Magnetic resonance enteroclysis compared with conventional enteroclysis and computed tomography enteroclysis: a critically appraised topic

Recent advances in CT and MR technology, particularly the advent of multidetector CT (MDCT), the advent of rapidly changing gradients in industry standard MRI scanners, enabling ultrafast sequences, have led to an expansion in the role of cross sectional imaging in the investigation of small bowel disorders. We conducted an evidence-based review of MR enteroclysis (MRE) and how it performs in comparison to CT enteroclysis (CTE) and the gold standard of conventional enteroclysis (CE) for diagnosis of small bowel Crohn’s disease and small bowel neoplasia. We used the standard 5 step evidence-based medicine method of ask, search, appraise, apply and evaluate. We found 3 relevant level 1B studies, and one level 3B study. No studies evaluating MRE in small bowel neoplasia were found. MRE does not perform as well as CE in evaluation of fine mucosal detail, but the additional extraluminal detail, and absence of ionising radiation enhances its overall performance. It was not possible to establish the relative diagnostic performances of MRE and CTE from existing literature. CTE does involve patient irradiation. For patients in whom jejunal intubation and enteroclysis is considered to evaluate the small bowel, MRE should be considered the first-line investigation, local resources and expertise permitting.