The Role of MR Enterography in Assessing Crohn’s Disease Activity and Treatment Response

Congress:

ECR 2019

Poster Number:

C-2442

Type:

Scientific Exhibit

Keywords:

Abdomen, Small bowel, MR, MR-Diffusion/Perfusion, Diagnostic procedure, Inflammation

Authors:

A. Viviani¹, E. Ricci¹, C. Guerra², S. Santini³; ¹PESCIA/IT, ²Foggia/IT, ³empoli/IT

DOI:

10.26044/ecr2019/C-2442

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-2442

Fig. 1: Thickening of the walls of the small intestine

Fig. 2: Homogeneous wall contrast enhancement

Fig. 3: Mucosal wall contrast enhancement

Fig. 4: Loss of haustration

Aims and objectives

MR enterography has become the primary imaging modality in the assessment of Crohn's disease in both children and adults. With the introduction of mulecule-targeted biologic agents into the clinical setting MR enterography is increasingly utilized to evaluate disease activity and response to therapy. Now the use of diffusion-weighted imaging is useful in detecting occult disease activity evaluating early treatment response/resistance and differentiating inflammatory from fibrotic strictures. The lesions are usually transmural. Aabout two thirds of patients with Crohn's disease will develop complications within 10 years....

Methods and materials

In our institution we perform MR enterography with a 1.5T GE, Signa Excite scanner with a multichannel phased array body coil. Oral contrast (water and Isocolan) and hioscine butylbromide ,as a bowel paralytic, are administrated to all the patients. Direct sequences T1 and T2 were acquired in the axial e coronal plane and DWI sequences on the axial plane. Subsequently a 3D dynamic dependent T1 sequence with fat suppression. We analyzed 221 opatients (130 females and 91 males, age 17-43)

Results

Crohn's disease is characterized by inflammatory lesions in the gastrointestinal tract, most commonly in the terminal ileum and colon. The lesions are usually transmural, which can lead to complications like stenoses, fistulas and abscesses. While most patients first present with inflammation only, about two thirds of patients will develop complications within 10 years. We analized: 1. Localization of the disease 2. Bowel thickness. The normal bowel wall has a thickness of 1-3 mm. A common categorization is 3-5 mm for mild thickening, 5-7 mm for...

Conclusion

MR Enterography is an ideal imaging modality in the assessment of Crohn's disease, offering both structural and functional information without the use of ionizing radiation

Personal information

References

1. Masselli G, Casciani E, Polettini E, Gualdi G. Comparison of MR enteroclysis with MR enterography and conventional enteroclysis in patients with Crohn’s disease.Eur Radiol.2008;18:438–447. doi: 10.1007/s00330-007-0763-2. 2. Horsthuis K, Bipat S, Stokkers PC, Stoker J. Magnetic resonance imaging for evaluation of disease activity in Crohn’s disease: a systematic review.Eur Radiol.2009;19:1450–1460. doi: 10.1007/s00330-008-1287-0 3. Hafeez R, Punwani S, Boulos P, Bloom S, McCartney S, Halligan S, Taylor SA. Diagnostic and therapeutic impact of MR enterography in Crohn’s disease.Clin Radiol.2011;66:1148–1158. doi: 10.1016/j.crad.2010.12.018. 4. Cronin CG, Lohan...