This poster is published under an
open license. Please read the
disclaimer for further details.
Type:
Educational Exhibit
Keywords:
Small bowel, MR, Structured reporting, Inflammation, Fistula
Authors:
K. Markiet, A. M. Szymańska-Dubowik, D. K. Galaska, K. Gwozdziewicz, K. Skrobisz, E. Szurowska; Gdansk/PL
DOI:
10.1594/ecr2015/C-1431
Background
Crohn’s disease (CD) is an idiopathic chronic inflammatory disease of the gastrointestinal tract often encountered in young adults with tendency to frequent relapses.
CD may affect any part of the digestive tract.
However,
the small intestine,
in particular the terminal ileum,
is most commonly affected.
Disease is characterized by so called skip-lesions - areas of inflammation separated with regions of normal mucosa.
Inflammation most commonly manifests as ulceration,
varying from superficial lesions to deep linear ulcers.
As it is often a transmural process complications such as bowel obstruction,
fistulae formation and abscesses are encountered.
These findings allow to typically classify CD as primarily active inflammatory,
penetrating of fibrostenotic disease.
Treatment differs depending on the assessment of disease activity.
Active inflammatory disease without penetrating component is generally treated with immnunosupressants and steroids,
penetrating disease is treated mainly with antibiotics and biologics and when an obstructing stricture is present it is usually treated surgically unless active inflammation coexists.
According to the joint consensus guidelines of European Crohn's and Colitis Organisation (ECCO) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) on the diagnosis and management of Inflammatory Bowel Disease (IBD) a single gold standard for the diagnosis of CD is not yet available.
The diagnosis is established by clinical assessment combined with endoscopic,
histological,
radiological and biochemical findings.
Computed tomography (CT) and Magnetic Resonance (MR) examinations are current standards for assessing CD,
showing comparable diagnostic accuracy for the detection of small intestine inflammatory lesions.
Both imaging techniques allow evaluation of the extension and activity of the disease based on wall thickness and increased enhancement after intravenous contrast media administration.
Both are suitable to detect extraluminal complications.
CT is less time-consuming and more easily available than MR.
Advantages of MR include lack of ionizing radiation and improved soft tissue contrast resolution compared with CT as well as the ability to image the small bowel dynamically while its limitations are higher cost,
lower spatial resolution and greater susceptibility to motion-related blurring and artifacts.
However,
in view of frequent follow-up studies and lack of radiation exposure MR should be considered a method of choice if accessible.
A recent study by Hafeez et al.
showed that MRE had a positive diagnostic impact in patients under investigation for CD and influenced therapeutic strategy in 61% of the patients.
MRE shows an overall sensitivity of 85% for active inflammatory disease (Lee et al.
2009) and correlates well with the surgical findings of stricture,
abscess and fistula with sensitivities of 95,
92,
72% and specificities of 72,
90,
76% respectively (Pozza et al.
2011).