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Computed tomography enterography and magnetic resonance enterography in the diagnosis of Crohn's disease.

Kim SH - Intest Res (2015)

Bottom Line: Imaging of the small bowel is complicated by its length and its overlapping loops.Recently, however, the development of crosssectional imaging techniques, such as computed tomography enterography (CTE) and magnetic resonance enterography (MRE) has shifted fundamental paradigms in the diagnosis and management of patients with suspected or known Crohn's disease (CD).CTE and MRE are noninvasive imaging tests that involve the use of intraluminal oral and intravenous contrast agents to evaluate the small bowel.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.

ABSTRACT
Imaging of the small bowel is complicated by its length and its overlapping loops. Recently, however, the development of crosssectional imaging techniques, such as computed tomography enterography (CTE) and magnetic resonance enterography (MRE) has shifted fundamental paradigms in the diagnosis and management of patients with suspected or known Crohn's disease (CD). CTE and MRE are noninvasive imaging tests that involve the use of intraluminal oral and intravenous contrast agents to evaluate the small bowel. Here, we review recent advances in each cross-sectional imaging modality, their advantages and disadvantages, and their diagnostic performances in the evaluation of small bowel lesions in CD.

No MeSH data available.


Related in: MedlinePlus

An anal fistula and perianal abscess in a 27-year-old man with CD. (A) An axial CT image shows a large perianal abscess (*) just next to the anus (a). However, the anal fistula itself is not apparent on the CT image. (B) In contrast, serial T2-weighted magnetic resonance images clearly depict an anal fistula itself (arrows), which connects the anal lumen (a) and perianal abscess (*).
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Figure 13: An anal fistula and perianal abscess in a 27-year-old man with CD. (A) An axial CT image shows a large perianal abscess (*) just next to the anus (a). However, the anal fistula itself is not apparent on the CT image. (B) In contrast, serial T2-weighted magnetic resonance images clearly depict an anal fistula itself (arrows), which connects the anal lumen (a) and perianal abscess (*).

Mentions: One population-based study of CD patients found that the cumulative risk for developing a fistula was 33% after 10 years and 50% after 20 years.37 The most common type of fistula in CD is a perianal fistula (Fig. 13). Unlike other types of fistula commonly seen in CD, including enteroenteric, enterocolic, or colocolic fistulas, perianal fistulas are often present in the absence of anal or rectal inflammation. In a recent study of 36 patients with surgical correlations, CTE correctly determined the presence or absence of fistulas in 94% of patients with an accuracy of 86% for the number of fistulas.13 Another study of 38 patients using CT with a positive oral contrast medium had a slightly lower accuracy rate of 77% for the detection of fistulas.38 Although CTE is typically performed with a neutral oral contrast medium, if fistulas are the primary indication, a switch to a positive oral contrast medium can be considered to opacify any fistula tracts. MRI is considered to be a better imaging modality for depicting perianal complications owing to its high soft tissue contrast (Fig. 13).


Computed tomography enterography and magnetic resonance enterography in the diagnosis of Crohn's disease.

Kim SH - Intest Res (2015)

An anal fistula and perianal abscess in a 27-year-old man with CD. (A) An axial CT image shows a large perianal abscess (*) just next to the anus (a). However, the anal fistula itself is not apparent on the CT image. (B) In contrast, serial T2-weighted magnetic resonance images clearly depict an anal fistula itself (arrows), which connects the anal lumen (a) and perianal abscess (*).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4316219&req=5

Figure 13: An anal fistula and perianal abscess in a 27-year-old man with CD. (A) An axial CT image shows a large perianal abscess (*) just next to the anus (a). However, the anal fistula itself is not apparent on the CT image. (B) In contrast, serial T2-weighted magnetic resonance images clearly depict an anal fistula itself (arrows), which connects the anal lumen (a) and perianal abscess (*).
Mentions: One population-based study of CD patients found that the cumulative risk for developing a fistula was 33% after 10 years and 50% after 20 years.37 The most common type of fistula in CD is a perianal fistula (Fig. 13). Unlike other types of fistula commonly seen in CD, including enteroenteric, enterocolic, or colocolic fistulas, perianal fistulas are often present in the absence of anal or rectal inflammation. In a recent study of 36 patients with surgical correlations, CTE correctly determined the presence or absence of fistulas in 94% of patients with an accuracy of 86% for the number of fistulas.13 Another study of 38 patients using CT with a positive oral contrast medium had a slightly lower accuracy rate of 77% for the detection of fistulas.38 Although CTE is typically performed with a neutral oral contrast medium, if fistulas are the primary indication, a switch to a positive oral contrast medium can be considered to opacify any fistula tracts. MRI is considered to be a better imaging modality for depicting perianal complications owing to its high soft tissue contrast (Fig. 13).

Bottom Line: Imaging of the small bowel is complicated by its length and its overlapping loops.Recently, however, the development of crosssectional imaging techniques, such as computed tomography enterography (CTE) and magnetic resonance enterography (MRE) has shifted fundamental paradigms in the diagnosis and management of patients with suspected or known Crohn's disease (CD).CTE and MRE are noninvasive imaging tests that involve the use of intraluminal oral and intravenous contrast agents to evaluate the small bowel.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.

ABSTRACT
Imaging of the small bowel is complicated by its length and its overlapping loops. Recently, however, the development of crosssectional imaging techniques, such as computed tomography enterography (CTE) and magnetic resonance enterography (MRE) has shifted fundamental paradigms in the diagnosis and management of patients with suspected or known Crohn's disease (CD). CTE and MRE are noninvasive imaging tests that involve the use of intraluminal oral and intravenous contrast agents to evaluate the small bowel. Here, we review recent advances in each cross-sectional imaging modality, their advantages and disadvantages, and their diagnostic performances in the evaluation of small bowel lesions in CD.

No MeSH data available.


Related in: MedlinePlus