Requiem for barium? ▸

Crohn’s disease is common in young people. There is concern therefore about the radiation dose from repeated barium studies. There is a growing literature detailing the alternative use of magnetic resonance imaging (MRI) to image the bowel in active Crohn’s. In this study from Manitoba, Bernstein et al compared barium small bowel follow through with MRI in patients with known Crohn’s disease. (Their previous study had shown that follow through is much better tolerated than small bowel enteroclysis, and is equally sensitive.)

They recruited 47 patients, but because of restrictions for the MRI scans (asthma, claustrophobia, and presence of internal metal objects), only 30 patients were able to have both examinations. In 18, the findings were the same for both (10 normal). In four the barium study showed additional information, and in eight the MRI showed more information. The MRI scan picked up abscess, active inflammation, and distal abnormalities, which on barium follow through were lost due to dilution of barium. Colonic disease and extraintestinal …