Correlation of MRI-determined small bowel Crohn’s disease categories with medical response and surgical pathology
Open Access
- 1 January 2009
- journal article
- Published by Baishideng Publishing Group Inc. in World Journal of Gastroenterology
- Vol. 15 (27), 3367-3375
- https://doi.org/10.3748/wjg.15.3367
Abstract
AIM: To determine whether magnetic resonance imaging (MRI) can be used to categorize small bowel Crohn’s disease (SB CD) into groups that correlate with response to medical therapy and surgical pathology. METHODS: Data was collected from all patients with MRI evidence of SB CD without significant colonic disease over a 32-mo period. Two radiologists, blinded to clinical findings, evaluated each MRI and grouped them based on bowel wall thickness and wall enhancement. These categories were: (1) “fibrosis”, (2) “mild segmental hyper-enhancement and mild wall thickening”, (3) “mild segmental hyper-enhancement and marked wall thickening”, (4) “marked segmental transmural hyper-enhancement”. Patient response to additional medical therapy post-MRI was prospectively determined at 8-wk. Non-responders underwent endoscopy and were offered therapeutic endoscopy or surgery. Surgical pathology was assessed against the MRI category. RESULTS: Fifty-five patients were included. Females and category “2” patients were more likely, and patients with luminal narrowing and hold-up less likely, to respond to medical therapy (P < 0.05). Seventeen patients underwent surgery. The surgical pathological findings of fibrosis and the severity of inflammation correlated with the MRI category in all cases. CONCLUSION: Our findings suggest that SB CD can be grouped by the MRI findings and that these groups are associated with patients more likely to respond to continued medical therapy. The MRI categories also correlated with the presence and level of intestinal inflammation and fibrosis on surgical pathology, and may be of prognostic use in the management of CD patients.Keywords
This publication has 28 references indexed in Scilit:
- Assessment of Crohn?s disease activity in the small bowel with MR and conventional enteroclysis: preliminary resultsEuropean Radiology, 2004
- Modern Imaging Using Computer Tomography and Magnetic Resonance Imaging for Inflammatory Bowel Disease (IBD) AU1Inflammatory Bowel Diseases, 2004
- Helical CT of the small bowel with an alternative oral contrast material in patients with Crohn diseaseAbdominal Radiology, 2003
- Crohn Disease with Endoscopic Correlation: Single-Shot Fast Spin-Echo and Gadolinium-enhanced Fat-suppressed Spoiled Gradient-Echo MR ImagingRadiology, 2002
- MR Imaging Evaluation of the Activity of Crohn's DiseaseAmerican Journal of Roentgenology, 2001
- Value of Double-Contrast Barium Enema Performed Immediately After Incomplete ColonoscopyAmerican Journal of Roentgenology, 2001
- Enteroclysis and spiral CT examination in diagnosis and evaluation of small bowel Crohn's disease.2000
- Abscesses in Crohn disease: percutaneous drainage.Radiology, 1987
- The long-term outcome in Crohn's diseaseDiseases of the Colon & Rectum, 1987
- Long-term follow-up of patients with Crohn's diseaseGastroenterology, 1985