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Outcomes of Computed Tomography and Magnetic Resonance Enterography in Clinical Practice of Inflammatory Bowel Disease

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Abstract

Background

Computed tomography (CT) and magnetic resonance (MR) enterography are now widely used to diagnose and monitor Crohn’s disease.

Aim

We sought to assess the use of enterography for management of inflammatory bowel disease (IBD) in our medical center.

Methods

We performed a retrospective review of all patients diagnosed with IBD who underwent MR or CT enterography from November 1, 2010 to October 25, 2012 at our institution. We assessed disease complications identified by enterography, agreement between disease activity determined by endoscopy and enterography, association between inflammatory markers and enterography-determined disease activity and recommended changes in medical and surgical management following enterography.

Results

A total of 311 enterography studies (291 MR and 20 CT enterographies) were performed on 270 patients, including 258 (83.0 %) on patients with presumed Crohn’s disease and 53 (17.0 %) with presumed ulcerative colitis. Active small bowel (SB) disease was noted in 73/311 (23.5 %) studies. Complications including strictures, perianal fistulas, abscesses and SB fistulas were noted in 108/311 (34.7 %) studies. Endoscopic and enterography defined active disease had an agreement of κ = 0.36 in the ileum (n = 179). A total of 142/311 (45.7 %) enterographies were associated with recommended medication changes within 90 days while surgery or endoscopic dilation of stricture was recommended following 41/311 (13.2 %) enterographies. Enterography resulted in a change in diagnosis from ulcerative colitis to Crohn’s in 5/311 (1.6 %) studies.

Conclusion

Enterography reveals active disease and complications not evident on endoscopy and should be considered in the initial diagnosis, assessment of disease activity, and monitoring of therapy in patients with IBD.

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References

  1. Baumgart DC, Sandborn WJ. Crohn’s disease. Lancet. 2012;380:1590–1605.

    Article  PubMed  Google Scholar 

  2. Louis E. Epidemiology of the transition from early to late Crohn’s disease. Dig Dis. 2012;30:376–379.

    Article  PubMed  Google Scholar 

  3. Loftus EV Jr, Schoenfeld P, Sandborn WJ. The epidemiology and natural history of Crohn’s disease in population-based patient cohorts from North America: a systematic review. Aliment Pharmacol Ther. 2002;16:51–60.

    Article  PubMed  Google Scholar 

  4. Saibeni S, Rondonotti E, Iozzelli A, et al. Imaging of the small bowel in Crohn’s disease: a review of old and new techniques. World J Gastroenterol. 2007;13:3279–3287.

    PubMed  Google Scholar 

  5. Grand DJ, Harris A, Loftus EV Jr. Imaging for luminal disease and complications: CT enterography, MR enterography, small-bowel follow-through, and ultrasound. Gastroenterol Clin North Am. 2012;41:497–512.

    Article  PubMed  Google Scholar 

  6. Raptopoulos V, Schwartz RK, McNicholas MM, et al. Multiplanar helical CT enterography in patients with Crohn’s disease. AJR Am J Roentgenol. 1997;169:1545–1550.

    Article  CAS  PubMed  Google Scholar 

  7. Sinha R, Verma R, Verma S, et al. MR enterography of Crohn disease: part 1, rationale, technique, and pitfalls. AJR Am J Roentgenol. 2011;197:76–79.

    Article  PubMed  Google Scholar 

  8. Negaard A, Paulsen V, Sandvik L, et al. A prospective randomized comparison between two MRI studies of the small bowel in Crohn’s disease, the oral contrast method and MR enteroclysis. Eur Radiol. 2007;17:2294–2301.

    Article  PubMed  Google Scholar 

  9. Masselli G, Casciani E, Polettini E, et al. Comparison of MR enteroclysis with MR enterography and conventional enteroclysis in patients with Crohn’s disease. Eur Radiol. 2008;18:438–447.

    Article  PubMed  Google Scholar 

  10. Wold PB, Fletcher JG, Johnson CD, et al. Assessment of small bowel Crohn disease: noninvasive peroral CT enterography compared with other imaging methods and endoscopy—feasibility study. Radiology. 2003;229:275–281.

    Article  PubMed  Google Scholar 

  11. Siddiki H, Fidler J. MR imaging of the small bowel in Crohn’s disease. Eur J Radiol. 2009;69:409–417.

    Article  PubMed  Google Scholar 

  12. Lee SS, Kim AY, Yang SK, et al. Crohn disease of the small bowel: comparison of CT enterography, MR enterography, and small-bowel follow-through as diagnostic techniques. Radiology. 2009;251:751–761.

    Article  PubMed  Google Scholar 

  13. Schreyer AG, Geissler A, Albrich H, et al. Abdominal MRI after enteroclysis or with oral contrast in patients with suspected or proven Crohn’s disease. Clin Gastroenterol Hepatol. 2004;2:491–497.

    Article  PubMed  Google Scholar 

  14. Minordi LM, Vecchioli A, Guidi L, et al. Multidetector CT enteroclysis versus barium enteroclysis with methylcellulose in patients with suspected small bowel disease. Eur Radiol. 2006;16:1527–1536.

    Article  PubMed  Google Scholar 

  15. Sailer J, Peloschek P, Schober E, et al. Diagnostic value of CT enteroclysis compared with conventional enteroclysis in patients with Crohn’s disease. AJR Am J Roentgenol. 2005;185:1575–1581.

    Article  PubMed  Google Scholar 

  16. Samuel S, Bruining DH, Loftus EV Jr, et al. Endoscopic skipping of the distal terminal ileum in Crohn’s disease can lead to negative results from ileocolonoscopy. Clin Gastroenterol Hepatol. 2012;10:1253–1259.

    Article  PubMed  Google Scholar 

  17. Tang L, Cai H, Moore L, et al. Evaluation of endoscopic and imaging modalities in the diagnosis of structural disorders of the ileal pouch. Inflamm Bowel Dis. 2010;16:1526–1531.

    Article  PubMed  Google Scholar 

  18. Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357:2277–2284.

    Article  CAS  PubMed  Google Scholar 

  19. Desmond AN, O’Regan K, Curran C, et al. Crohn’s disease: factors associated with exposure to high levels of diagnostic radiation. Gut. 2008;57:1524–1529.

    Article  CAS  PubMed  Google Scholar 

  20. Cipriano LE, Levesque BG, Zaric GS, et al. Cost-effectiveness of imaging strategies to reduce radiation-induced cancer risk in Crohn’s disease. Inflamm Bowel Dis. 2012;18:1240–1248.

    Article  PubMed  Google Scholar 

  21. Siddiki HA, Fidler JL, Fletcher JG, et al. Prospective comparison of state-of-the-art MR enterography and CT enterography in small-bowel Crohn’s disease. AJR Am J Roentgenol. 2009;193:113–121.

    Article  PubMed  Google Scholar 

  22. Sinha R, Verma R, Verma S, et al. MR enterography of Crohn disease: part 2, imaging and pathologic findings. AJR Am J Roentgenol. 2011;197:80–85.

    Article  PubMed  Google Scholar 

  23. Koh DM, Miao Y, Chinn RJ, et al. MR imaging evaluation of the activity of Crohn’s disease. AJR Am J Roentgenol. 2001;177:1325–1332.

    Article  CAS  PubMed  Google Scholar 

  24. Meyers MA, McGuire PV. Spiral CT demonstration of hypervascularity in Crohn disease: “vascular jejunization of the ileum” or the “comb sign”. Abdom Imaging. 1995;20:327–332.

    Article  CAS  PubMed  Google Scholar 

  25. Bruining DH, Siddiki HA, Fletcher JG, et al. Prevalence of penetrating disease and extraintestinal manifestations of Crohn’s disease detected with CT enterography. Inflamm Bowel Dis. 2008;14:1701–1706.

    Article  PubMed  Google Scholar 

  26. Paparo F, Bacigalupo L, Garello I, et al. Crohn’s disease: prevalence of intestinal and extraintestinal manifestations detected by computed tomography enterography with water enema. Abdom Imaging. 2012;37:326–337.

    Article  CAS  PubMed  Google Scholar 

  27. Zappa M, Stefanescu C, Cazals-Hatem D, et al. Which magnetic resonance imaging findings accurately evaluate inflammation in small bowel Crohn’s disease? A retrospective comparison with surgical pathologic analysis. Inflamm Bowel Dis. 2011;17:984–993.

    Article  PubMed  Google Scholar 

  28. Messaris E, Chandolias N, Grand D, et al. Role of magnetic resonance enterography in the management of Crohn disease. Arch Surg. 2010;145:471–475.

    Article  PubMed  Google Scholar 

  29. Ha CY, Kumar N, Raptis CA, et al. Magnetic resonance enterography: safe and effective imaging for stricturing Crohn’s disease. Dig Dis Sci. 2011;56:2906–2913.

    Article  PubMed  Google Scholar 

  30. Grieser C, Denecke T, Steffen IG, et al. Magnetic resonance enteroclysis in patients with Crohn’s disease: fat saturated T2-weighted sequences for evaluation of inflammatory activity. J Crohns Colitis. 2012;6:294–301.

    Article  PubMed  Google Scholar 

  31. Colombel JF, Solem CA, Sandborn WJ, et al. Quantitative measurement and visual assessment of ileal Crohn’s disease activity by computed tomography enterography: correlation with endoscopic severity and C reactive protein. Gut. 2006;55:1561–1567.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Gallego JC, Echarri AI, Porta A, et al. Ileal Crohn’s disease: MRI with endoscopic correlation. Eur J Radiol. 2011;80:e8–e12.

    Article  PubMed  Google Scholar 

  33. Grand DJ, Kampalath V, Harris A, et al. MR enterography correlates highly with colonoscopy and histology for both distal ileal and colonic Crohn’s disease in 310 patients. Eur J Radiol. 2012;81:e763–e769.

    Article  PubMed  Google Scholar 

  34. Gee MS, Harisinghani MG. MRI in patients with inflammatory bowel disease. J Magn Reson Imaging. 2011;33:527–534.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Kroeker KI, Lam S, Birchall I, et al. Patients with IBD are exposed to high levels of ionizing radiation through CT scan diagnostic imaging: a five-year study. J Clin Gastroenterol. 2011;45:34–39.

    Article  PubMed  Google Scholar 

  36. Jensen MD, Ormstrup T, Vagn-Hansen C, et al. Interobserver and intermodality agreement for detection of small bowel Crohn’s disease with MR enterography and CT enterography. Inflamm Bowel Dis. 2011;17:1081–1088.

    Article  PubMed  Google Scholar 

  37. Jensen MD, Nathan T, Rafaelsen SR, et al. Diagnostic accuracy of capsule endoscopy for small bowel Crohn’s disease is superior to that of MR enterography or CT enterography. Clin Gastroenterol Hepatol. 2011;9:124–129.

    Article  PubMed  Google Scholar 

  38. Fiorino G, Bonifacio C, Peyrin-Biroulet L, et al. Prospective comparison of computed tomography enterography and magnetic resonance enterography for assessment of disease activity and complications in ileocolonic Crohn’s disease. Inflamm Bowel Dis. 2011;17:1073–1080.

    Article  CAS  PubMed  Google Scholar 

  39. Solem CA, Loftus EV Jr, Tremaine WJ, et al. Correlation of C-reactive protein with clinical, endoscopic, histologic, and radiographic activity in inflammatory bowel disease. Inflamm Bowel Dis. 2005;11:707–712.

    Article  PubMed  Google Scholar 

  40. Sauer CG, Middleton JP, Alazraki A, et al. Comparison of magnetic resonance enterography with endoscopy, histopathology, and laboratory evaluation in pediatric Crohn disease. J Pediatr Gastroenterol Nutr. 2012;55:178–184.

    Article  PubMed  Google Scholar 

  41. Ordas I, Rimola J, Garcia-Bosch O, et al. Diagnostic accuracy of magnetic resonance colonography for the evaluation of disease activity and severity in ulcerative colitis: a prospective study. Gut. 2013;62:1566–1572.

    Google Scholar 

  42. Hartley JE, Fazio VW, Remzi FH, et al. Analysis of the outcome of ileal pouch-anal anastomosis in patients with Crohn’s disease. Dis Colon Rectum. 2004;47:1808–1815.

    Article  CAS  PubMed  Google Scholar 

  43. Braveman JM, Schoetz DJ Jr, Marcello PW, et al. The fate of the ileal pouch in patients developing Crohn’s disease. Dis Colon Rectum. 2004;47:1613–1619.

    Article  PubMed  Google Scholar 

  44. Brown CJ, Maclean AR, Cohen Z, et al. Crohn’s disease and indeterminate colitis and the ileal pouch-anal anastomosis: outcomes and patterns of failure. Dis Colon Rectum. 2005;48:1542–1549.

    Article  PubMed  Google Scholar 

  45. Hahnloser D, Pemberton JH, Wolff BG, et al. Results at up to 20 years after ileal pouch-anal anastomosis for chronic ulcerative colitis. Br J Surg. 2007;94:333–340.

    Article  CAS  PubMed  Google Scholar 

  46. de Oca J, Sanchez-Santos R, Rague JM, et al. Long-term results of ileal pouch-anal anastomosis in Crohn’s disease. Inflamm Bowel Dis. 2003;9:171–175.

    Article  PubMed  Google Scholar 

  47. Bruining DH, Loftus EV Jr, Ehman EC, et al. Computed tomography enterography detects intestinal wall changes and effects of treatment in patients with Crohn’s disease. Clin Gastroenterol Hepatol. 2011;9(679–683):e1.

    PubMed  Google Scholar 

  48. Higgins PD, Caoili E, Zimmermann M, et al. Computed tomographic enterography adds information to clinical management in small bowel Crohn’s disease. Inflamm Bowel Dis. 2007;13:262–268.

    Article  PubMed  Google Scholar 

  49. Hafeez R, Punwani S, Boulos P, et al. Diagnostic and therapeutic impact of MR enterography in Crohn’s disease. Clin Radiol. 2011;66:1148–1158.

    Article  CAS  PubMed  Google Scholar 

  50. Booya F, Akram S, Fletcher JG, et al. CT enterography and fistulizing Crohn’s disease: clinical benefit and radiographic findings. Abdom Imaging. 2009;34:467–475.

    Article  PubMed  Google Scholar 

  51. Jensen MD, Nathan T, Kjeldsen J, et al. Incidental findings at MRI-enterography in patients with suspected or known Crohn’s disease. World J Gastroenterol. 2010;16:76–82.

    PubMed Central  PubMed  Google Scholar 

  52. Menys A, Atkinson D, Odille F, et al. Quantified terminal ileal motility during MR enterography as a potential biomarker of Crohn’s disease activity: a preliminary study. Eur Radiol. 2012;22:2494–2501.

    Article  PubMed  Google Scholar 

  53. Shyn PB, Mortele KJ, Britz-Cunningham SH, et al. Low-dose 18F-FDG PET/CT enterography: improving on CT enterography assessment of patients with Crohn disease. J Nucl Med. 2010;51:1841–1848.

    Article  PubMed  Google Scholar 

  54. Al-Hawary M, Zimmermann EM. A new look at Crohn’s disease: novel imaging techniques. Curr Opin Gastroenterol. 2012;28:334–340.

    PubMed  Google Scholar 

  55. Oto A, Kayhan A, Williams JT, et al. Active Crohn’s disease in the small bowel: evaluation by diffusion weighted imaging and quantitative dynamic contrast enhanced MR imaging. J Magn Reson Imaging. 2011;33:615–624.

    Article  PubMed  Google Scholar 

  56. D’Haens G, Feagan B, Colombel JF, et al. Challenges to the design, execution, and analysis of randomized controlled trials for inflammatory bowel disease. Gastroenterology. 2012;143:1461–1469.

    Article  PubMed  Google Scholar 

  57. Leyendecker JR, Bloomfeld RS, DiSantis DJ, et al. MR enterography in the management of patients with Crohn disease. Radiographics. 2009;29:1827–1846.

    Article  PubMed  Google Scholar 

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Conflict of interest

Cynthia Santillan—Consulting at Robarts Clinical Research. Barrett Levesque—Consulting at Santarus, Prometheus Labs, Castlight Health as well as speaking and teaching at Warner Chilcott, Salix, UCB Pharma, Abbott Labs. William Sandborn has no conflicts relevant to this study. Suresh Pola, Niraj S. Patel, Ramya Muralimohan, Guangyong Zou, and Derek Patel have nothing to disclose.

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Authors and Affiliations

  1. Department of Medicine, University of California San Diego, La Jolla, CA, USA

    Niraj S. Patel & Ramya Muralimohan

  2. Division of Gastroenterology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0956, USA

    Suresh Pola, Derek Patel, Barrett G. Levesque & William J. Sandborn

  3. Division of Gastroenterology, Robarts Research Institute, Western University, London, ON, Canada

    G. Y. Zou & Barrett G. Levesque

  4. Department of Epidemiology and Biostatistics, Western University, London, ON, Canada

    G. Y. Zou

  5. Department of Radiology, University of California San Diego, La Jolla, CA, USA

    Cynthia Santillan

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  1. Niraj S. Patel
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Correspondence to William J. Sandborn.

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Niraj S. Patel and Suresh Pola are co first-authors.

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Patel, N.S., Pola, S., Muralimohan, R. et al. Outcomes of Computed Tomography and Magnetic Resonance Enterography in Clinical Practice of Inflammatory Bowel Disease. Dig Dis Sci 59, 838–849 (2014). https://doi.org/10.1007/s10620-013-2964-7

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  • DOI: https://doi.org/10.1007/s10620-013-2964-7

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