Comparison of conventional abdominal CT with MR-enterography in patients with active Crohn's disease and acute abdominal pain.
OBJECTIVE
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.


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.
Schreyer
Andreas G
AG
Department of Radiology, University Medical Center Regensburg, 93042 Regensburg, Germany. andreas.schreyer@klinik.uni-regensburg.de
Hoffstetter
Patrick
P
Daneschnejad
Michel
M
Jung
Ernst-Michael
EM
Pawlik
Michael
M
Friedrich
Chris
C
Fellner
Claudia
C
Strauch
Ulrike
U
Klebl
Frank
F
Herfarth
Hans
H
Zorger
Niels
N
D015746:Abdominal Pain / Q000175:diagnosis* / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D003424:Crohn Disease / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011860:Radiography, Abdominal / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult