Learning objectives
To review the imaging findings in the small bowel suggestive of Crohn disease.
To illustrate the different imaging techniques used on diagnosis and follow-up in Crohn disease.
To describe the usefulness of the main imaging techniques carried out in Crohn disease.
Background
Crohn disease is an idiopathic and chronic granulomatous inflammatory disease of the gastrointestinal tract with a tendency toward remission and relapse.
Crohn disease can affect any part of the gastrointestinal tract from the mouth to the anus,
often involving multiple discontinuous sites.
The small intestine is affected in 80% of cases,
most often at the terminal ileum.
There is a familiar tendency,
and smoking habit is believed to be a risk factor.
Both genders are equally affected and there is a peak of involvement in...
Imaging findings OR Procedure details
INTRODUCTION:
The earliest change seen in Crohn disease occurs in the submucosa and consists of lymphoid hyperplasia and lymphedema.
The main anatomopathological findings at this stage are aphthoid ulcers.
As the disease progresses,
it extends transmurally to the serosa and beyond to the mesentery and adjacent organs.
The bowel wall is thickened by a combination of oedema,
inflammatory infiltrates and fibrosis.
Aphthoid ulcers develop into linear ulcers (deeper) and fissures,
causing an ulceronodular or “cobblestone” appearance.
There is the possibility of deep ulcers to develop...
Conclusion
Conventional techniques have traditionally been performed in Crohn disease because radiologist wide experience.
Ultrasound is useful in emergency services.
With enteroclysis modality,
we obtain a better loop distension,
but with more technical difficulties.
With enterography,
images quality obtained is enough for diagnosis.
Its nonionizing nature makes MRI a great technique in Crohn disease.
The selection of the technique will depend on the radiologist experience and the equipment availability.
References
Leyendecker JR,
Bloomfeld RS,
DiSantis DJ,
Waters GS,
Mott R,
Bechtold RE.
MR enterography in the management of patients with Crohn Disease.
Radiographics.
2009; 29:1827-46.
Ripollés-González T,
Martínez-Pérez MJ.
Técnicas seccionales de imagen en la enfermedad de Crohn: ecografía,
tomografía computarizada y resonancia magnética.
Radiología.
2007; 49(2): 97-108.
Umschaden HW,
Szolar D,
Gasser J,
et al.
Small-Bowel Disease: comparison of MR enteroclysis images with conventional enteroclysis and surgical findings.
Radiology 2000; 215:717-725.
Herraiz-Hidalgo L,
Álvarez-Moreno E,
Carrascoso-Arranz J,
et al. Entero-resonancia magnétrica: revisión de la...