Aims and objectives
Crohn's disease is an inflammatory process of the gastrointestinal tract usually affecting the small intestine but it can attack every part of the bowel and digestive tract.
Typically indentified changes affect limitated areas of the bowel,
are asymetrical with superficial to deep ulceration of the wall.
The diagnostics and monitoring of the disease can bring a lot of difficulties and still the most effective methods are to be searched as patients are usually young adults with tendency to relapses and serious complications.
MRI is known...
Methods and materials
50 consecutive patients with histologically confirmed Crohn's disease were examined in Radiology Department of Medical University of Gdańsk,
Poland in 2013 and 2014.
32 patients aged 33±0,3had features of active inflammation described in histological report,
18 patients aged 38±0,4 had chronic changes reported.
We analyzed the data retrospectively.
All of them,
specially prepared to the examination (with a proper bowel distention),
performed MR-enterography with the use of 1,5-T Siemens scanner of a phased array surface coil andwith the use of a protocol consisted of 11...
Results
In our functional assessment using two MR modalities: DWI ( with ADC maps) and DCE-MRI we intentified 29 cases of active inflammation( with a presence of hyperenhancement of the wall and mural diffusion restriction),
15 of chronic (with mild or little wall enhancement and without restricted diffusion).
We also found 6 problematical cases: in 3 of them we found no radiological pathologies in MRI examination,
in 2 cases we noticed wall enhancement without diffusion restriction,
in 1 case restriction without a wall enhancement.
The ADC...
Conclusion
Both methods: DWI and DCE-MRI allow to distinguish most of the patients with active and chronic stage of disease in radiological practice.
We found DWI sequence to be the most helpful in recognition of inflammed part of the bowel; ADC map for b=800 was the most efficient in our assessment.
Radiological methods of identification the bowel pathology should always be supported by clinical data and laboratory tests.
References
Oto A,
Kayhan A,
Williams JT,
Fan X,
Yun L,
Arkani S,
Rubin DT.
Active Crohn's disease in the small bowel: evaluation by diffusion weighted imaging and quantitative dynamic contrast enhanced MR imaging.
J Magn Reson Imaging.
2011 Mar;33(3):615-24.
Sempere GA,
Martinez Sanjuan V,
Medina Chulia E,
et al.
MRI evaluation of inflammatory activity in Crohn’s disease.
Am J Roentgenol.
2005;184(6):1829–35.
Smith EA,
Dillman JR,
Adler J,
Dematos-Maillard VL,
Strouse PJ.
MR enterography of extraluminal manifestations of inflammatory bowel disease in children and adolescents: moving...