Rationale and Objectives
Patients with known Crohn’s disease (CD) and an acute onset of severe abdominal pain attending an emergency room frequently undergo contrast-enhanced emergency computed tomography (CT) for complication assessment. To assess small bowel changes, an additional dedicated imaging procedure such as magnetic resonance enterography (MRE) is regularly performed. Therefore, these patients undergo two imaging procedures, although the clinical and diagnostic value of such an approach is not known. In a retrospective study, we compared the diagnostic value of a conventional abdominal CT with a dedicated small bowel MRE to assess bowel wall changes as well as typical complications in patients with advanced CD.
Materials and Methods
We retrospectively evaluated 53 patients with CD having a conventional abdominal multidetector-CT (MD-CT) and MRE within 2 days. Image quality and bowel inflammation was analyzed for each bowel segment. Lymph nodes, abscesses, and fistulas were evaluated.
Results
For small bowel and colon assessment, there was no significant difference for image quality between CT and MRE. Inflammation diagnosis was not significantly different between CT (69.4%) and MRE (71.4%). Colonic inflammation was diagnosed in 30.2% based on CT and 14.3% based on MRE. The difference for the detection of lymph nodes was significant (CT 49; MRE 27), whereas the differences between fistula (CT 25, MRE 27) or abscesses (CT and MRE 32) detection were not significant.
Conclusions
In patients with known advanced CD with acute abdominal pain conventional abdominal MD-CT, which is frequently performed as an emergency imaging procedure, is sufficient for bowel wall assessment. Based on our data, additional dedicated small bowel imaging such as MRE seems not to be necessary.
Crohn’s disease (CD) is an incurable chronic condition that can affect the entire gastrointestinal system. Histologically, it typically affects the whole bowel wall in contrast to ulcerative colitis, which is restricted to the mucosal intestinal layer. Because of these particular spreading features, a subset of patients develops major complications during the diseases course, such as fistulas and consecutive abscesses. Frequently, patients with advanced CD are undergoing emergency imaging because of acute abdominal pain for the evaluation of complications such as abscesses with consecutive radiological interventional therapy by computed tomography (CT)-guided abscess drainage.
Most of these patients are examined by a routine CT of the abdomen applying positive contrast orally and rectally with an additional intravenous contrast. After establishing the diagnosis of CD or therapy of the complications, such as abscess drainage, in some of these patients, a further diagnostic workup for the small bowel is performed. In addition to the conventional examinations such as small bowel enteroclysis or small bowel follow-through, sectional imaging methods such as MR- and CT-enteroclysis or magnetic resonance enterography (MRE) and CT-enterography are now often used to assess the small bowel . For CT-enterography and MRE, intraluminal contrast medium is given orally . These studies are also used to assess extra-enteric lesions .
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Material and methods
Patients
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MD-CT
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MRE
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Data Analysis
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Results
Pathologic Findings of the Small Bowel
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Table 1
Results of Image Quality and Inflamed Bowel Segments in 53 Patients with Advanced Crohn’s Disease and Abdominal Pain
Jejunum Ileum Terminal Ileum Cecum and Ascending Colon Transverse Colon Descending Colon Sigmoid Colon/ Rectum Diagnostic quality CT 32/53 (60%) 46/53 (87%) 49/53 (92%) 49/53 (92%) 52/53 (98%) 51/53 (96%) 50/53 (94%) MRE 32/53 (60%) 47/53 (89%) 49/53 (92%) 45/53 (92%) 48/53 (91%) 48/53 (91%) 47/53 (89%) Suboptimal quality CT 21/53 (40%) 7/53 (13%) 4/53 (8%) 4/53 (8%) 1/53 (2%) 2/53 (4%) 3/53 (6%) MRE 21/53 (40%) 6/53 (11%) 4/53 (8%) 8/53 (8%) 5/53 (9%) 5/53 (9%) 6/53 (11%) Not inflamed CT 25/32 (78%) 29/46 (63%) 15/49 (31%) 34/49 (69%) 40/52 (77%) 36/51 (71%) 31/50 (62%) MRE 23/32 (72%) 31/47 (66%) 14/49 (29%) 31/45 (69%) 35/48 (73%) 37/48 (77%) 31/47 (66%) Moderately inflamed CT 5/32 (16%) 9/46 (20%) 13/49 (27%) 6/49 (12%) 2/52 (4%) 7/51 (14%) 11/50 (22%) MRE 7/32 (22%) 8/47 (17%) 12/49 (24%) 6/45 (13%) 6/48 (13%) 4/48 (8%) 11/47 (23%) Inflamed CT 2/32 (6%) 11/46 (24%) 21/49 (43%) 9/49 (18%) 10/52 (19%) 8/51 (16%) 8/50 (16%) MRE 2/32 (6%) 10/47 (21%) 23/49 (47%) 8/45 (18%) 7/48 (14%) 7/48 (15%) 5/47 (11%)
CT: computed tomography; MRE: magnetic resonance enterography.
Image quality as well as inflammation grading (not inflamed, moderately inflamed, inflamed) are assessed in seven different bowel segments by routine abdominal multidetector-CT (CT) and MR-enterography (MRE).
Patients n = 53, bowel segments n = 371.
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Pathologic Findings of the Colon
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Evaluation of Extraintestinal Pathologies
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Table 2
Additional Diagnostic Features such as Presence of a Fistula, Abscess, or Local Enlarged Lymph Nodes >1cm in 53 Patients with Acute Abdominal Pain and Known Active Crohn’s Disease
Fistula Abscess Enlarged lymph Nodes Computed tomography 25 32 49 Magnetic resonance enterography 27 32 37
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Discussion
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Conclusion
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