Role of MRI enterography in the evaluation ofPatients with Crohn's Disease
Marwa Samir El-Naggar;
Abstract
Crohn's disease is a chronic relapsing inflammatory bowel disease that may involve any part of the gastrointestinal tract from mouth to anus and is characterized by recurrent episodes of exacerbation and remission. The distal ileum and colon are the most frequently affected parts. It is characterized by chronic segmental inflammation that may progressively extend through all layers of the intestinal wall and involve extra-intestinal structures.
Using the MRE as a tool for the follow up of a patient with Crohn's disease has the following advantages:
1- State of the art MRE has rapidly emerged as successful small bowel imaging modality, offering detailed morphologic information, and also permitting evaluation of extraluminal and extraintestinal manifestation of disease. Even subtle disease manifestations may be detected when adequate distention of the small bowel is achieved.
2- The lack of ionizing radiation may make MRE the preferred modality for evaluation of small bowel disease as a significant percentage of patients with Crohn's disease are first diagnosed during childhood and adolescence. The chronic course of disease with alternating states of remission and recurrence, compromising quality of life and physical development of the affected young patients, the need for therapy surveillance and the dilemma of how to time surgical intervention necessitate frequent diagnostic imaging studies. In CT and with conventional enteroclysis, high doses of ionizing radiation accumulate over the course of the disease. Alsopregnant patients and those with iodine contrast agents allergy or decreased renal clearance may also benefit from shifting to this technique.
3- The sensitivity and specificity values of MRI for the detection of Crohn's disease have been reported in scientific studies to range from 88% to 98% and from 78% to 100%, respectively.
4- The ability to perform cine and multiplaner images in segments of the intestine which allows low grade obstructions to be detected and the ability to distinguish between inflammatory activity and fibrosis ,determining the cause of bowel obstruction is important with obstructing bowel strictures into medical treatment (with concomitant active disease) and surgical intervention (with chronic fibrosis alone).
5- The information on disease activity is not matched by any other imaging method, with recent studies describing also a potential role of MRI for noninvasive evaluation of disease activity by means of quantitative measurements. The ability of MR enterography to differentiate active from inactive bowel inflammation, an important distinction during follow up imaging of patients with Crohn's disease undergoing medical therapy as the MRE provides an accurate noninvasive assessment of Crohn's disease activity and can aid in formulating treatment strategies for symptomatic patients and assessing therapy response. This distinction is particularly important given the recent advent of biologic therapies targeting specific inflammatory molecules, such as tumor necrosis factor–α, which are more likely to be effective in patients with active inflammation.
6- Malignant degeneration may be better demonstrate
Using the MRE as a tool for the follow up of a patient with Crohn's disease has the following advantages:
1- State of the art MRE has rapidly emerged as successful small bowel imaging modality, offering detailed morphologic information, and also permitting evaluation of extraluminal and extraintestinal manifestation of disease. Even subtle disease manifestations may be detected when adequate distention of the small bowel is achieved.
2- The lack of ionizing radiation may make MRE the preferred modality for evaluation of small bowel disease as a significant percentage of patients with Crohn's disease are first diagnosed during childhood and adolescence. The chronic course of disease with alternating states of remission and recurrence, compromising quality of life and physical development of the affected young patients, the need for therapy surveillance and the dilemma of how to time surgical intervention necessitate frequent diagnostic imaging studies. In CT and with conventional enteroclysis, high doses of ionizing radiation accumulate over the course of the disease. Alsopregnant patients and those with iodine contrast agents allergy or decreased renal clearance may also benefit from shifting to this technique.
3- The sensitivity and specificity values of MRI for the detection of Crohn's disease have been reported in scientific studies to range from 88% to 98% and from 78% to 100%, respectively.
4- The ability to perform cine and multiplaner images in segments of the intestine which allows low grade obstructions to be detected and the ability to distinguish between inflammatory activity and fibrosis ,determining the cause of bowel obstruction is important with obstructing bowel strictures into medical treatment (with concomitant active disease) and surgical intervention (with chronic fibrosis alone).
5- The information on disease activity is not matched by any other imaging method, with recent studies describing also a potential role of MRI for noninvasive evaluation of disease activity by means of quantitative measurements. The ability of MR enterography to differentiate active from inactive bowel inflammation, an important distinction during follow up imaging of patients with Crohn's disease undergoing medical therapy as the MRE provides an accurate noninvasive assessment of Crohn's disease activity and can aid in formulating treatment strategies for symptomatic patients and assessing therapy response. This distinction is particularly important given the recent advent of biologic therapies targeting specific inflammatory molecules, such as tumor necrosis factor–α, which are more likely to be effective in patients with active inflammation.
6- Malignant degeneration may be better demonstrate
Other data
| Title | Role of MRI enterography in the evaluation ofPatients with Crohn's Disease | Other Titles | دور الرنـين المغناطيسـي للأمعـاء الدقيقـة في تشخيص ومتابعة مرض كرون | Authors | Marwa Samir El-Naggar | Issue Date | 2014 |
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