Comparison of magnetic resonance imaging and video capsule enteroscopy in diagnosing small-bowel pathology: localization-dependent diagnostic yield.
OBJECTIVE
New technology has considerably advanced the diagnosis of small-bowel pathology. However, its significance in clinical algorithms has not yet been fully assessed. The aim of the present analysis was to compare the diagnostic utility and yield of video-capsule enteroscopy (VCE) to that of magnetic resonance imaging (MRI) in patients with suspected or established Crohn's disease (Group I), obscure gastrointestinal blood loss (Group II), or suspected tumors (Group III).


METHODS
Forty-six out of 182 patients who underwent both modalities were included: 21 in Group I, 20 in Group II, and five in Group III. Pathology was assessed in three predetermined sections of the small bowel (upper, middle, and lower). The McNemar and Wilcoxon tests were used for statistical analysis.


RESULTS
In Group I, lesions were found by VCE in nine of the 21 patients and by MRI in six. In five patients, both modalities showed pathology. In Group II, pathological changes were detected in 11 of the 20 patients by VCE and in eight patients by MRI. In five cases, pathology was found with both modalities. In Group III, neither modality showed small-bowel pathology. For the patient groups combined, diagnostic yield was 43% with VCE and 30% with MRI. The diagnostic yield of VCE was superior to that of MRI in the upper small bowel in both Groups I and II.


CONCLUSIONS
VCE is superior to MRI for the detection of lesions related to Crohn's disease or obscure gastrointestinal bleeding in the upper small bowel.
University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. ulrich.boecker@umm.de
Ulrich
U
Böcker
Dietmar
D
Dinter
Caroline
C
Litterer
Frank
F
Hummel
Phillip
P
Knebel
Andreas
A
Franke
Christel
C
Weiss
Manfred V
MV
Singer
J-Matthias
JM
Löhr
D000293:Adolescent; D000328:Adult; D000368:Aged; D053704:Capsule Endoscopy; D003287:Contrast Media; D003424:Crohn Disease / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D019786:Gadolinium DTPA; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007414:Intestinal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D007421:Intestine, Small / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018709:Statistics, Nonparametric
D003287:Contrast Media; D019786:Gadolinium DTPA