Crohn disease of the small bowel: comparison of CT enterography, MR enterography, and small-bowel follow-through as diagnostic techniques.
OBJECTIVE
To prospectively compare the accuracy of computed tomographic (CT) and magnetic resonance (MR) enterography and small-bowel follow-through (SBFT) examination for detection of active small-bowel inflammation and extraenteric complications in patients with Crohn disease (CD).


METHODS
The institutional review board approved the study protocol; informed consent was obtained from all participants. Thirty-one consecutive patients who had CD or who were suspected of having CD underwent CT and MR enterography, SBFT, and ileocolonoscopy. Two independent readers reviewed CT and MR enterographic and SBFT images for presence of active terminal ileitis and extraenteric complications. Accuracy values of CT and MR enterography and SBFT for identification of active terminal ileitis were evaluated with the receiver operating characteristic method, with ileocolonoscopic findings as the reference standard. Sensitivity values of CT and MR enterography and SBFT for detection of extraenteric complications were compared by using the McNemar test, with results of imaging studies, surgery, and physical examination as reference standards.


RESULTS
The study population included 30 patients (17 men, 13 women; mean age, 29.0 years) with CD. Differences in areas under the receiver operating characteristic curves for CT enterography (0.900 and 0.894), MR enterography (0.933 and 0.950), and SBFT (0.883 and 0.928) for readers 1 and 2, respectively, in the detection of active terminal ileitis were not significant (P > .017). Sensitivity values for detection of extraenteric complications were significantly higher for CT and MR enterography (100% for both) than they were for SBFT (32% for reader 1 and 37% for reader 2) (P < .001).


CONCLUSIONS
Because MR enterography has a diagnostic effectiveness comparable to that of CT enterography, this technique has potential to be used as a radiation-free alternative for evaluation of patients with CD.
Lee
Seung Soo
SS
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap2-Dong, Songpa-Gu, Seoul 138-040, Korea.
Kim
Ah Young
AY
Yang
Suk-Kyun
SK
Chung
Jun-Won
JW
Kim
So Yeon
SY
Park
Seong Ho
SH
Ha
Hyun Kwon
HK
D000293:Adolescent; D000328:Adult; D003287:Contrast Media; D003424:Crohn Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007421:Intestine, Small; D007472:Iohexol / Q000031:analogs & derivatives; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; D007472:Iohexol; C038192:iopromide; D019786:Gadolinium DTPA