Crohn's disease evaluation: comparison of contrast-enhanced MR imaging and single-phase helical CT scanning

The purpose of this study was to evaluate the use of gadolinium and barium-enhanced magnetic resonance (MR) imaging in detecting intestinal and extraintestinal Crohn's disease and compare MRI with contrast-enhanced helical computed tomography (CT). Twenty-six patients with Crohn's disease underwent imaging examinations, including gadolinium-enhanced, fat suppressed fast multiplanar spoiled gradient-recalled (FMPSPGR) MR imaging with oral 2% barium sulfate and rectal water and with helical CT using i.v. and positive (13) or negative (13) intestinal contrast material. MR images and CT scans were reviewed separately by two radiologists for bowel wall thickness and enhancement, presence of abscess, phlegmon, and fistula. MR images and CT scans were then compared side by side. Surgical, endoscopic, and histopathologic findings and results of barium studies were reviewed to determine the location and severity of involvement of intestinal Crohn's disease. Depiction of mural thickening and/or enhancement was superior on the MR images, which showed 55 (85%) and 52 (80%) of 65 abnormal bowel segments for the two observers, compared with helical CT, which showed 39 (60%) and 42 (65%; P < 0.001, P < 0.05) of bowel segments affected by Crohn's disease. Segments of bowel with moderate or marked mural thickening were depicted equally on MR imaging and helical CT. In mildly diseased segments of bowel, with only slight thickening and enhancement, MR imaging depicted 22 (79%) and 19 (68%) of 28 segments, compared with helical CT, which depicted 9 (32%; P < 0.01), and 13 (46%; P > 0.05) of 28 segments. In the side-by side comparison, MR imaging was preferred over helical CT for depicting normal bowel wall (MR 71%, CT 4%, equal 25%; P < 0.001), mural thickening (MR 41%, CT 11% equal 48%; P < 0.01), mural enhancement (MR 89%, equal 11%; P < 0.001), and overall GI tract evaluation (MR 52%, CT 10%, equal 38%; P < 0.001). Gadolinium-enhanced MR imaging with oral dilute barium sulfate and rectal water depicts intestinal and extraintestinal changes of Crohn's disease and shows promise as a clinically useful tool.     

多层螺旋CT对肠道Crohn病的诊断价值

目的:探讨多层螺旋CT(MDCT)Crohn病影像特点及诊断价值。方法:对我院经病理证实的14例肠道Crohn病患者的MDCT影像特点进行回顾性分析。结果:所有病例均有跳跃性肠壁增厚,8例表现为肠壁环形增厚,同时伴有粘膜强化和分层形成"靶征"及"双晕征";有11例表现为增厚肠壁分层消失,增强不明显,肠壁厚度多在5～11mm。4例表现为病变段肠管周围肠系膜水肿及增厚,蜂窝织炎,其中并发脓肿1例。7例表现为肠系膜淋巴结肿大。有3例表现为肠系膜血管增多增粗形成"梳征"。其中"靶征"、"双晕征"及"梳征",均提示与病变活动度相关。结论:MDCT不但能准确显示Crohn病病变部位、肠外病变,还能区分活动性与非活动性病变。MDCT可作为Crohn病首选影像学检查方法。     

MRI诊断对小肠疾病的价值及其与小肠钡灌肠的比较

目的:探讨MRI对小肠疾病的诊断价值。方法:28例患者行小肠MRI检查,其中19例同期行小肠钡灌肠检查。所有24例小肠病变患者中13例经手术证实,1例血管性病变经DSA造影证实,另10例均结合临床病史作出诊断,并对MRI各种检查序列进行了比较。结果:在显示肠腔狭窄、肠外压迹方面,MRI与小肠钡灌肠的差异没有显著性意义(P>0．05)。在显示肠壁肿块和增厚方面,MR优于小肠钡灌肠检查(P<0．05和P<0．01)。MRI各序列在显示肠壁异常改变、肠腔狭窄、肠外压迹和粘膜异常方面,差异存在显著性意义(P<0．05)。结论:MRI能更好地显示小肠病变时肠壁及系膜改变,弥补了小肠钡灌肠检查的不足。     

CT enterography: noninvasive evaluation of Crohn's disease and obscure gastrointestinal bleed

CT enterography (CTE) is a noninvasive imaging test using neutral intraluminal contrast and intravenous contrast to evaluate the small bowel. Multiphasic imaging is used in evaluating obscure gastrointestinal bleeding (OGIB), and single-phase enteric imaging is used for all other indications, including Crohn's disease (CD). CTE findings of CD include bowel wall thickening, mucosal hyperenhancement, and mural stratification. CTE findings of angiodyplasias include a vascular tuft visible during arterial phase and an early draining mesenteric vein. Early studies indicate that CTE is superior to barium examination in the evaluation of CD and is complementary to capsule endoscopy in the evaluation of OGIB.     

MSCT对克罗恩病活动性的判定

目的:探讨克罗恩病的CT表现特点。方法:回顾性分析经病理证实的32例克罗恩病的CT表现,均采用多层螺旋CT平扫+增强。结果:有26例表现为黏膜增厚和分层形成"靶征"和"双边征",肠壁厚度多在8～10mm;有5例同时有病变段肠管周围纤维脂肪成分增多及系膜血管增多、增粗。结论:多层螺旋CT不但能准确显示克罗恩病肠壁、肠系膜及周围结构的异常,增强CT还能区分活动性或非活动性病变,有助于临床采取合理而积极的治疗方案。     

An Immunoglobulin G4-Related Sclerosing Disease of the Small Bowel: CT and Small Bowel Series Findings

Immunoglobulin G4 (IgG4)-related sclerosing disease is rare and is known to involve various organs. We present a case of histologically proven IgG4-related sclerosing disease of the small bowel with imaging findings on computed tomography (CT) and small bowel series. CT showed irregular wall thickening, loss of mural stratification and aneurysmal dilatation of the distal ileum. Small bowel series showed aneurysmal dilatations, interloop adhesion with traction and abrupt angulation.     

Gastrointestinal complications in the neutropenic patient: characterization and differentiation with abdominal CT

PURPOSE: To characterize the computed tomographic (CT) findings of gastrointestinal complications in neutropenic patients and to identify CT features that can help differentiate these complications. MATERIALS AND METHODS: Abdominal CT scans obtained during a 6-year period were reviewed retrospectively to identify 76 neutropenic patients with radiologic bowel abnormalities. Scans were analyzed for wall thickening, pneumatosis, wall nodularity, mucosal enhancement, bowel dilatation, ascites, and mesenteric stranding. The location and extent of abnormalities were noted. Independent chart and pathology report reviews were used to determine the patients' final diagnoses: neutropenic enterocolitis (n = 53), Clostridium difficile colitis (n = 14), graft-versus-host disease (n = 7), cytomegaloviral colitis (n = 1), and ischemic bowel (n = 1). Results were assessed with the Student t test for quantitative wall thickness and the chi2 test for the number of patients with each diagnosis who demonstrated each CT finding. RESULTS: Mean bowel wall thickening was greatest in C difficile colitis (12 mm) and least in graft-versus-host disease (5 mm). Pneumatosis was limited to neutropenic enterocolitis (21% [11 of 53 patients]) and bowel ischemia. Wall nodularity was significantly more common (P <.01) in C difficile colitis (36% [five of 14 patients]). In graft-versus-host disease, the rates of mucosal enhancement and bowel dilatation were highest (P <.05) (71% [five of seven patients] and 86% [six of seven patients], respectively). In C difficile colitis, the rates of ascites and mesenteric stranding were highest (57% [eight of 14 patients] and 71% [10 of 14 patients], respectively). Although findings in neutropenic enterocolitis and graft-versus-host disease could involve any bowel segment, C difficile colitis was always limited to the colon. CONCLUSION: Several CT findings can help differentiate specific gastrointestinal complications in neutropenic patients.     

X线、CT和MRI对小肠Crohn病诊断价值的评价

目的:探讨X线、CT和MRI对小肠Crohn病的诊断价值及其限度.材料和方法:分析经肠镜、手术和病理诊断的26例小肠Crohn病的X线、CT和MRI表现,其中X线小肠灌肠13例,CT小肠造影15例,MRI检查13例(其中小肠MRI水成像和注气小肠灌肠分别为7例和6例),同时行X线小肠灌肠和CT检查7例,行X线小肠灌肠和MRI检查8例,行CT和MRI检查2例.结果:13例小肠Crohn病的X线表现为多个节段性病变12例(92%),线形溃疡11例(85%),卵石征11例(85%),瘘管形成4例,不对称性病变伴假憩室样改变3例,误诊为肠管外炎性肿块和脓肿3例.15例CT小肠造影表现为肠壁增厚15例(100%),强化增加13例(87%),多节段性病变13例(87%),肠管周围蜂窝织炎11例(73%),脓肿和炎性肿块5例,瘘管形成3例.13例MRI表现为肠壁强化增加13例(100%),肠壁增厚12例(92%),多节段性病变11例(85%),肠管周围蜂窝织炎9例(69%),炎性肿块6例,瘘管2例.CT和MRI均未显示肠壁线形溃疡和卵石征.结论:X线小肠灌肠易于显示小肠Crohn病线形溃疡和卵石征的特征性改变,对小肠Crohn病的初次诊断具有重要价值,但难以明确显示肠管外炎性肿块和脓肿;CT和MRI均难以显示肠壁线形溃疡和卵石征,但可明确显示病变肠壁及其周围并发症,对于指导临床治疗以及评价临床疗效具有重要价值.     

Crohn's disease: CT enterography manifestations before and after treatment

Purpose

The purpose of this study was to determine whether CT enterography (CTE) changes of Crohn's disease (CD) after treatment correlated with clinical remission.

Materials and methods

We retrospectively studied 50 known CD patients (male: 35; female: 15) with clinical remission in a period of 3 years (2005–2008). CD was diagnosed by clinical, enteroscopic and pathologic manifestations. Clinical remission was identified by experienced gastroenterologists using the combing criteria of clinical, endoscopy and laboratory tests. First CTE and endoscopy exams were performed during their first hospitalization in our hospital meanwhile CD diagnosis was made during that time. Repeated CTE and endoscopy exams were done after treatment. CTE findings were determined by two experienced radiologists with double-blind approach. Each patient was analyzed for the CTE parameters including bowel wall attenuation, bowel wall thickening (>3 mm), bowel wall thickening types (type A: multilayered mural stratification; type B: two layers with strong mucosal enhancement and prominent low-density submucosa; type C: two layers without strong mucosal enhancement; type D: homogeneous enhancement) comb sign, luminal stenosis (mild: luminal diameter 2–3 cm; moderate: luminal diameter 1–2 cm; severe: luminal diameter < 1 cm) and the presence of extraenteric complications (such as fistulas and abscess). All the quantitative parameters were measured three times by each review.

Results

After treatment, bowel wall thickening was attenuated in 88% of CD patients. Thickness of bowel wall was decreased from 8.8 ± 2.8 mm to 6.4 ± 1.9 mm (P < 0.001). CT value of bowel wall in portal stage was also declined from 90.0 ± 15.4 (HU) to73.4 ± 14.2 (HU (P < 0.001). The percentage of patients with type A or B bowel wall thickening was decreased from 78.7% to 35.4%, while those with type C or D thickening was increased from 21.2% to 64.6% (P < 0.001). The percentage of patients with comb sign was decreased from 88% to 60% (P = 0.001). The percentage of patients with moderate or severe luminal stenosis was reduced from 74% to 32% (P < 0.001). The ROC (receiver operating characteristic) analysis showed bowel wall attenuation (A_z = 0.89) and bowel wall thickness (A_z = 0.81) were the two best parameters to predict disease activity, and combining of these two values was better than using them solely (κ = 0.71, P < 0.001). The bowel wall attenuation (OR = 9.56, P < 0.001) and bowel wall thickness (OR = 3.32, P = 0.001) were significantly correlated with the disease activity in the following logistic regression analysis.

Conclusion

Therapeutic effect of CD and disease activity can be properly evaluated by CTE.     

MSCT对结肠Crohn病的诊断价值

目的:探讨MSCT对结肠Crohn病的诊断价值。方法:回顾性分析经内镜、手术及病理证实的39例结肠Crohn病患者的MSCT影像学表现。结果:39例中多节段病变30例(76.9%),单独大肠受累4例(10.3%)、大肠伴小肠受累35例(89.7%)。大肠病变累及盲肠31例(79.5%)、升结肠26例(66.7%)、横结肠17例(43.6%)、降结肠10例(25.6%)、乙状结肠16例(41.0%)、直肠6例(15.4%)。MSCT征象:肠壁增厚、强化增加、肠壁分层、肠腔狭窄、肠壁脓肿、肠系膜血管增多("梳征")、病变肠管周围纤维脂肪增多、蜂窝织炎、腹腔脓肿和炎性肿块、肛周病变、瘘管/窦道、系膜淋巴结肿等。肠管增厚、肠壁分层、强化增加、肠壁内脓肿、病变肠管周围蜂窝织炎、"梳征"等可提示病变处在活动期。结论:结肠Crohn病易累及盲、升结肠,MSCT表现有一定特征性,MSCT在显示肠壁病变及肠腔外并发症以及判断病变是否在活动期具有优势。     

CT在克隆氏病诊断中的应用

目的:评价CT在克隆氏病诊断中的价值。方法:对14例经病理证实的克隆氏病的CT表现进行回顾性分析。结果:所有病例均可见肠壁环形或不规则增厚、肠腔变形、狭窄。6例伴小肠梗阻;2例伴回肠末段不规则炎性肿块;2例见瘘管形成。结论:CT可提供克隆氏病的小肠梗阻平面,病变的范围及并发症等信息。     

CT features with pathologic correlation of acute gastrointestinal graft-versus-host disease after bone marrow transplantation in adults

OBJECTIVE: This study was conducted to describe the CT features of acute gastrointestinal graft-versus-host disease in adults and to correlate these findings with the pathologic grades of disease severity. MATERIALS AND METHODS: Patients (n = 22) with a history of allogeneic bone marrow transplantation and pathologically confirmed acute gastrointestinal graft-versus-host disease underwent contrast-enhanced (n = 13) and unenhanced (n = 9) CT. CT scans were retrospectively evaluated for intestinal and extraintestinal abnormalities by two radiologists who were unaware of the biopsy results. The CT findings were correlated with the pathologic grade of disease severity using the Pearson's correlation coefficient and the two-tailed nonparametric Spearman's rank correlation coefficient. RESULTS: CT features included small-bowel wall thickening (22/22), engorgement of the vasa recta adjacent to affected bowel segments (20/22), stranding of the mesenteric fat (16/22), large-bowel wall thickening (13/22), bowel dilatation proximal to thickened wall segments (5/22), ascites (10/22), periportal edema (8/22), mucosal enhancement (7/13), and serosal enhancement (4/13). The wall thickening had a discontinuous distribution in nine patients (41%). Bowel wall thickening was associated with high-grade graft-versus-host disease in patients in whom the distal esophagus (p = 0.015), ileum (p = 0.034), or ascending colon (p = 0.05) was involved. Increasing numbers of thickened bowel segments correlated with high-grade graft-versus-host disease (r = 0.548, p = 0.008). Increasing numbers of abnormal CT findings did not correlate with high-grade graft-versus-host disease (r = 0.117, p = 0.604). CONCLUSION: A variety of bowel abnormalities can be seen on CT in patients with acute graft-versus-host disease. CT findings associated with high-grade graft-versus-host disease are thickening of the distal esophagus, ileum, or ascending colon, as well as increasing numbers of thickened bowel wall segments.     

Multidetector CT of the small bowel: evaluation after oral hyperhydration with isotonic solution

PURPOSE: The aim of our study was to assess the diagnostic capabilities of multidetector CT in the evaluation of the small bowel in different pathological conditions, with the use of oral hyperhydration with isotonic solution. MATERIALS AND METHODS: The study retrospectively evaluated 106 patients who underwent multidetector CT of the small bowel. Four groups were considered on the basis of the clinical findings: group A (48 cases), with suspected or certain chronic inflammatory disease of the small bowel; group B (16 cases), with suspected neoplastic lesion of the small bowel; group C (17 cases), patients affected by malabsorption; group D (25 cases), others: 13 cases with non-specific abdominal pain, 4 cases with occult bleeding, 8 cases affected by fever of unknown origin. Thirteen patients had previously undergone surgical intestinal resection. In all cases the CT examination was performed after the oral administration of 2000 mL polyethylene glycol electrolyte balanced solution; before the scan, N-butyl scopolamine or glucagon were administered intravenously to obtain rapid inhibition of bowel peristalsis. All multidetector CT scans were acquired at baseline and 50 seconds after the I.V. administration of 110-130 ml high-concentration non-ionic iodinated contrast medium. The images were subsequently processed on a dedicated workstation (Advantage Windows 4.0, GE Medical Systems) to obtain multiplanar reconstruction (MPR). We considered the following CT findings: fold distribution, wall thickening and stratification and contrast enhancement, extraparietal involvement and abnormalities of the abdominal organs. The CT diagnoses were compared with the clinical and laboratory findings (86 cases) and with the results of barium follow-through (55 cases), ileo-colonoscopy (45 cases) or surgery (28 cases). RESULTS: CT examination allowed the correct diagnosis in 86/106 cases (89%); 20 patients were not included in the study because of a poor (11 cases) or absent (9 cases) small bowel loop distension. The final diagnoses in the 86 patients were: Crohn's disease of the small bowel (38 cases), Crohn's disease of the duodenum (1 case), granulomatous colitis (3 cases), malabsorption (8 cases), neoplastic lesion (4 cases), post-radiation conglomeration of ileal loops (1 case), intestinal lymphangiectasia (1 case), ulceration of the last ileal loop (1 case). In 29 cases no abnormalities of the small bowel were found. Spiral CT yielded 52 true positive cases, 5 false negative cases, 2 false positive cases, and 27 true negative RESULTS: The sensitivity of the technique was 91%, specificity 93% and diagnostic accuracy 92%. CONCLUSIONS: Multidetector CT of the small bowel performed after oral hyperhydration with isosmotic solution, proved to be an accurate and thorough technique. It can be considered a safe and effective alternative to conventional radiographic studies and to small bowel spiral CT enema in patients that refuse the nasojejunal balloon catheter or the administration of methylcellulose.     

多层CT在小肠Crohn病中的应用

目的：探讨小肠Crohn病的MSCT表现特点。方法：回顾性分析经病理证实的45例小肠Crohn病患者的MSCT征象,评价增强扫描不同期相（动脉期和门脉期）中病变肠管的强化方式及其意义。结果：45例中病变多发38例,单发7例;所有病例均出现肠壁增厚,表现为环形或偏心性增厚。增强扫描示病变段肠壁有较明显强化,呈多层状或均一强化,各种增厚及强化方式多混合存在于同一病例中;门脉期病变强化更加充分。36例合并肠系膜淋巴结肿大;13例患者出现肠系膜改变,主要表现为系膜密度升高、模糊（10例）,系膜血管增生及“梳样征”（7例）;21例合并肠外器官改变,包括肛周脓肿2例、腰大肌脓肿1例、骶髂关节炎1例、肾结石6例、胆囊结石及胆囊炎13例;并发瘘管穿孔1例,不全梗阻5例。结论：小肠Crohn病的MSCT表现有一定特征性,MSCT在小肠Crohn病的早期诊断及疾病发展阶段的判断中具有重要价值。     

Is it Crohn's disease or intestinal tuberculosis? CT analysis

A computed tomographic (CT) analysis of 36 patients with differential diagnosis of intestinal tuberculosis (IT) or Crohn's disease (CD) in barium gastrointestinal studies was undertaken to identify distinguishing bowel wall or mesenteric features which could provide a radiological definitive diagnosis. Final diagnoses obtained in 32 cases were tuberculosis (N=18), CD (N=9), carcinoid (N=2), chronic appendicitis (N=2) and bowel infarction (N=1). In IT, the bowel wall changes were varied: absence of wall thickening (N=6), minimal asymmetric wall thickening with and without mucosal tethering (N=8), minimal symmetric wall thickening often with mild peritonitis (N=3), exophytic mass encircling bowel lumen (N=4). Mural stratification (target sign) was not found. CD showed concentric or symmetrical wall thickening ranging from 0.6 to 1.5 mm and mural stratification occurred in about a half of the cases. Lymphadenopathy was the commonest associated feature in both but in IT, the nodes were larger and a third had necrotic centers. Displacement of bowel loops was more often due to enlarged lymphadenopathy in IT while in CD it was frequently due to fibrofatty change. CT was able to provide the correct diagnosis in 26 out of these 32 (81%) cases of indeterminate barium studies. CT is recommended when barium gastrointestinal studies are unable to differentiate between intestinal tuberculosis and Crohn's disease.     

Imaging of small bowel Crohn's disease: can abdominal CT replace barium radiography?

Objectives: To analyze imaging features and compare the diagnostic information provided by abdominal computed tomography (CT) and enteroclysis to see whether CT can replace barium examinations in the assessment of patients with small bowel Crohn's disease. Methods: The abdominal CT studies and enteroclysis of 33 patients with small bowel Crohn's disease who underwent both examinations within a 2-week time period were retrospectively reviewed and scored for the presence and severity of the following features: mural edema, ulceration, small bowel obstruction, stricture, sinus tract formation, fistula, abscess, extraintestinal manifestations, and total number of intestinal sites involved. The statistical significance of the differences for each variable was calculated. Results: A total of 37 case sets were reviewed. CT demonstrated 10 (27 %) abscesses compared to 7 (19 %) shown by enteroclysis. Three extraintestinal sites shown by CT were not demonstrated by enteroclysis. Enteroclysis detected a larger number of intestinal sites of involvement (54 vs. 47) and more cases of ulceration (78 % vs. 19 %), small bowel obstruction (46 % vs. 16 %), stricture (38 % vs. 11 %), fistula formation (24 % vs. 8 %), and sinus tract formation (27 % vs. 5 %). The two modalities were similar in characterizing and grading the severity of mural thickening (CT showed 41 %, enteroclysis 46 %). Conclusion: Abdominal CT and enteroclysis provide unique and complementary diagnostic information in patients with Crohn's disease of the small bowel. Both methods may be required for the accurate assessment of the severity and extent of Crohn's disease of the small bowel. The choice of initial examination will depend on the clinical issue in question.     

Bowel disease: prospective comparison of CT and 1.5-T pre- and postcontrast MR imaging with T1-weighted fat-suppressed and breath-hold FLASH sequences.

The potential of new high-field-strength magnetic resonance (MR) imaging sequences to evaluate bowel disease was investigated and compared with computed tomographic (CT) studies. Thirty-two patients were studied, 14 with known or suspected gastrointestinal tumors and 18 with known or suspected bowel inflammatory conditions. T1-weighted fat-suppressed spin-echo and breath-hold FLASH (fast low-angle shot) images were obtained before and after intravenous injection of 0.1 mmol/kg gadopentetate dimeglumine. Pathologic confirmation was obtained by biopsy (n = 18), surgical excision (n = 8), or endoscopy (n = 6). CT and MR images were analyzed separately in a prospective fashion and reviewed by consensus. Information from CT and MR images was comparable in cases of confirmed bowel neoplasia. CT scans had better spatial resolution, while fat-suppressed gadolinium-enhanced MR images had better contrast resolution. In the 18 cases of bowel inflammation, CT scans showed concentric wall thickening in 16, while MR images showed concentric wall thickening in 14 and increased contrast enhancement in 17. Contrast enhancement was better appreciated on fat-suppressed images than on FLASH images. The results suggest that MR imaging may play a role in the evaluation of bowel disease.     

Unusual causes of colonic wall thickening on computed tomography

Computed tomography (CT) appearances in "colitis" are often non-specific, and include mural thickening and mesenteric fat stranding. In the western world, the majority of cases will have, or be subsequently diagnosed with, inflammatory bowel disease, pseudomembranous colitis or ischaemic colitis. However, other rare conditions may also produce these rather non-specific signs. We present a number of cases demonstrating colonic wall thickening on CT due to rarer diagnoses, which are correlated with the histopathological features. Some of these CT appearances have not been described previously in the literature.     

Magnetic Resonance enteroclysis imaging in Crohn's disease

PURPOSE: To assess the role of magnetic resonance enteroclysis (MRE) in patients with Crohn's disease, in order to identify involved segments, define the extension and evaluate transmural alterations. MATERIALS AND METHODS: Eighteen patients with known Crohn's disease were studied with MR (1.5 T), with breath-hold T2-weighted TSE, T2-weighted TSE SPIR and 3D T1-weighted sequences before and after gadolinium injection (0.2 mmol/kg) in the coronal and axial planes. The small bowel was distended by the administration of 2 l of methylcellulose through a nasojejunal tube and drug induced hypotony. Typical patterns of Crohn's disease, such as mucosal abnormalities, parietal thickening and narrowing of the bowel, prestenotic dilation, fibrofatty proliferation and enlarged lymph nodes were analysed on radiological and MRE images. MRE was performed within 30 days from conventional radiological studies (conventional enteroclysis and small bowel follow-through). RESULTS: Good distension of the bowel wall was obtained in all cases. MRE assessed the presence of parietal thickening and narrowing of the bowel wall (14/18 cases) and the presence of prestenotic dilatation (12/18 cases). Vascular enhancement (14/18 cases), transmural abnormalities (8/18 cases), fibrofatty proliferation (3/18 cases), abscess formation (2/18 cases) and enlarged mesenteric lymph nodes (6/18 cases) were also observed. MRE missed small fistulas which were visible in radiological studies in two patients. CONCLUSIONS: MRE appears to be a promising technique in patients with Crohn's disease. Due to limited spatial resolution MRE could be a useful adjunct to radiological studies and in following up selected groups of patients with prior known disease.     

Multiplanar spiral CT enterography in patients with Crohn's disease using a negative oral contrast material: initial results of a noninvasive imaging approach

The aim of this study was to prospectively define the role of multiplanar spiral CT enterography with a new negative oral contrast material for noninvasive assessment of the small bowel in patients with Crohn's disease. Thirty patients with established Crohn's disease prospectively underwent spiral CT enterography at 45-60 min after distension of the small bowel with 1400 ml of a negative oral contrast material (Mucofalk water enema). Spiral CT scans were obtained 50 s after administration of intravenous contrast material with the following parameters: 5-mm collimation; 7.5-mm/s table feed; and 3-mm reconstruction interval. The adequacy of bowel opacification, luminal distension, and the contribution of two-dimensional multiplanar reformatted imaging were assessed by two observers. Spiral CT imaging findings were compared with results of enteroclysis as well as endoscopic and histological findings in all patients. Spiral CT enterography with Mucofalk water enema was well tolerated in 29 of 30 patients. Findings on spiral CT enterography were comparable with those of barium studies in 25 of 30 patients, superior to those on barium studies in 4 patients, and inferior in 1 patient ( p<0.05). The addition of multiplanar reformatted images to axial spiral CT scans significantly improved observers' confidence in image interpretation ( p<0.05) but did not reveal additional abnormalities. Multiplanar spiral CT enterography with Mucofalk excellently provides information in patients with Crohn's disease. This technique accurately depicts the level of small bowel obstruction and the extent of inflammatory small bowel disease and its extraluminal complications.