and Flavio Caprioli (2016) Evolving roles of cross-sectional imaging in Crohn's disease. Digestive and Liver Disease 48(9):975. doi: 10.1016/j.dld.2016.05.017
  27. Danny G. Cheriyan, Eoin Slattery, Shaunagh McDermott, Aoife Kilcoyne, Craig Kingston, Denise Keegan, Hugh E. Mulcahy, Glen A. Doherty, Dermot E. Malone and Seamus J. Murphy (2013) Impact of magnetic resonance enterography in the management of small bowel Crohn’s disease. European Journal of Gastroenterology & Hepatology 25(5):550. doi: 10.1097/MEG.0b013e32835d4e9c

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.