Abdominal MRI after enteroclysis or with oral contrast in patients with suspected or proven Crohn's disease (original) (raw)
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Crohn disease of the small bowel: MR enteroclysis versus conventional enteroclysis
Abdominal Imaging, 2006
Enteroclysis has been suggested as the technique of choice for the evaluation of Crohn disease of the small intestine. Adequate distention of the entire small bowel with barium suspension allows the radiologic demonstration of mucosal abnormalities and provides functional information by defining distensibility or fixation of the small bowel loops. The principal disadvantage of conventional enteroclysis is the limited indirect information on the state of the bowel wall and extramural extension of Crohn disease, and its effectiveness may be hindered owing to overlapping bowel loops. Moreover, the radiation dose administered to patients, mostly at a young age, should be considered. Magnetic resonance (MR) enteroclysis is an emerging technique for small bowel imaging and was introduced to overcome the limitations of conventional enteroclysis and MR cross-sectional imaging by combining the advantages of both into one technique. MR enteroclysis has the potential to change how the small bowel is assessed because of the functional information, soft tissue contrast, direct multiplanar imaging capabilities, and lack of ionizing radiation.
American Journal of Roentgenology, 2005
OBJECTIVE. The objective of our study was to assess the diagnostic value of CT enteroclysis compared with conventional enteroclysis in patients with Crohn's disease. SUBJECTS AND METHODS. Fifty consecutive patients (26 women, 24 men; mean age, 36.3 years; age range, 18-52 years) with histologically proven Crohn's disease underwent CT enteroclysis and conventional enteroclysis (median time interval, 21.7 days) during a symptomatic stage of their disease. Both techniques were compared with regard to diagnostic yield in assessing the presence and extent of disease. Imaging findings were compared with surgery, follow-up examinations, or both. RESULTS. CT enteroclysis and conventional enteroclysis were successfully performed in all 50 patients. Crohn's disease-associated radiographic changes were found in 44 patients (88%) using CT enteroclysis and in 42 patients (84%) using conventional enteroclysis. Significantly more Crohn's disease-associated abnormalities were diagnosed with CT enteroclysis than with enteroclysis (p < 0.01). Minimal inflammatory changes of the mucosa were diagnosed in 44 patients (88%) using CT enteroclysis and in 42 patients (84%) using enteroclysis. Both imaging methods depicted stenotic bowel segments in 34 patients (68%), and prestenotic dilatation was diagnosed in 20 patients (40%) with CT enteroclysis and in 15 (30%) with enteroclysis. Fistulas were found in 18 patients (36%) with CT enteroclysis and in eight (16%) with enteroclysis (p < 0.01). Skip lesions could be seen in 17 (34%) and three patients (6%), respectively (p < 0.01). Conglomeration of bowel loops tumors was diagnosed with CT enteroclysis in 13 patients (26%) and in three patients (6%) using conventional enteroclysis (p < 0.01). Only CT enteroclysis depicted abscesses in eight patients (16%) (p < 0.01). CONCLUSION. CT enteroclysis proved to be significantly superior to conventional enteroclysis in depicting Crohn's disease-associated intra-and extramural abnormalities. CT enteroclysis is the imaging method of choice and should replace enteroclysis in patients with Crohn's disease.
Computed tomography enteroclysis in comparison with ileoscopy in patients with Crohn's disease
International journal of colorectal disease, 2003
Enteroclysis and computed tomography (CT) have been recently combined in to assess small bowel alterations. We compared the accuracy of CT enteroclysis to that of endoscopy in detecting bowel wall alterations of the terminal or neoterminal ileum in Crohn's disease (CD) patients and assessed whether postcontrast wall density is related to clinical activity of CD. A total of 39 patients referred for either established or suspected CD were enrolled. Diagnosis used ileocolonoscopy with histology; clinical activity was measured by CDAI. Contrast-enhanced spiral CT of the abdomen was performed after distension of the small bowel with an enema of methylcellulose. Retrograde ileocolonoscopy diagnosed 30 patients with CD of the ileum, while 9 patients served as controls. CT enteroclysis detected CD in 26 patients (86.7%) and in none of the control group. Three of four patients with false-negative findings on CT enteroclysis had postsurgical CD recurrence. The overall sensitivity and spec...
MR enteroclysis: technical considerations and clinical applications
European Radiology, 2002
Magnetic resonance enteroclysis (MRE) is an emerging technique for the evaluation of small bowel abnormalities. Adequate luminal distention, achieved by the administration of iso-osmotic water solution through a nasojejunal catheter, in combination with ultrafast sequences, such as single-shot turbo spin echo, true fast imaging with steady precession, half-Fourier acquired single-shot turbo spin echo, and 3D fast low-angle shot, results in excellent anatomic demonstration of the small bowel. Magnetic resonance fluoroscopy can be performed during MRE examination and might be useful in studying low-grade stenosis or motility-related disorders. Magnetic resonance enteroclysis is very promising in detecting the number and extent of involved small bowel segments in patients with Crohn's disease, and in disclosing lumen narrowing and extramural manifestations and complications of the disease. Initial experience shows that MRE is very efficient in the diagnosis of small bowel tumors and can be used in the evaluation of small bowel obstruction.
Conventional enteroclysis with complementary MR enteroclysis: a combination of small bowel imaging
Abdominal Imaging, 2005
In recent years, there have been important improvements in different technologies and procedures to evaluate small bowel diseases. Among these new technologies and procedures: push enteroscopy, capsule endoscopy, magnetic resonance enteroclysis (MRE), and computed tomographic enteroclysis (CTE) have provided competitive and/or complementary modalities compared with classic conventional small bowel through and conventional enteroclysis (CE) examinations [1-10]. As very well appreciated, all modalities have their own advantages and disadvantages and indications and limitations. Despite these technologic advances, radiologic workup remains the first stage in the diagnosis of small bowel diseases and CE is the gold standard in the evaluation of mucosal pathologies, morphologic changes, and luminal and functional abnormalities . However, in some cases, the effectiveness of CE decreases due to overlapping bowel loops. In addition, pathologic changes may not be limited to the small bowel wall. Although CE provides indirect findings concerning the wall and perienteric structures, complementary imaging is often needed in cases in which the pathologic changes go beyond the small bowel wall. Cross-sectional imaging methods such as computed tomography (CT) and magnetic resonance imaginig (MRI) are not affected by overlapping bowel loops, provide sufficient information about mural pathologies, and determine the extraluminal extension of the disease and surrounding structures. Multidetectorrow CT (MDCT) and MRI have become successful alternative cross-sectional imaging modalities for more detailed small bowel examinations . MRI has multiplanar imaging capacity and excellent soft tissue contrast without any radiation exposure. In addition, with improved breath-hold, fast and ultrafast imaging sequences, high performance gradient coils, and dedicated abdominal phased array coils, image quality of gastrointestinal MRI has improved and the timing handicap has been overcome . MDCT shares the same advantages as MRI but radiation poses well-known risks ]. This report discusses the technique and findings of the combination of CE and MRE in the evaluation of different small bowel diseases.