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Small bowel MR enterography: problem solving in Crohn's disease.

Griffin N, Grant LA, Anderson S, Irving P, Sanderson J - Insights Imaging (2012)

Bottom Line: Clinical indices, endoscopic and histological findings have traditionally been used as surrogate markers but all have limitations.MRE can help address this question.The purpose of this pictorial review is to (1) detail the MRE protocol used at our institution; (2) describe the rationale for the MR sequences used and their limitations; (3) compare MRE with other small bowel imaging techniques; (4) discuss how MRE can help distinguish between inflammatory, stricturing and penetrating disease, and thus facilitate management of this difficult condition.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Guy's & St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK, nyreegriffin100@gmail.com.

ABSTRACT
Magnetic resonance enterography (MRE) is fast becoming the first-line radiological investigation to evaluate the small bowel in patients with Crohn's disease. It can demonstrate both mural and extramural complications. The lack of ionizing radiation, together with high-contrast resolution, multiplanar capability and cine-imaging make it an attractive imaging modality in such patients who need prolonged follow-up. A key question in the management of such patients is the assessment of disease activity. Clinical indices, endoscopic and histological findings have traditionally been used as surrogate markers but all have limitations. MRE can help address this question. The purpose of this pictorial review is to (1) detail the MRE protocol used at our institution; (2) describe the rationale for the MR sequences used and their limitations; (3) compare MRE with other small bowel imaging techniques; (4) discuss how MRE can help distinguish between inflammatory, stricturing and penetrating disease, and thus facilitate management of this difficult condition. Main Messages • MR enterography (MRE) is the preferred imaging investigation to assess Crohn's disease. T2-weighted, post-contrast and diffusion-weighted imaging (DWI) can be used. • MRE offers no radiation exposure, high-contrast resolution, multiplanar ability and cine imaging. • MRE can help define disease activity, a key question in the management of Crohn's disease. • MRE can help distinguish between inflammatory, stricturing and penetrating disease. • MRE can demonstrate both mural and extramural complications.

No MeSH data available.


Related in: MedlinePlus

Typical example of response to treatment with a biologic: a axial T1 fat-saturated post-contrast image shows a thickened avidly enhancing segment of midileum with stratified pattern of enhancement (arrows) in keeping with active inflammation; b axial T1 fat-saturated post-contrast image following 8 months of infliximab shows inflammation has been downstaged with reduction in mural thickening and enhancement which is now homogeneous (arrows)
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Fig16: Typical example of response to treatment with a biologic: a axial T1 fat-saturated post-contrast image shows a thickened avidly enhancing segment of midileum with stratified pattern of enhancement (arrows) in keeping with active inflammation; b axial T1 fat-saturated post-contrast image following 8 months of infliximab shows inflammation has been downstaged with reduction in mural thickening and enhancement which is now homogeneous (arrows)

Mentions: MRE is a useful tool in the assessment of treatment response following medical therapy. It has been shown that when MRI is performed during an acute relapse and then in remission, a reduction in both mural contrast enhancement and in mural thickness in affected segments is seen [28]. However, luminal stenosis may persist. As stated earlier, biologics such as infliximab and adalimumab have been used to treat patients with CD resistant to other therapies with mucosal healing as a key treatment goal. From our experience, MRE can be used to show a significant reduction in inflammatory activity (as demonstrated by reduced mural thickening, oedema and enhancement) following treatment with such agents (Fig. 16a, b). DWI may have a role in response assessment with a predicted decrease in the degree of restricted diffusion. However, as yet there are no published papers on this subject.Fig. 16


Small bowel MR enterography: problem solving in Crohn's disease.

Griffin N, Grant LA, Anderson S, Irving P, Sanderson J - Insights Imaging (2012)

Typical example of response to treatment with a biologic: a axial T1 fat-saturated post-contrast image shows a thickened avidly enhancing segment of midileum with stratified pattern of enhancement (arrows) in keeping with active inflammation; b axial T1 fat-saturated post-contrast image following 8 months of infliximab shows inflammation has been downstaged with reduction in mural thickening and enhancement which is now homogeneous (arrows)
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3369125&req=5

Fig16: Typical example of response to treatment with a biologic: a axial T1 fat-saturated post-contrast image shows a thickened avidly enhancing segment of midileum with stratified pattern of enhancement (arrows) in keeping with active inflammation; b axial T1 fat-saturated post-contrast image following 8 months of infliximab shows inflammation has been downstaged with reduction in mural thickening and enhancement which is now homogeneous (arrows)
Mentions: MRE is a useful tool in the assessment of treatment response following medical therapy. It has been shown that when MRI is performed during an acute relapse and then in remission, a reduction in both mural contrast enhancement and in mural thickness in affected segments is seen [28]. However, luminal stenosis may persist. As stated earlier, biologics such as infliximab and adalimumab have been used to treat patients with CD resistant to other therapies with mucosal healing as a key treatment goal. From our experience, MRE can be used to show a significant reduction in inflammatory activity (as demonstrated by reduced mural thickening, oedema and enhancement) following treatment with such agents (Fig. 16a, b). DWI may have a role in response assessment with a predicted decrease in the degree of restricted diffusion. However, as yet there are no published papers on this subject.Fig. 16

Bottom Line: Clinical indices, endoscopic and histological findings have traditionally been used as surrogate markers but all have limitations.MRE can help address this question.The purpose of this pictorial review is to (1) detail the MRE protocol used at our institution; (2) describe the rationale for the MR sequences used and their limitations; (3) compare MRE with other small bowel imaging techniques; (4) discuss how MRE can help distinguish between inflammatory, stricturing and penetrating disease, and thus facilitate management of this difficult condition.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Guy's & St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK, nyreegriffin100@gmail.com.

ABSTRACT
Magnetic resonance enterography (MRE) is fast becoming the first-line radiological investigation to evaluate the small bowel in patients with Crohn's disease. It can demonstrate both mural and extramural complications. The lack of ionizing radiation, together with high-contrast resolution, multiplanar capability and cine-imaging make it an attractive imaging modality in such patients who need prolonged follow-up. A key question in the management of such patients is the assessment of disease activity. Clinical indices, endoscopic and histological findings have traditionally been used as surrogate markers but all have limitations. MRE can help address this question. The purpose of this pictorial review is to (1) detail the MRE protocol used at our institution; (2) describe the rationale for the MR sequences used and their limitations; (3) compare MRE with other small bowel imaging techniques; (4) discuss how MRE can help distinguish between inflammatory, stricturing and penetrating disease, and thus facilitate management of this difficult condition. Main Messages • MR enterography (MRE) is the preferred imaging investigation to assess Crohn's disease. T2-weighted, post-contrast and diffusion-weighted imaging (DWI) can be used. • MRE offers no radiation exposure, high-contrast resolution, multiplanar ability and cine imaging. • MRE can help define disease activity, a key question in the management of Crohn's disease. • MRE can help distinguish between inflammatory, stricturing and penetrating disease. • MRE can demonstrate both mural and extramural complications.

No MeSH data available.


Related in: MedlinePlus