A prospective comparison study of MRI versus small bowel follow-through in recurrent Crohn's disease.
BACKGROUND
We aimed to determine the utility of magnetic resonance imaging (MRI) compared with small bowel follow-through (SBFT) in the assessment of known Crohn's disease.


METHODS
Subjects, over age 18 yr who were to undergo SBFT investigations to assess for complications or extent of Crohn's disease were eligible. SBFT was performed by a single radiologist (IB), and within 4 wk MRI was performed by a single radiologist (HG) who was blinded to the SBFT results. For MRI, oral contrast was 2% barium sulfate (1,350 mL). After unenhanced T1 weighted images and single shot fast spin echo T2 imaging, intravenous (IV) glucagon and gadolinium were given. Fast multiplanar spoiled-gradient recalled T1 coronal sequences were obtained followed by abdominal and pelvic axial images. MRI and SBFT were compared for extent of disease, presence of complications, and for identification of extraintestinal disease.


RESULTS
Paired studies were undertaken within a mean of 22 days in 30 subjects. Ten studies were normal by both modalities and 8 studies showed similar extent of Crohn's disease. SBFT revealed additional information in 4, including a stricture in 1 and ileosigmoid fistulas in 2. MRI provided enhanced information in 8, including identifying active inflammation in strictured areas based on wall enhancement patterns, vasa recta changes, and lymphadenopathy.


CONCLUSIONS
On the basis of cost and accessibility, SBFT may still be a first line procedure of choice in some centers without MRI, but MRI's advantages of no radiation and the potential to identify active inflammation in strictured areas, extraintestinal, and colorectal disease make it an attractive alternative.
Bernstein
Charles N
CN
Department of Medicine and Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, Canada.
Greenberg
Howard
H
Boult
Ian
I
Chubey
Shirley
S
Leblanc
Corrine
C
Ryner
Lawrence
L
D001466:Barium Sulfate / Q000008:administration & dosage; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000000981:diagnostic imaging; D003287:Contrast Media / Q000008:administration & dosage; D003424:Crohn Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D019786:Gadolinium DTPA / Q000008:administration & dosage; D005765:Gastrointestinal Agents / Q000008:administration & dosage; D005934:Glucagon / Q000008:administration & dosage; D006801:Humans; D007077:Ileal Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007275:Injections, Intravenous; D007412:Intestinal Fistula / Q000175:diagnosis / Q000000981:diagnostic imaging; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000473:pathology*; D007579:Jejunal Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging / Q000379:methods*; D011446:Prospective Studies; D011856:Radiographic Image Enhancement; D012008:Recurrence; D012810:Sigmoid Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging; D016037:Single-Blind Method
D003287:Contrast Media; D005765:Gastrointestinal Agents; D001466:Barium Sulfate; D005934:Glucagon; D019786:Gadolinium DTPA