Assessment of Imaging Features of Crohn’s Disease with MR Enterography

Background: To evaluate the frequency of pathological findings determined on magnetic resonance (MR) enterography (MRE) in patients with Crohn’s Disease.Methods: A retrospective analysis of the MRE images was made in 34 female and 41 male patients (mean age 41 years) with Crohn’s disease. The prevalence of bowel wall (mural thickening, mural edema, mural fat deposits, mucosal enhancement, ulceration, cobblestone appearance, pseudopolyps) and mesenteric fatty tissue alterations (fatty tissue proliferation, mesenteric hypervascularity, enlarged lymph nodes, peri-enteric inflammation, reactive fluid), complications due to penetrating (fistula, sinus tract, abscess) and stenosing processes (fibrotic and inflammatory stenosis, obstruction, dilatation), and involvement of the colon were determined.Results: The most frequently observed changes in the bowel wall and mesenteric fatty tissue were mural thickening (98.7%) and enlargement of mesenteric lymph nodes (76%), respectively. Stenosis was the most common complication (76%). The most frequently seen pathology of the colon was ileocecal valve thickening and enhancement (74.7%).Conclusion: MR enterography is a useful imaging modality for the evaluation of changes in both the mesenteric fatty tissue and the bowel wall. As there is no use of ionizing radiation, MR enterography should be the preferred imaging modality during follow-up of patients with Crohn’s disease.     

Effectiveness and Power of Abdominal Ultrasonography in the Assessment of Crohn’s Disease Activity: Comparison with Clinical,Endoscopic, and CT Enterography Findings

Background: Non-invasive methods play an important role in clinical assessment of Crohn’s disease. Recent studies have highlighted the effectiveness and reliability of intestinal ultrasonography. We aimed to examine the relationship between intestinal ultrasonography and the clinical, endoscopic, and computed tomography enterography findings, and to assess the activity of Crohn’s disease.Methods: This was a 1-year prospective study involving patients diagnosed with Crohn’s Disease. Clinical and endoscopic activity indices, and intestinal ultrasonography and computed tomography enterography findings were evaluated. Intestinal wall thickness, mesenteric inflammation, lymphadenopathy, and complications were evaluated by intestinal ultrasonograpy and computed tomography enterography, while the superior mesenteric artery flow velocity, resistive index, and Limberg score were assessed by Doppler intestinal ultrasonography.Results: Seventy-nine patients with Crohn’s disease were included. A significant correlation was found between intestinal wall thickness, mesenteric inflammation, and complications in intestinal ultrasonography and computed tomography enterography (P = .0001). According to the receiver operating curve analysis, the intestinal wall thickness, and mesenteric inflammation were correlated with the Crohn’s Disease Activity Index, Harvey–Bradshaw Index, and SES-CD scores (P ˂ .05), and they were very effective in distinguishing active from inactive disease. According to the Crohn’s Disease Activity Index and SES-CD scores, Doppler flow velocity of the superior mesenteric artery was significantly higher in the active group than in the inactive group (P ˂ .05). The Limberg score was very consistent with the Crohn’s Disease Activity Index, Harvey–Bradshaw Index , and the results of the Simple Endoscopic Score for Crohn’s Disease (P < .0001).Conclusion: Our study showed that intestinal ultrasonography is an effective and reliable method for assessment of Crohn’s disease activity compared to clinical, endoscopic, and CTE findings.     

Small bowel obstruction following computed tomography and magnetic resonance enterography using psyllium seed husk as an oral contrast agent

The authors report a case series describing four patients who developed small bowel obstruction following the use of psyllium seed husk as an oral contrast agent for computed tomography or magnetic resonance enterography. Radiologists who oversee computed tomography and magnetic resonance enterography should be aware of this potential complication when using psyllium seed husk and other bulking agents, particularly when imaging patients with known or suspected small bowel strictures or active inflammation.     

Magnetic resonance enterography in refractory iron deficiency anemia: A pictorial overview

AIM: To highlight magnetic resonance enterography (MRE) for diagnosis of patients with refractory iron deficiency anemia and normal endoscopy results.METHODS: Fifty-three patients diagnosed with iron deficiency anemia refractory to treatment and normal gastroscopy and colonoscopy results were admitted to this prospective study between June 2013 and December 2013. All patients underwent a standardized MRE examination with a 1.5 Tesla magnetic resonance imaging system using two six-channel phased-array abdominal coils. Adequate bowel distention and fast imaging sequences were utilized to achieve diagnostic accuracy. All segments of the small bowel, duodenum, jejunum, and ileum were examined in detail. All cases were examined independently by two radiologists with > 5 years of experience in abdominal magnetic resonance imaging. A consensus reading was performed for each patient following image examination. Both radiologists were blinded to patient history, laboratory findings, and endoscopy results.RESULTS: Twenty (37.7%) male and 33 (62.3%) female patients were included in the study. The mean age of the patients was 52.2 ± 13.6 years (range: 19-81 years, median 51.0). The age difference between the male and female patient groups was not statistically significant (54.8 ± 16.3 years vs 50.7 ± 11.7 years). MRE results were normal for 49 patients (92.5%). Four patients had abnormal MRE results. One patient with antral thickening was diagnosed with antral gastritis in the second-look gastroscopy. One patient had focal wall thickening in the 3^rd and 4^th portions of the duodenum. The affected areas were biopsied in a subsequent duodenoscopy, and adenocarcinoma was diagnosed. One patient had a fistula and focal contrast enhancement in the distal ileal segments, consistent with Crohn’s disease. One patient had focal wall thickening with luminal narrowing in the mid-jejunum that was later biopsied during a double-balloon enteroscopy, and lymphoma was diagnosed.CONCLUSION: MRE is a non-invasive and effective alternative for evaluating possible malignancies of the small intestines and can serve as a guide for a second-look endoscopy.     

双气囊小肠镜与CT小肠成像在小肠克罗恩病诊断中的临床应用研究

【】目的 探讨双气囊小肠镜与CT小肠成像在小肠克罗恩病(Crohn’s disease,CD)诊断中的价值。方法 回顾性分析125例临床怀疑小肠CD行CT小肠成像及双气囊小肠镜检查患者的临床资料,以病理诊断结合内镜表现和临床随访结果为最终诊断结果,分析CT小肠成像、双气囊小肠镜在小肠CD的检出率和确诊率,并分析两者联合对小肠CD的诊断价值。结果 双气囊小肠镜检出小肠CD 78例,检出率为62.4％(78／125),最终经病理及临床随访确诊74例,确诊率为94.8％(74／78)；双气囊小肠镜诊断小肠CD的敏感度为100%,特异性为92.2%,准确性为96.8%；CT小肠成像检出小肠CD 56例,检出率为44.8％(56／125),最终经双气囊小肠镜及病理及临床随访确诊50例,确诊率为89．3％(50／56)；CT小肠成像诊断小肠CD的敏感度为69.4%,特异性为88.7%,准确性为77.6%；双气囊小肠镜对小肠CD检出率和确诊率均高于CT小肠成像。结论 双气囊小肠镜在小肠CD诊断中具有较好的应用价值,在行小肠镜前先行CT小肠成像,可以更好地指导选择小肠镜的进镜方式,减少经济支出及减轻病人痛苦；对存在内镜检查禁忌症者CTE可作为首选辅助检查手段。     

Improved comprehensive evaluation of Crohn’s disease activity by intestinal computed tomography enterography combined with endoscopy and biochemical indicators

Background and study aimsThe treatment approach for Crohn’s disease (CD) is focused on mucosal healing and resolution of transmural inflammation. The aim of this study is to evaluate the correlation between computed tomography enterography (CTE) and other treatments, in particular, endoscopy and biochemical indicators, in newly diagnosed patients with CD.Patients and methodsOne hundred twenty-three patients with CD who received CTE in Xiangya Hospital, Central South University, China, from April 2017 to April 2019 were included. The clinical case data and imaging results were retrospectively reviewed. The clinical activity of CD was determined by the Crohn’s disease activity index (CDAI) score and biochemical indicators. The relationships between CTE and endoscopy, CDAI score, and inflammatory markers were evaluated.ResultsThe diagnostic rate of CTE of the 123CD patients was 68.3% (84/123). Logistic regression analysis showed that the specific CTE manifestations related to CD activity were intestinal wall stratification, comb sign, and abdominal abscesses (P < 0.05). Spearman’s rank correlation analysis showed that inflammatory markers positively correlated with different CTE imaging manifestations.ConclusionIntestinal CTE combined with endoscopy and biochemical indicators is both comprehensive and effective in evaluating the condition of CD patients.     

胶囊内镜、CT小肠成像、小肠造影及回结肠镜对克罗恩病诊断价值的比较

目的 比较4种影像技术方法在小肠克罗恩病(CD)诊断中的应用价值.方法 57例经临床病理诊断为小肠CD的患者伴有不同程度腹痛、消瘦、腹泻或发热、大便潜血阳性等症状体征,进行回结肠镜、CT小肠成像(CTE)、胶囊内镜(CE)、小肠造影(SBFT)检查,发现异常患者则具体记录病变部位、性质,并对单项检杳及两项检查联合的阳性检出率进行比较.结果 57例CD患者中50例完成了回结肠镜检查,33例发现回肠末端溃疡(66.00%),17例回肠末端正常;CTE 34例,发现小肠病变29例(85.29%);CE 27例,其中1例发生CE在胃内潴留未达小肠,发现小肠病变26例(96.30%);SBFT 39例,发现小肠病变26例(66.67%).CE诊断CD的阳性率最高(96.30%),而回结肠镜最低(66.0%),4种检查方法的阳性率差异有统计学意义(P=0.006).两种检查方法联合的诊断CD的阳性检出率:CE+CTE为92.86%(13/14),SBFT+CTE为90.91%(20/22),CE+回结肠镜为95.65%(22/23),CE+SBFT为100%(17/17),回结肠镜+CTE为89.66%(26/29),回结肠镜+SBFT为77.78%(28/36),两种检查联合的组间比较,差异无统计学意义(P=0.140).结论 CE、CTE诊断轻度、中度CD的阳性率比SBFT高,CE发现早期黏膜病变较好,CTE发现肠壁及肠外病变较好,最重要的是CE及CTE可应用于非梗阻性小肠CD患者,传统技术如SBFT或回结肠镜阴性或不能明确诊断时,CE还可用于解释临床症状、随访及指导治疗.     

双气囊小肠镜在小肠克罗恩病中的诊断价值研究

目的 探讨双气囊小肠镜在小肠克罗恩病(CD)诊断中的价值.方法 回顾性总结141例临床怀疑小肠CD行双气囊小肠镜检查患者的临床资料,以病理诊断结合内镜表现和临床随访结果为最终诊断结果,对比分析小肠CD双气囊小肠镜、CT小肠成像以及胶囊内镜的检出率和确诊率.结果 双气囊小肠镜检出小肠CD 128例,检出率为90.8％( 128/141),最终经病理及临床随访确诊126例,确诊率为98.4％ (126/128);CT小肠成像检出小肠CD 19例,检出率为76.0％( 19/25),最终经病理及临床随访确诊17例,确诊率为89.5％ (17/19);胶囊内镜镜检出小肠CD 15例,检出率为60.0％( 15/25),最终经病理及临床随访确诊14例,确诊率为93.3％ (14/15).双气囊小肠镜组小肠CD检出率和确诊率均高于胶囊内镜和CT小肠成像.结论 双气囊小肠镜在小肠CD诊断中具有较好的应用价值,对存在内镜检查禁忌证者CT小肠成像可作为首选辅助检查手段.     

CT Enterography for Crohn’s Disease: Accurate Preoperative Diagnostic Imaging

Purpose CT enterography (CTE) is a technique that provides detailed images of the small bowel by using a low Hounsfield unit oral contrast media. This study was designed to correlate CTE findings with operative findings in patients with Crohn’s disease. Methods We performed a retrospective study of all patients with Crohn’s disease of the small bowel or colon, who had CTE and subsequent small bowel or colon surgery within three months after the CT examination. CTE findings of stricture, fistula, inflammatory mass, abscess, and combinations of these abnormalities were compared with operative findings. Specialist radiologists and fellowship-trained colorectal surgeons participated in the study. The Fisher’s exact test or chi-squared tests were used with respect to categorical data, and the Wilcoxon’s rank-sum test was used for quantitative data. Results In 36 patients, the presence or absence of stricture, fistula, abscess, or inflammatory mass was correctly determined by CTE in 100, 94, 100, and 97 percent, respectively. The accuracy for stricture or fistula number was 83 and 86 percent, respectively. There were nine patients with multiple disease phenotypes identified on CTE of which eight were confirmed at surgery. CTE overestimated or underestimated the extent of disease in 11 patients (31 percent). Conclusions CTE is an accurate preoperative diagnostic imaging study for small-bowel Crohn’s disease. The ability of this imaging study to detect both luminal and extraluminal pathology is a distinct advantage of CTE compared with small-bowel contrast studies. Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6, 2007.