Introduction Recent advances in the immunopathogenesis and therapy of inflammatory bowel disease (IBD) coupled with bolder definitions of disease control have led to increasing reliance on imaging. Increased awareness of the potential downstream effects of ionising radiation has placed more emphasis on radiation-free imaging. We aimed to assess the role of magnetic resonance enterography (MRE) in assessing Crohn's disease.
Methods We conducted a retrospective review of 141 consecutive MRE studies performed between June 2009 and November 2010. Clinical data were obtained from electronic patient record review. Inflammatory markers, radiological investigations and ileocolonoscopy when performed within 90 days of MR enterography were recorded. MRE reports were recorded using accepted activity criteria- small bowel dilatation, stenosis, wall thickening, enhancement, mucosal irregularity, mesenteric inflammation, hypervascularity, lymph node enlargement, abscesses, fistulation and extraintestinal features.
Results Of 67 patients with IBD, 60 had Crohn's disease and 59 examinations were complete. Thirty- nine of 67 patients were female, mean age 34 (range 16–68) and median disease duration of 5 years (range 0–39). Abnormalities were noted in 47 MRE scans; 34 had active non-stricturing, 12 active stricturing and one fibrostenotic disease. Within the active groups, there were four fistulae and three abscesses in four patients. Ileo-colonoscopy was performed in 14 of these patients with 12/14 showing active colitis and raised CRP in 11/16 within 90 days of MRE. Treatment was increased in 47% of the active non-stricturing group, 3/16 to azathioprine, 8/16 to infliximab, 4/16 to surgery with no change to treatment in the remaining 53%, of whom 4/8 had normal ileo-colonoscopy and 13/16 normal CRP. In 83% of active stricturing patient treatment was increased, one to azathioprine, six to biologics, three to surgery. Four of 12 patients in this group had an elevated CRP and 4/7 had active colitis at ileo-colonoscopy. Of 12 normal MRE, treatment was not increased in 92%. Of these, CRP was normal in 10/11 and ileo-colonoscopy normal in 4/7. Treatment was increased in one to biologics, with an elevated CRP and moderately severe colitis at colonoscopy. The fibrostenotic subject had normal CRP and mild colitis at colonoscopy, and proceeded to surgery. All the abscess/fistula subjects had raised inflammatory markers. Two were referred for surgery, one started biologics and one treated with antibiotics.
Conclusion The small bowel remains difficult to assess endoscopically. MRE adds to the assessment of patients with Crohn's disease, in addition to endoscopy and biological markers identifying patients with active disease where treatment escalation may result in meaningful benefit.
Competing interests None declared.
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